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

Case No. ADJ6999645
Regular
Mar 04, 2011

SANDY DROUIN vs. HEALTHCARE PARTNERS, TRAVELERS DIAMOND BAR

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration because the underlying order denying a deposition was not a final order. The Board also denied the defendant's Petition for Removal, finding no showing of significant prejudice or irreparable harm. The defendant had argued the WCJ erred in denying their request to compel a deposition due to insufficient provision for travel expenses. The Board noted unprofessional conduct by both attorneys.

Petition for ReconsiderationPetition for RemovalOrder Denying Petition to Compel AttendanceDeposition CostsTransportation ExpensesAirline E-TicketTravel ExpensesFinal OrderSubstantive RightsIrreparable Harm
References
Case No. ADJ7049850 ADJ7289794 ADJ7523255
Regular
May 11, 2015

FREDDIE B. GUZMAN vs. MARTENS CHEVROLET, EMPLOYERS COMPENSATION INSURANCE COMPANY

This case involves an applicant seeking reconsideration of an order denying his petition to enforce an award for out-of-pocket medical and travel expenses. The Workers' Compensation Appeals Board granted the petition for reconsideration, finding the applicant was denied due process. The Board rescinded the prior order and returned the matter for further proceedings and a new decision, noting the applicant's right to a hearing was violated. This decision allows for a proper hearing to address the disputed reimbursement claims.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition to Enforce AwardSelf-Procured TreatmentOut-of-Pocket ExpensesDue ProcessWCJ OrderHearing DenialMedical Expenses ReimbursementTravel Expenses Reimbursement
References
Case No. ADJ3727929
Regular
Jul 17, 2013

JOE GAGNE vs. FRU CON CONSTRUCTION, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board adopted the WCJ's report, which found that the applicant was only temporarily disabled from June 1, 2007, to July 23, 2007, and was not entitled to further travel expense reimbursement. The WCJ determined that while one physician's opinion could constitute substantial evidence, that opinion lacked sufficient clarity and consistency to support the applicant's broader claims of temporary disability and cumulative trauma to the left knee and back. The Board affirmed that a single physician's considered opinion can be substantial evidence, even if inconsistent with other medical opinions.

Petition for ReconsiderationDeniedSubstantial EvidencePlace v. Workmen's Comp. Appeals Bd.Fru Con ConstructionZurich North AmericaADJ3727929SAC 0315536ApplicantTemporarily Disabled
References
Case No. ADJ7437756
Regular
Mar 23, 2012

Antonio Parvool vs. TONY'S FOOD SERVICE, TRAVELERS INDEMNITY OF CONNECTICUT

The Workers' Compensation Appeals Board granted reconsideration, finding that applicant Antonio Parvool sustained an industrial injury while employed as a chef's assistant and traveling for his employer. The Board overturned the original finding that the applicant's dive into a pool at an employer-provided hotel was not work-related, applying the "commercial traveler rule." This rule presumes an employee is acting within the scope of employment during business travel, including activities reasonably necessary for comfort. The Board clarified that Labor Code section 3600(a)(9) regarding recreational activities does not apply to commercial travelers.

Commercial traveler ruleIndustrial injuryCourse of employmentReconsiderationFindings and OrdersLabor Code section 3600(a)(9)Reasonable expectancyImpliedly requiredWCJOff-duty recreational activity
References
Case No. ADJ1938020 (LAO 0877660)
Regular
Jul 21, 2010

FRANCISCO PEREZ vs. KING TACO RESTAURANTS, INC., AMERICAN CASUALTY

This case involves an applicant seeking reimbursement for travel expenses incurred to attend a Qualified Medical Evaluator (QME) appointment. The applicant relocated out of state after sustaining an industrial knee injury. The defendant initially disputed medical findings, triggering the QME process, and later refused to reimburse travel expenses to the out-of-state QME. The Workers' Compensation Appeals Board ruled that the applicant was entitled to travel expenses, citing relevant Labor Code sections and precedent. Sanctions were denied, and penalty issues were deferred.

ADJ1938020LAO 0877660King Taco RestaurantsInc.American CasualtyQualified Medical EvaluatorQME panelLabor Code Section 4062.2Labor Code Section 4061Labor Code Section 4600
References
Case No. ADJ6910970
Regular
Oct 18, 2010

LOUIS SOTO vs. LOWE'S HOME IMPROVEMENT

This case involves an applicant claiming injury to his right wrist, leg, and shoulder. The defendant sought reconsideration of an award finding unreasonable delay in authorizing a recommended angiogram and paying medical travel expenses. The Appeals Board granted reconsideration, modifying the award to assess the 25% penalty for the delayed angiogram against its actual payment amount, rather than its estimated value. Otherwise, the original award, including penalties for delayed medical travel expenses and the necessity of the angiogram, was affirmed.

