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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ2401554 (FRE 023126)
Regular
Jan 07, 2013

JOSHUA GROSSMAN vs. ARAMARK UNIFORM SERVICE, ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration, reversing the judge's decision and finding the defendant liable for self-procured medical treatment. The defendant failed to prove they properly transferred the applicant into their Medical Provider Network (MPN) and neglected or refused to provide reasonable treatment by failing to ensure MPN physician availability. Consequently, the applicant's self-procured treatment from the lien claimant is deemed reasonable and compensable. The defendant is liable for the reasonable cost of this treatment, plus interest and penalties.

MPNself-procured medical treatmentneglect or refusal to provide medical treatmentprimary treating physicianlien claimantreasonable medical treatmentAramark Uniform ServiceAce American Insurance CompanySan Joaquin Accident & Medical GroupKnight v. Liberty Mut. Ins. Co.
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
Case No. ADJ18027061
Regular
Sep 10, 2025

HEATHER TILLER KELLEY vs. SACRAMENTO CITY UNIFIED SCHOOL DISTRICT

Defendant Sacramento City Unified School District sought reconsideration of a WCAB decision that found applicant Heather Tiller Kelley sustained industrial injuries and that reports from her treating physicians (Mark Zuber, D.C., Adrienne Pasek, Psy.D., and Kasra Maasumi, M.D.) were admissible. Defendant argued these physicians lacked a proper treatment relationship and that the reports were improperly obtained. The Workers' Compensation Appeals Board denied the petition for reconsideration, affirming that defendant relinquished medical control by denying liability, allowing applicant to self-procure treatment, and thus the treating physician reports were admissible in proceedings.

WCABPetition for ReconsiderationOpinion and Order Granting PetitionAdmissible EvidenceTreating PhysiciansMedical-Legal ReportsLabor Code Section 4062.2Self-Procured TreatmentRemoval StandardPermanent and Stationary Status
References
Case No. ADJ7685567
Regular
Feb 12, 2015

KATHLEEN O'NEAL vs. HALE ALOHA/MARK ONE CORPORATION, CALIFORNIA SELF-INSURERS' SECURITY FUND

This case involves a dispute over authorization for cervical surgery for applicant Kathleen O'Neal. The defendant argued that Dr. McCormack, who recommended the surgery, was a one-time consultant, not a treating physician, and thus his request for authorization was not subject to utilization review (UR). The Workers' Compensation Appeals Board (WCAB) affirmed the judge's order, finding Dr. McCormack acted as a treating physician by undertaking to obtain authorization and proceed with the surgery. Therefore, the defendant's failure to submit Dr. McCormack's request for authorization to UR in a timely manner meant the UR denial was invalid. The WCAB concluded the defendant was obligated to provide the surgery as it was supported by substantial medical evidence and reasonably necessary.

Utilization ReviewAuthorization RequestTreating PhysicianConsulting PhysicianPrimary Treating PhysicianSecondary Treating PhysicianWorkers' Compensation Appeals BoardAdministrative Director's RuleTimelinessJurisdiction
References
Case No. ADJ9438375
Regular
Dec 15, 2016

MARIA FALCON vs. MARRIOTT HOTEL

The Workers' Compensation Appeals Board granted the applicant's Petition for Reconsideration, amending the original decision. The Board found that the defendant's Marriott Hotel failed to provide the applicant with timely medical treatment within their Medical Provider Network (MPN). Applicant attempted to designate five different MPN physicians, but each refused to treat her. This repeated failure constitutes a denial of care, entitling the applicant to seek treatment outside the MPN at the defendant's expense.

Medical Provider NetworkMPN denialOut-of-network treatmentAccess standardsPrimary treating physicianPhysician availabilityLabor Code section 4600Labor Code section 4616Petition for ReconsiderationFindings of Fact and Award
References
Case No. ADJ8035089, ADJ8033530, ADJ8033513
Regular
Jun 27, 2012

Linda Barajas vs. First Group America, Chartis

The Appeals Board overturned a WCJ's denial of reimbursement for a self-procured gym membership. The applicant's claim was in delay status when her physician prescribed the membership, and she notified the adjuster without objection before purchasing it. The Board found the gym membership reasonable and consistent with ACOEM guidelines for shoulder treatment, though limited to six months. Therefore, the applicant is awarded one-half the cost of her 12-month membership as reasonable self-procured medical treatment.

Workers' Compensation Appeals BoardReconsiderationSelf-procured medical treatmentGym membershipTreating physicianDelay statusACOEM guidelinesLabor Code 5402(c)Utilization reviewIndustrial injury
References
Case No. ADJ1524412 (RDG 0043469)
Regular
Oct 18, 2011

STEPHEN FLESHMAN vs. MANDINA'S CUSTOM CABINETS, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over ongoing chiropractic treatment for a back injury sustained in 1989. The defendant sought reconsideration of a prior award granting weekly chiropractic visits, arguing the treatment wasn't providing functional restoration after 21 years. The Appeals Board affirmed the award of 90 days of weekly chiropractic treatment, finding it supported by the treating chiropractor's reports and testimony. However, the Board amended the order to require further medical evaluation after the 90 days to determine future treatment needs.

Workers' Compensation Appeals BoardIndustrial InjuryBack and SpineStipulated AwardPermanent DisabilityFurther Medical TreatmentChiropractic TreatmentChronic Pain Medical Treatment GuidelinesFunctional RestorationProgress Report
References
Case No. ANA 0378959
Regular
May 27, 2000

MAI HO vs. MARRIOTT INTERNATIONAL

The Appeals Board granted reconsideration to reverse a restitution order against chiropractor Vu Phan, D.C., who provided unauthorized treatment. While Phan is not entitled to further payment for treatment not authorized by the employer, the Board found that the employer voluntarily paid $6,500 for past treatment and thus cannot recover it absent fraud, thus denying the employer's restitution claim. The Board otherwise affirmed the original decision denying Phan's lien claim for the unauthorized treatment.

Workers' Compensation Appeals BoardLien claimantRestitutionOverpaymentMedical treatmentUnauthorized treatmentPrimary treating physicianSelf-procured treatmentUnjust enrichmentVoluntary payment
References
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