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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ1923190
Regular
Jul 19, 2010

Richard Martinez vs. SIFLING BROTHERS, ZENITH INSURANCE COMPANY

Lien claimants, Dr. Silver and Dr. Bresler, sought payment for medical services exceeding the Official Medical Fee Schedule (OMFS). They argued their services warranted higher fees due to "extraordinary circumstances" and defendant's alleged improper billing practices. The Workers' Compensation Appeals Board denied their petitions for reconsideration, finding they failed to meet the burden of proof. The board held that lien claimants must demonstrate extraordinary circumstances justifying fees above the OMFS and present evidence of their usual and customary fees.

Workers' Compensation Appeals BoardRichard MartinezSifling BrothersZenith Insurance CompanyDavid BreslerDavid SilverSupplemental Findings and AwardOfficial Medical Fee ScheduleLien ClaimantsReconsideration
References
Case No. ADJ2367528 (SFO 0509283)
Regular
Mar 22, 2011

GUILLERMO BAYLEY vs. YMCA OF THE EAST BAY, TRAVELERS INSURANCE

This case involves a dispute over the payment for a 15-day hospitalization for an industrial injury. Stanford University Medical Center, a lien claimant, sought additional payment beyond the amount calculated under the Official Medical Fee Schedule (OMFS). The Appeals Board granted reconsideration, finding that California Code of Regulations, title 8, section 9792(c) allows for fees exceeding the OMFS if extraordinary circumstances related to the unusual nature of services rendered are proven. The case was returned to the trial level for further development of evidence regarding these extraordinary circumstances and to determine if the claimed fee is reasonable.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationInpatient Hospital Fee ScheduleOfficial Medical Fee Schedule (OMFS)Extraordinary CircumstancesDiagnosis-Related Group (DRG)Reasonable FeeLabor CodeMedical Treatment
References
Case No. ADJ18067229
Regular
Jul 10, 2025

RAY GUTIERREZ vs. CMAX COMMERCIAL MAINTENANCE, INC.; PALOMAR SPECIALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the Petition for Reconsideration filed by CMAX COMMERCIAL MAINTENANCE, INC. and PALOMAR SPECIALTY INSURANCE COMPANY (Defendants) regarding the continuation of home health care for applicant RAY GUTIERREZ. The WCAB affirmed the WCJ's finding that the defendants failed to meet their burden of proof to show a change in the applicant's medical condition or circumstances to justify terminating previously authorized ongoing home health care, citing the principles established in Patterson v. The Oaks Farm. The decision also clarified the applicability of Labor Code section 5909 regarding the timeline for acting on reconsideration petitions, which was met by the Board. Commissioner Razo dissented, arguing Patterson should not apply due to the initial limited authorization and that a change in circumstances was evident.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Utilization ReviewPatterson v. The Oaks FarmRequest for AuthorizationChange of CircumstancesHome Health CareMedical NecessityWCJ Report
References
Case No. ADJ10857876; ADJ10857882
Regular
Mar 06, 2023

MINNIE BYRD vs. CITY OF LOS ANGELES

The Board rescinded the prior order, finding the defendant failed to prove a change in circumstances justifying the termination of applicant's home healthcare provider, Myra Shaw. The defendant must pay Ms. Shaw for services rendered, and the matter is returned for further proceedings. Applicant's objection to exhibits 12 and 13 was overruled.

Workers Compensation Appeals BoardMinnie ByrdCity of Los AngelesOpinion and Decision After ReconsiderationFindings of Fact and OrderWCJhome healthcare servicesMyra ShawExhibits 12 and 13change in circumstances
References
Case No. ADJ10110995
Regular
Oct 14, 2020

PRESTON LEE BROWN SCOTT vs. CITY OF LOS ANGELES, THE HARTFORD

The applicant, Preston Lee Brown Scott, was declared a vexatious litigant in 2018 and is subject to a pre-filing order. This order requires him to obtain prior approval from a judge before filing any documents with the Workers' Compensation Appeals Board (WCAB). He has filed multiple petitions for reconsideration without this approval. The WCAB has reviewed these filings and found no significant change in circumstances to warrant acceptance. Therefore, the documents submitted by Mr. Scott are not accepted for filing.

Vexatious litigantPre-filing orderWorkers' Compensation Appeals BoardRule 10430Rule 10782In pro perPetition for ReconsiderationAdjudication of claimDeclaration of readinessPleading
References
Case No. ADJ7912638
Regular
Apr 17, 2013

MARIA CASTREJON vs. BOLTHOUSE FARMS INC., BROADSPIRE

This case involves a petition for removal by the defendant, Bolthouse Farms, seeking to change the venue from Marina del Rey to Bakersfield. The defendant argued inconvenience for the applicant and witnesses residing in Kern County. Although the initial judge denied the venue change due to insufficient witness detail, the Appeals Board granted the petition for removal. The Board ultimately changed the venue to Bakersfield, considering the applicant's lack of opposition and the overall balance of equities.

Petition for RemovalChange of VenueWorkers' Compensation Appeals BoardLabor Code Section 5501.5(a)(3)Kern CountyBolthouse FarmsMarina del ReyBakersfieldIndustrial InjuryReduction in Workforce
References
Case No. ADJ6864354
Regular
Mar 29, 2017

AGUSTIN MORENO vs. ARANDA'S WOODCRAFT, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration, rescinding a previous order that dismissed his case for lack of prosecution. The WCAB found that the applicant would suffer substantial prejudice if the dismissal stood, as he had sustained a significant admitted industrial injury requiring surgery. Balancing the equities, the WCAB determined that the potential harm to the applicant outweighed any hardship to the defendant in allowing the case to proceed on its merits. The matter was returned to the trial level for further proceedings.

Petition for ReconsiderationOrder Dismissing CaseLack of ProsecutionWCJLabor CodeSubstantial JusticeApplication for Adjudication of ClaimDeclaration of Readiness to ProceedMandatory Settlement ConferencePetition to Dismiss
References
Case No. ADJ7620210
Regular
Feb 02, 2012

MATTHEW BROWN vs. PENINSULA PONTIAC AUTOMOBILE, AM TRUST NORTH AMERICA, MAJESTIC INSURANCE COMPANY

Defendant insurance company sought removal of an order setting a workers' compensation case for trial, arguing insufficient discovery. The Board denied the petition, finding the defendant waived objections by failing to object to two prior Declarations of Readiness. The Board also noted the defendant's lack of diligence in obtaining requested discovery and the absence of extraordinary circumstances justifying further delay. The order allowing the trial judge discretion for limited medical evidence was upheld.

Petition for RemovalQualified Medical ExaminerDiscoveryMandatory Settlement ConferenceDeclaration of ReadinessObjectionTrialDepositionTemporary Total DisabilityDue Diligence
References
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