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

Case No. ADJ1560752
Regular
Sep 09, 2025

EUGENE FLOWERS vs. RAY MAC PAINTING, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed the January 12, 2021 Findings and Award (F&A) in the case of Eugene Flowers, who sustained an industrial injury to his right shoulder and subsequently alleged a psyche injury. Defendant State Compensation Insurance Fund sought reconsideration, contesting the reasonableness of treatment provided by lien claimant Behavioral Medicine and Health Psychology, liability for statutory increase and interest, and the validity of the lien due to declaration requirements. The WCAB, adopting the WCJ's report, concluded that the applicant's psyche injury was a compensable consequence, the psychological treatment was medically necessary and reasonable, and the lien was not barred by the late filing of the declaration under Labor Code section 4903.8(d). Consequently, the F&A, which ordered payment for adjusted charges along with statutory interest and increase, was upheld.

ReconsiderationFindings and AwardBehavioral Medicine and Health Psychologyindustrial injurypsychemedically reasonablenecessarystatutory increaseinterestlien claimant
References
Case No. ADJ3934515 (MON 0271347) ADJ4001097 (LAO 0780370)
Regular
Feb 16, 2017

PRISCILLA DIAZ vs. PUBLIC HEALTH FOUNDATION ENTERPRISES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Dr. David Silver's Petition for Reconsideration. The Board affirmed the Administrative Law Judge's finding that the lien claimant take nothing on his lien. This was based on the lien claimant's failure to meet his burden of proof that the services rendered were reasonable and necessary for the applicant's industrial injury. Furthermore, the lien claimant failed to adequately establish the costs of his services with sufficient supporting evidence.

Lien claimantPetition for ReconsiderationJoint Findings and OrderWorkers' Compensation Appeals BoardAdministrative Law Judgemedically necessaryburden of proofsubstantial evidenceLabor Code section 4903.8(d)reasonable and necessary medical treatment
References
Case No. BAK 0139905
Regular
Dec 21, 2007

JOSE DE JESUS ZEPEDA (JOSE DE JESUS ZEPEDA MARTINEZ) vs. ARTS CUSTOM CABINETS, AACA/AMERICAN COMMERCIAL CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration of a Findings and Award concerning lien claimant's facility fees. The Board found the record insufficient to determine if the discogram and discectomy were reasonable and necessary treatments for the applicant's industrial injury. The case is returned to the trial level for further development of the medical record, including addressing ACOEM guidelines and the reasonableness of surgical center fees.

Lien claimantReconsiderationFindings and AwardFacility feesEpidural injectionsDiscogramDiscectomyHerniated nucleus pulposusReasonable and necessaryMedical evidence
References
Case No. ADJ8725365
Regular
Oct 15, 2019

ADAM STEWART vs. KUNZIK AND SARA CONSTRUCTION, CYPRESS INSURANCE COMPANY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

This case involves a lien claimant seeking reconsideration of a decision disallowing their lien for copying services. The Administrative Law Judge (ALJ) initially found no substantial evidence that the services were reasonable and necessary because there was no "contested claim." However, the Appeals Board rescinded the decision, finding the ALJ's reasoning based on stipulations and the "immediately accepted case" status was insufficient. The Board remanded the case for further proceedings, emphasizing that a contested claim exists when an employer rejects liability or fails to respond to benefit demands, and the lien claimant bears the burden of proving this.

WORKERS' COMPENSATION APPEALS BOARDMed-Legal PhotocopyFindings and OrderWCJreconsiderationlien claimantreasonable and necessarycontested claimApplication for Adjudication of ClaimCompromise and Release
References
Case No. ADJ8948890
Regular
Oct 07, 2025

ANTONIO COLINDRES vs. PRESTIGE MOTORCOACH CORP.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Lien claimant, Reliable Medical Supply, sought reconsideration of a Findings and Order issued on July 24, 2025, which found that the medical treatment services provided to applicant were not reasonably required to cure or relieve the effects of the industrial injury. Reliable Medical Supply contended that the issue of medical necessity was not raised on the pretrial conference statement. The Appeals Board denied the petition for reconsideration, agreeing with the WCJ that the lien claimant failed to prove the medical treatment services were reasonable and necessary, noting the absence of a DWC Form RFA and lack of MTUS citations in Dr. Shah's report.