Workers' Compensation Appeals BoardReconsiderationMedical Travel ExpensesLabor Code Section 4600Angiogram StudyMedical Provider Network (MPN)Permanent Disability AdvancesPenaltiesLabor Code Section 5814Unreasonable Delay
References
Case No. ADJ6708293
Regular
Apr 04, 2013

Derrick Ransom vs. Jacksonville Jaguars, ACE Insurance, Arizona Cardinals, Travelers Indemnity Company, Gulf Insurance, Kansas City Chiefs, TIG Insurance, Risks Enterprise Management

This case concerns a workers' compensation claim filed by Derrick Ransom, a former professional football player. The Jacksonville Jaguars, through their insurer, petitioned for reconsideration of a finding that ordered them to pay for diagnostic testing and travel expenses before a jurisdictional determination. The Appeals Board found that ordering payment before establishing jurisdiction was improper. Therefore, the previous award was rescinded, and the matter was returned to the trial level to first determine if the Appeals Board has jurisdiction over the Jaguars.

Workers' Compensation Appeals BoardReconsiderationJurisdictionJacksonville JaguarsACE InsuranceArizona CardinalsTravelers Indemnity CompanyKansas City ChiefsTIG InsuranceQualified Medical Evaluator
References
Case No. ADJ5744485 ADJ6979008 ADJ6979031
Regular
Sep 16, 2010

BRIAN MENICUCCI vs. STATE OF CALIFORNIA, DEPARTMENT OF TRANSPORTATION, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

This Workers' Compensation Appeals Board decision clarifies that injured employees are not geographically restricted when selecting a physician within a defendant's Medical Provider Network (MPN). While general treatment under Labor Code section 4600(c) has a reasonable geographic limitation, this restriction does not apply to MPN physicians. The Board affirmed the ALJ's decision, holding that an employee can choose any MPN physician, regardless of distance, after their initial visit. The case specifically avoided ruling on travel expense reimbursement or injuries sustained during travel to the chosen physician.

Medical Provider NetworkMPNreasonable geographic areaLabor Code section 4600(c)Labor Code section 4616 et seq.Administrative Director Rule 9780(h)Administrative Director Rule 9767.6(e)physician of his or her choicestatutory constructionstatutory omission
References
Case No. ADJ3292672
Regular
Nov 08, 2012

SUSAN VIRDIER vs. CONCENTRA MANAGED CARE, ATLANTIC MUTUAL INSURANCE COMPANY (in liquidation), CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRAVELERS INDEMNITY INSURANCE COMPANY

This case concerns Travelers Indemnity Insurance Company's petition for reconsideration regarding its liability for applicant Susan Verdier's medical treatment. Travelers argued it should not be responsible for medical care in ADJ4661775, as it did not insure the employer at the time of the specific left wrist injury in ADJ3701452, and the cumulative trauma injury in ADJ4661775 involved different body parts. The Board denied the petition, holding that medical treatment expenses are not apportionable and that Travelers' coverage for the cumulative trauma period constitutes "other insurance" when the primary insurer is insolvent. The Board found no medical evidence distinguishing the need for treatment between the upper extremities and the wrist, thus upholding the finding that Travelers is available coverage for the award.

Workers Compensation Appeals BoardConcentra Managed CareAtlantic Mutual Insurance CompanyCalifornia Insurance Guarantee AssociationTravelers Indemnity Insurance CompanyreconsiderationFindings and Ordersother coveragemedical treatmentcumulative trauma
References
Case No. ADJ3344826 (SAL 0075781)
Regular
Jun 08, 2011

Ronald Fryer vs. CORNUCOPIA COMMUNITY MARKET, TRAVELERS INSURANCE

The Workers' Compensation Appeals Board reviewed Travelers Insurance's petition for reconsideration of a $10,000 sanction order. The Board affirmed that Travelers engaged in sanctionable conduct by violating a prior order to allow applicant treatment outside their Medical Provider Network and by failing to pay authorized medical bills. However, the Board reduced the total sanction amount to $2,500, finding the initial imposition excessive given the circumstances. Applicant's separate claims for reimbursement of expenses were not addressed in this decision but may be pursued in future proceedings.

Workers' Compensation Appeals BoardTravelers InsuranceFindings and OrdersanctionsMedical Provider NetworkMPNprimary treating physicianDr. Nicodemusself-procured medical treatmentcontinuity of care
References
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