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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8132431
Regular
Feb 12, 2018

Nichole Delgado vs. EL TEPEYAC CAFÉ; CRMBC(SIG), AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board affirmed a prior decision finding the defendant liable for a lien claimant's photocopying services. The Board determined the lien claimant complied with statutory requirements for valid liens, including a declaration under penalty of perjury. Furthermore, the defendant failed to timely object to the billed services or their reasonableness within the 60-day period mandated by Labor Code section 4622. Consequently, the defendant is liable for the billed amount, a 10% statutory increase, and interest.

Labor Code section 4622Labor Code section 4903.8medical-legal lienphotocopy servicesdeclaration under penalty of perjuryreasonableness of chargesstatutory increaseinterestobjection periodtimely filing
References
Case No. ADJ3535372 (POM 0252700) ADJ4563878 (POM 0290856)
Regular
Sep 23, 2013

JANET BOWEN vs. MICHAEL J'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by INTERCARE INSURANCE SERVICES for PACIFIC NATIONAL INSURANCE, in liquidation, GLENDORA CONTINENTAL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior order finding the California Insurance Guarantee Association (CIGA) entitled to reimbursement from the State Compensation Insurance Fund (SCIF). SCIF argued CIGA's reimbursement claim was untimely and that CIGA knew of SCIF's joint liability. CIGA asserted SCIF never contested the reimbursement amount. The Board affirmed the WCJ's decision, clarifying CIGA's statutory role and distinguishing "coverage" from "covered claim," deeming SCIF's arguments regarding coverage misplaced.

California Workers CompensationCIGASCIFReimbursementPetition for ReconsiderationFindings and OrderStipulated AwardCovered ClaimsInsolvent InsurerInsurance Code Section 1063
References
Case No. ADJ2255696 (VNO 0497652)
Regular
May 15, 2009

TATIANA ZAKIANS vs. BLOOMINGDALES

Lien claimant Sam Alaiti, M.D., sought reconsideration of a WCJ's order reducing his lien by over $80\%$. The WCJ recommended granting reconsideration, noting procedural issues with the petition's timely attention by the judge. The Appeals Board found the petition timely filed, but it did not come to their attention until after the statutory reconsideration period had passed. Citing due process principles, the Board held the reconsideration period begins upon their actual notice. Therefore, the Board granted reconsideration, rescinded the prior order, and returned the matter to the trial level for further proceedings.

Lien claimantPetition for ReconsiderationOrder Reducing LienOrder to Pay Lienworkers' compensation administrative law judgeEAMSFileNetstatutory time periodAppeals Boarddue process
References
Case No. SJO 0210015
Regular
Mar 04, 2008

CARLOS SALAZAR vs. JOSE VIDRIO, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns whether a comprehensive personal liability policy provided by Liberty Mutual to Jose Vidrio covered applicant Carlos Salazar's workers' compensation claim for injuries sustained while working at Vidrio's residence. The Appeals Board affirmed the arbitrator's decision, finding that Insurance Code section 11590 mandates such coverage for residential employees incidental to the dwelling's use, regardless of specific policy wording. The Board also confirmed Salazar met the statutory employee criteria of working over 52 hours and earning over $100 in the 90 days prior to injury.

Workers' Compensation Appeals BoardIndustrial InjuryResidential EmployeeComprehensive Personal Liability InsuranceLabor Code section 3351(d)Insurance Code section 11590Labor Code section 3352(h)Incidental DutiesDwelling MaintenanceUninsured Employers Benefits Trust Fund
References
Case No. SAL 0113062
Regular
Jan 02, 2008

, Maria LOURDES TAPIA, vs. REGENT ASSISTED LIVING, ALASKA NATIONAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a decision upholding a 24-visit limit for chiropractic treatment per industrial injury. The applicant argued that the statutory cap conflicted with the liberal construction mandate of Labor Code section 3202, but the Board found no ambiguity in the clear language of Labor Code section 4604.5(d)(1). The Board further clarified that the provision allowing employers to authorize additional visits in writing (LC 4604.5(d)(2)) did not remove the cap, nor did it render chiropractors meaningless within the workers' compensation system.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 4604.5(d)(1)chiropractic visitsoccupational therapyphysical therapyLiberal constructionLabor Code Section 3202employer authorizationFindings & Order
References
Case No. ADJ6933348, ADJ6933382
Regular
Apr 30, 2013

SILVESTRE BAUTISTA vs. HI-SHEAR CORPORATION, ZURICH NORTH AMERICA

This case concerns a defendant's petition for reconsideration of a worker's compensation award. The Board granted reconsideration, affirming the finding of industrial injury but modifying the temporary disability award. Specifically, the Board limited temporary disability benefits to 104 compensable weeks, as mandated by Labor Code section 4656(c), overruling the administrative law judge's interpretation. The award was recalculated to reflect this statutory limit, with attorney fees and a lien for unemployment benefits also addressed.

WCABReconsiderationJoint Findings and AwardIndustrial InjuryCumulative InjuryTemporary DisabilityLabor Code Section 4656Compensable WeeksDate of InjuryDate of Commencement of Temporary Disability Payment
References
Case No. VNO 497379
Regular
Dec 27, 2007

AGNES MERCADO vs. AMERICAN DAWN, INC., HIGHLANDS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to correct errors in the original award to lien claimant S&B Surgery Center. The Board reduced the award for certain epidural injections and a lysis procedure based on corrected billing and relevance of the comparative study. Despite defendant's arguments, the Board affirmed the award of statutory interest on unpaid medical bills, finding the defendant failed to meet statutory requirements for contesting payment.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and AwardEpidural BlocksLumbar DiscographyCompromise and ReleaseLabor Code Section 4603.2Medical TreatmentInterest
References
Case No. ADJ4647589
Regular
Dec 10, 2019

ORIS PAYTON vs. CAL EXPO FAIRGROUNDS, CALIFORNIA FAIR SERVICES AUTHORITY

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration. The applicant sought further physical therapy beyond the statutory limit of 24 visits. The WCAB adopted the Workers' Compensation Administrative Law Judge's report, which concluded that the WCAB lacks the authority to challenge the constitutionality of a statute, including Labor Code section 4604.5, which limits physical therapy visits. Therefore, the applicant's request for treatment exceeding the statutory allowance was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeFindings and AwardIndustrial InjuryCumulative Work ActivitiesMedical TreatmentPhysical TherapyStipulationsAgreed Medical Examiner
References
Case No. ADJ9531226
Regular
Dec 04, 2018

JULICES MARTINEZ vs. SUN VALLEY GROUP, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the administrative law judge's decision. The lien claimant argued that the defendant's explanations of review (EORs) were deficient and did not trigger the lien claimant's obligation to request a second review. However, the Board found that the defendant's EORs substantially complied with statutory requirements and provided sufficient guidance to the lien claimant. Because the lien claimant failed to request a second review within the statutory timeframe, their objections to the billing were deemed waived.

Workers' Compensation Appeals BoardLien ClaimantExplanation of Review (EOR)Labor Code Section 4622Medical-legal ExpensesContested ClaimPetition for ReconsiderationAdministrative Director Rule 9794Second ReviewBill Review
References
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