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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ1635668 (OXN 0148383)
Regular
May 08, 2014

MARTHA MORALES vs. RICK BORQUEZ, D.D.S., STATE FARM INSURANCE

This case involves a lien claimant seeking payment for psychiatric treatment and medication provided to the applicant. The initial WCJ disallowed the lien, finding the psychiatric treatment was not for a compensable consequence of the industrial injury and that the lien claimant failed to meet its burden of proof. The Appeals Board rescinded this decision, holding that the applicant's psychiatric condition was a compensable consequence of the industrial injury, as evidenced by the Compromise and Release, a QME's report, and the employer's prior payments for such treatment. The matter was returned to the trial level for further proceedings to determine the amount due to the lien claimant.

Workers Compensation Appeals BoardLien ClaimantOrchid Multispecialty Medical GroupPsychiatric TreatmentCompensable ConsequenceUtilization ReviewQualified Medical EvaluatorBurden of ProofPreponderance of the EvidenceCompromise and Release
References
Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ1315350 (VNO 0557111)
Regular
Apr 20, 2012

LINDA KAMBOW vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, VALLEY STATE PRISON FOR WOMEN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by an inmate laborer for orthopedic and psychiatric injuries. The Workers' Compensation Appeals Board denied reimbursement to Hepps Pharmacy for medications, as no prescription was provided. The Board also reversed an award to Southern California Mental Health Associates for psychiatric treatment, ruling that inmate psychiatric injuries are not compensable under Labor Code section 3208.3(j). The Board found that the psychiatric injury was a consequence of the industrial orthopedic injury, and thus not a compensable independent non-industrial condition requiring treatment to relieve orthopedic effects.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code 3208.3(j)Inmate laborerIndustrial orthopedic injuryNon-industrial psychiatric treatmentPrimary treating physicianSubstantial medical evidenceCompromise and Release AgreementLien trial
References
Case No. ADJ2593762 (SAC 0363364)
Regular
Jul 13, 2012

RICHARD HODGE vs. DEPENDABLE HIGHWAY EXPRESS, ZURICH NORTH AMERICA INSURANCE

The Workers' Compensation Appeals Board denied reconsideration, upholding the WCJ's decision to provide psychiatric treatment. Even if the need for psychiatric treatment stems from a potentially non-compensable psychiatric injury, the employer remains liable if the treatment is reasonably required to cure or relieve the effects of a compensable industrial injury. In this case, the applicant's psychiatric treatment was deemed necessary to address cognitive impairment caused by a compensable traumatic brain injury. Therefore, the employer is liable for this treatment under established case law, regardless of the nuances of the six-month employment rule.

Labor Code section 3208.3(d)sudden and extraordinary exceptionsix-month employment rulemedical treatmentLabor Code section 4600reasonably requiredcure or relievenon-compensable injurypsychiatric treatmenttraumatic brain injury
References
Case No. ADJ4599548 (MON 212034) ADJ1776170 (MON 224335) ADJ1414058 (MON 246016)
Regular
Jun 10, 2010

KRISTIAN VON RITZHOFF vs. OGDEN ENTERTAINMENT SERVICES

The applicant's petition for reconsideration is dismissed because it is successive, as they already sought reconsideration of a prior WCJ decision that the Board affirmed. Furthermore, the petition failed to clearly set forth its contentions as required by law. The Board held that a party cannot file a second petition for reconsideration after an unsuccessful first one; they must instead seek a writ of review. Therefore, the applicant's current petition is procedurally improper and is dismissed.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOpinion and OrderWCJTemporary disability indemnityPsychological treatmentPsychiatric treatmentNon-psychiatric treatmentNon-psychological treatmentAppeals Board Rule 10842(a)
References
Case No. ADJ9162432
Regular
Oct 23, 2017

TEODORO LARIOS vs. EASTBAY EQUITIES, INC. dba WENDY'S OLD FASHIONED HAMBURGERS, AMTRUST NORTH AMERICA

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded lien claims for psychiatric treatment. The defendant argues that Labor Code section 3208.3(d) bars these claims due to insufficient employment duration and that the prior WCAB opinion is res judicata. The WCAB granted reconsideration, rescinded the WCJ's decision, and remanded the case for further proceedings. The WCAB clarified that while psychiatric conditions may be claimed as compensable consequence injuries post-January 1, 2013, they do not increase permanent impairment ratings, and the six-month employment requirement under section 3208.3(d) still applies unless the treatment was essential for a physical injury.

Workers' Compensation Appeals BoardLabor Code Section 3208.3(d)Res JudicataMedical Treatment Utilization Schedule (MTUS)Official Medical Fee Schedule (OMFS)Independent Bill ReviewCompensable Consequence InjuryPsychiatric InjuryPermanent ImpairmentLength of Employment
References
Case No. ADJ1167311 (LBO 0303498) ADJ749429 (LBO 0296277)
Regular
Apr 29, 2011

RAMON ZIEBA vs. BAILLY SHOWCASE, SAFECO INSURANCE COMPANY

The Workers' Compensation Appeals Board denied lien claimant Dr. Halote's petition for reconsideration. Dr. Halote sought reimbursement for psychiatric treatment, arguing it was separate from a psychiatric injury claim. However, the only issue presented at trial was whether the applicant sustained a psychiatric injury arising out of and occurring in the course of employment. The Board found that the issue of the reasonableness of psychiatric treatment, for admitted orthopedic injuries, was not raised at trial and was therefore waived. Thus, the Board denied reconsideration as Dr. Halote could not raise this new issue for the first time on appeal.

Workers' Compensation Appeals Boardpsychiatric injuryAOE/COElien claimantPetition for ReconsiderationFindings of Factadministrative law judgeLabor Codecompensabilitypsychiatric treatment
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ7532885
Regular
Aug 01, 2016

DAVID AREVALO vs. THE MILLARD GROUP, AIG/NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding prior findings. The Board found the initial decision lacked substantial evidence and failed to address crucial issues like the MPN's validity and the employer's loss of medical control. The case is returned to the trial level for further proceedings to determine these issues and whether the employer refused, delayed, or denied medical treatment. The initial finding of denied treatment was based on insufficient evidence to establish liability for self-procured treatment.

MPNMedical Provider NetworkRefusal of TreatmentDelay of TreatmentDenial of TreatmentLoss of Medical ControlPanel Qualified Medical ExaminerPQMELien ClaimantsPrimary Treating Physician
References
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