Lien ClaimantPetition for ReconsiderationFindings and OrderPretrial Conference StatementMedical Treatment ServicesReasonable and NecessaryBurden of ProofUtilization ReviewMedical Treatment Utilization ScheduleAgreed Medical Evaluator
References
Case No. ADJ4399114 (POM 0281905) MF
Regular
Jun 27, 2013

RICARDO GARCIA vs. AMERICAN STAFF RESOURCES OF CALIFORNIA/TRIMCO, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CASCADE INSURANCE COMPANY, in liquidation, STATE COMPENSATION INSURANCE FUND

This case involves the State Compensation Insurance Fund (SCIF) seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB ordered SCIF to reimburse the California Insurance Guarantee Association (CIGA) $27,082.67 for costs incurred in a workers' compensation claim previously settled by SCIF. SCIF argued CIGA failed to prove reasonableness of costs and timely tendered the claim. The WCAB denied SCIF's petition, affirming the prior award, finding CIGA's expenditures were reasonable and necessary given SCIF's stipulation to the amounts spent and lack of evidence to the contrary. The Board clarified CIGA's legal status but upheld the reimbursement order based on statutory obligations and public policy.

Workers' Compensation Appeals BoardState Compensation Insurance FundCalifornia Insurance Guarantee AssociationCIGAreimbursementreasonable costsnecessary expenditurecompromise and releaseinvoluntary association of insurersstatutory duties
References
Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Case No. ADJ4225526 (GOL 0092072)
Regular
Apr 20, 2017

JESUS ARROYO vs. JOHN CRAVENS PLASTERING, STATE COMPENSATION INSURANCE FUND

This case involves Jesus Arroyo's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, adopting the reasoning of the workers' compensation administrative law judge. Medical evidence from Dr. Markovitz established that Arroyo suffered a total and permanent disability resulting from industrial injuries, including an aortic aneurysm repair and subsequent strokes. The Board found Dr. Markovitz's opinions constituted substantial medical evidence, despite conflicting defense opinions, and affirmed that all necessary medical care and permanent disability were industrially caused.

Workers' Compensation Appeals BoardJesus ArroyoJohn Cravens PlasteringState Compensation Insurance FundPetition for ReconsiderationAgreed Medical ExaminerGerald Markovitzechocardiogramaortic root dilationexpanding aortic aneurysm
References
Case No. ADJ7433042, ADJ7433045, ADJ7433048
Regular
Aug 06, 2013

MARIA GOMEZ vs. HARRIS RANCH BEEF CO., AIMS INSURANCE CO.

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of a prior decision. The WCJ disallowed the lien claimant's lien for medical treatment, finding that the lien claimant failed to prove the treatment was reasonable and necessary, and its charges were reasonable. The Board affirmed the WCJ's decision, holding that the lien claimant did not meet its evidentiary burden, and denied the petition.

Lien claimantPetition for ReconsiderationJoint Findings of Fact and Ordersubstantial evidencedisallowance of liensCompromise and Releaseuntimely serviceex parte communicationsubstantial medical evidencereasonable and necessary treatment
References
Case No. ADJ6700930
Regular
Feb 24, 2014

LUIS PENA vs. EDUARDO ZENDEJAS, VIRGINIA SURETY

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by a lien claimant, Precision Medical Group. The Board adopted the WCJ's report, which found the lien claimant failed to prove injury arising out of and in the course of employment, nor that the treatment was reasonable and necessary. The petition was also deficient for procedural reasons and contained facts not in evidence. The case was remanded to the WCJ to consider sanctions against the lien claimant and its representative.

Lien claimantPetition for ReconsiderationInjury AOE/COESanctionsFrivolousBad FaithLabor Code section 5813Notice of Intention to Impose SanctionsBurden of ProofContinuous Trauma
References
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