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

Case No. ADJ10975151
Regular
Jan 06, 2020

RUSSELL CAMARA vs. TESLA, INC., AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the Applicant sustained an admitted industrial injury to the lumbar spine. The Applicant's primary treating physician (PTP) designated a secondary physician to evaluate permanent and stationary status and impairment, whose report the PTP adopted. The defense challenged the validity of this secondary physician's report, arguing only the Panel Qualified Medical Examiner's (PQME) report was properly obtained. The Workers' Compensation Appeals Board denied the Petition for Reconsideration, affirming that the PTP, or a physician designated by the PTP, is authorized to render opinions on medical issues, provided proper notice and procedural requirements are met. The Board found the designation and subsequent report were compliant with Labor Code and Administrative Director Regulations.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianQualified Medical ExaminerLabor Code Section 4061.5Permanent and Stationary ReportMedical-Legal EvaluationSecondary PhysicianAdministrative Director Rule 9785Designation of Physician
References
Case No. ADJ10308959
Regular
Feb 25, 2019

Miguel Pena vs. Aqua Systems, Athens Administrators Concord

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior Findings and Award. The Board found that the applicant sustained an industrial injury to his psyche and that the defendant unreasonably delayed authorizing medical care for this condition. Consequently, a 25% penalty was imposed on the applicant's first visit with Dr. Lorant. However, the Board also determined that attorney's fees under Labor Code section 5814.5 were not warranted as there was no prior award specifically for psychiatric treatment.

WCABPetition for RemovalPetition for ReconsiderationFindings and Awardunreasonable delayauthorizing medical carepenaltyattorney's feesinjury AOE/COEpsyche
References
Case No. ADJ6751877 ADJ6997475
Regular
Nov 17, 2010

BLANCA SUSANA DE LA VEGA vs. SONY CORPORATION OF AMERICA

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The Board adopted the judge's report, which found the applicant was not entitled to spinal surgery based on the Agreed Medical Examiner's opinion. The applicant also failed to prove a new injury occurred on March 13, 2009, as evidence indicated a flare-up of a prior injury. The Board found the Agreed Medical Examiner's opinion constituted substantial evidence and saw no reason to deviate from it.

ADJ6751877ADJ6997475Petition for ReconsiderationAgreed Medical Examinerspinal surgerylumbar fusionhysterical conversion reactionAOE/COEsubstantial medical evidenceprimary treating physician
References
Case No. ADJ1946809 (LAO 0785099)
Regular
Dec 03, 2008

Steven M. Luas vs. The Boeing Company, AIG Claim Services, Inc.

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration regarding permanent disability and apportionment. While the applicant sustained an industrial injury, the Board found that the defendant presented sufficient secondary evidence to establish a prior 11.5% permanent disability award for a right hand injury. The case was remanded for further proceedings to allow for proper apportionment of the current permanent disability based on the prior award.

WCABPetition for ReconsiderationFindings and Awardaircraft systems installercumulative traumapermanent disabilityapportionmentprior permanent disability awardLabor Code section 4664(b)Kopping
References
Case No. ADJ1581465; (LAO 0850949) ADJ1167896; (LAO 0860970)
Regular
Sep 26, 2008

DANIEL CHAVEZ vs. LEHIGH CONSUMER PRODUCTS, SENTRY CLAIMS SERVICE

Reconsideration granted, rescinding the July 7, 2008 Order Approving Compromise and Release due to potential Medicare Secondary Payer issues. Case returned for further proceedings.

Compromise and ReleaseMedicare Secondary PayerOrder Approving Compromise and ReleasePetition for ReconsiderationWorkers' Compensation Appeals BoardWCJSet Aside OAC&RMedicare Set-Aside ArrangementRescindedTrial Level
References
Case No. ADJ7160976
Regular
Sep 25, 2012

ANTONETTA WILLIAMS vs. CLAIRE'S STORES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded the prior award and returned the case for further proceedings because the administrative law judge improperly relied on a secondary treating physician's report. The judge failed to establish that the requested attendant care was authorized or constituted substantial medical evidence. The Board emphasized that the primary treating physician must issue opinions on medical issues and the record needs further development to determine entitlement to attendant care.

Attendant carePrimary treating physicianSecondary treating physicianMedical treatment authorizationUtilization reviewSubstantial medical evidenceWorkers' Compensation Appeals BoardFindings and AwardReconsiderationAgreed Medical Examiner
References
Case No. ADJ7484505, ADJ7484506
Regular
Dec 18, 2019

FRANCISCO VILCHIS MONDRAGON vs. PACIFIC FLOOR COVERING, ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to award a lien claimant reimbursement for psychological treatment services. The Board found that the primary treating physician did refer the applicant to the lien claimant, received and reviewed the lien claimant's reports, and thus complied with reporting requirements. This reversed the trial judge's denial of the lien based on the primary physician's alleged failure to incorporate the secondary physician's reports. The matter was returned for determination of the amount owed.

Workers' Compensation Appeals BoardLien ClaimantPsychological Assessment ServicesPrimary Treating PhysicianSecondary Treating PhysicianRule 9785(e)(4)Reporting RequirementsMedical Treatment ExpensesIndustrial InjuryPsyche
References
Case No. ADJ7469888
Regular
Jul 09, 2013

MARIA RODRIGUEZ vs. MODERN DEVELOPMENT COMPANY, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award finding applicant sustained industrial injury with 59% permanent disability. The WCAB rescinded the award because the applicant's primary treating physician's final report, which incorporated secondary physician opinions, was improperly excluded from evidence. This exclusion prevented the WCAB from determining compliance with Labor Code section 4061.5 and relevant regulations. The case is returned to the WCJ for further proceedings and a new decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardPrimary Treating PhysicianSecondary Treating PhysiciansLabor Code Section 4061.5Rule 9785Mandatory Settlement Conferencesubstantial evidencecumulative trauma
References
Case No. ADJ8323717
Regular
Mar 24, 2014

MARIA GONZALEZ vs. AMERICAN APPAREL, INC.; NEW HAMPSHIRE INSURANCE COMPANY, administered by ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior "take nothing" order. The Board found that the administrative law judge improperly excluded four medical reports from secondary treating physicians, ruling they were admissible evidence even if not reviewed by the primary treating physician. The case is returned to the trial level for further proceedings and decision, with the admitted medical reports to be considered. The Board emphasized that this does not reopen discovery, but allows the WCJ to weigh all evidence to determine industrial causation.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderIndustrial CausationMedical ReportsAdmissible EvidencePrimary Treating PhysicianSecondary Treating PhysicianValdez v. Workers' Comp. Appeals Bd.Labor Code Section 4061.5
References
Case No. ADJ3543065 (AHM 0145064)
Regular
Jan 18, 2011

RAMON MARTINEZ vs. JUICE HARVEST CORP., PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the disallowance of Dr. Vazquez's lien. The Board agreed with the administrative law judge that there was insufficient evidence Dr. Vazquez provided medically necessary treatment to the applicant. Furthermore, as a secondary treating physician, Dr. Vazquez lacked the authority to provide treatment beyond the initial course recommended by the primary treating physician, Dr. Aun. The Board found that treatment provided outside Dr. Aun's authorization was not compensable.

Workers Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderCompromise and ReleaseMachine OperatorIndustrial InjuryRight ShoulderRight ElbowRight Hand
References
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