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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7258268
Regular
Dec 20, 2013

PATRICIA SMITH vs. WELLPOINT HEALTH NETWORKS, INC.; and ZURICH NORTH AMERICA INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original award. The Board found substantial evidence supported the necessity of a Jenny Craig weight loss program, including special diet food products, as reasonably necessary treatment. This was based on the applicant's need to lose weight for industrial back surgery and the program's proven success, evidenced by the applicant's 54-pound weight loss. The Board adopted the administrative law judge's report and recommendation in its entirety.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDJenny Craigweight loss programspecial diet food productsreasonably necessary treatmentindustrial back surgerysubstantial evidencemedical treatment
References
Case No. ADJ2117331 (OAK 0261803)
Regular
May 31, 2017

Janice Payne vs. Federal Express, BROADSPIRE

This case involves Janice Payne seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying her weight loss program extension. The WCJ initially ruled he lacked jurisdiction due to prior Utilization Review (UR) and Independent Medical Review (IMR) denials, which were not appealed. However, the applicant argued a 2003 Compromise and Release agreement designated Dr. Mandel as the ultimate medical arbiter for treatment disputes, superseding UR/IMR. The WCAB granted reconsideration, finding the contractual agreement to use Dr. Mandel remains enforceable despite subsequent UR/IMR legislation. The case is remanded to the trial level to consider Dr. Mandel's opinions on the weight loss program's medical necessity.

Compromise and ReleaseMedical ArbiterUtilization ReviewIndependent Medical ReviewWeight Loss ProgramContractual AgreementJurisdictionSubstantial JusticeStipulationMedical Treatment Dispute
References
Case No. VNO 343876
Regular
Jan 15, 2008

CASSANDRA GIBSON vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the County of Los Angeles' petition for reconsideration, upholding an award for the applicant's future medical treatment. This treatment included a weight loss program, bariatric surgery consultation, physical therapy, and an orthopedic mattress, which the defendant had unreasonably delayed providing. The Board found substantial medical evidence supported the necessity of this treatment and justified penalties for the defendant's delay.

Workers' Compensation Appeals BoardReconsiderationFuture Medical TreatmentWeight Loss ProgramBariatric Surgery ConsultationPhysical TherapyLumbar SpineOrthopedic MattressUnreasonable DelayLabor Code Section 5814 Penalties
References
Case No. GOL 0099075 GOL 0099076 GOL 0099077 GOL 0100393
Regular
Jan 10, 2008

LOIS M. HOUSMAN vs. SANTA BARBARA COTTAGE HOSPITAL, KEENAN & ASSOCIATES

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award concerning Lois Housman's entitlement to medical treatment. The Board ordered that the parties must follow the process outlined in Labor Code section 4062.2 to resolve the dispute regarding a pain psychology evaluation recommended by the applicant's treating physician. The finding that the applicant is entitled to a weight loss program was affirmed.

Workers' Compensation Appeals BoardSanta Barbara Cottage HospitalKeenan & AssociatesLois M. HousmanPetition for ReconsiderationFindings and AwardAdministrative Law Judge (WCJ)Weight Loss ProgramPsyche EvaluationDr. Errico
References
Case No. ADJ8935493
Regular
Dec 16, 2013

CYNTHIA LANDSIEDEL vs. SANTA ANA UNIFIED SCHOOL DISTRICT

This case involved an applicant seeking reconsideration or removal of a WCJ's decision denying bariatric surgery or a weight loss program for an industrial back, neck, and leg injury. The Appeals Board dismissed the Petition for Removal, finding it an inappropriate remedy as a final order existed and reconsideration was available. The Petition for Reconsideration was denied because the applicant failed to meet the burden of proof that the requested surgery was reasonably required to cure or relieve the industrial injury. Additionally, the petition was subject to dismissal due to improper verification, which was not cured despite notice.

Petition for RemovalPetition for ReconsiderationFindings and OrderIndustrial InjuryBariatric SurgeryWeight Loss ProgramMedical TreatmentUtilization ReviewBurden of ProofEvidentiary Burden
References
Case No. VNO 0509254
Regular
Apr 17, 2008

CAROL LEVENSON vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves a claim for bilateral hearing loss and tinnitus allegedly caused by noise exposure during firearms training. The Appeals Board found the opinion of the Agreed Medical Evaluator, Dr. Grossan, to be substantial evidence, concluding that the applicant's conditions were not work-related. Consequently, the Board denied the applicant's claim for hearing loss and tinnitus, awarding only reimbursement for medical-legal liens.

Workers' Compensation Appeals BoardRemovalTemporary DisabilityFindings and AwardLicensing Program AnalystBilateral Hearing LossFirearms TrainingShooting RangeTinnitusQualified Medical Evaluator (QME)
References
Case No. ADJ1055189 (VNO 0384673) ADJ1713367 (VNO 0396399)
Regular
Dec 05, 2008

Diane Martinez vs. STATE COMPENSATION INSURANCE FUND, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration and rescinded an arbitrator's award of weight loss treatment, attendant care, and household assistance. The Board found the arbitrator erred by conducting an independent investigation without notice to the parties and by failing to provide an adequate record, including a summary of evidence. The case is remanded for further proceedings before a new arbitrator or judge to ensure a proper evidentiary record supports any future award.

Workers' Compensation Appeals BoardState Compensation Insurance FundReconsiderationArbitratorWeight Reduction ProgramAttendant AssistanceHousehold AssistanceMedical JustificationDue ProcessIndependent Investigation
References
Case No. ADJ2766437 (OAK 0329978)
Regular
Mar 13, 2017

SCOTT ELLIOTT vs. CONTRA COSTA DOOR, INC., ZENITH INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to clarify that weight loss treatment awarded to applicant Scott Elliott is subject to Labor Code section 4610 et seq. The Board affirmed the original Findings and Award, which found applicant sustained injuries to multiple body parts resulting in permanent total disability without apportionment. Defendants' other contentions, including challenges to medical evidence and the vocational rehabilitation finding, were rejected. The Board found the original decision was supported by substantial evidence and adopted the WCJ's report.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint and Several Findings and AwardAgreed Medical Examiner (AME)Permanent Total DisabilityApportionmentVocational EvaluatorFuture Medical TreatmentWeight Loss TreatmentLabor Code section 4610
References
Case No. ADJ8954364
Regular
Jul 06, 2015

MARK FINNEY vs. ZURICH INSURANCE, PATRIOT RISK SERVICES

This Workers' Compensation Appeals Board case, ADJ8954364, involved applicant Mark Finney seeking reconsideration of a decision that denied permanent impairment from a left eye injury. Finney argued he had developed glaucoma and sustained vision loss due to the injury. The Workers' Compensation Judge found no substantial evidence that the glaucoma was caused by the injury, nor was there sufficient evidence of specific vision loss as defined by the AMA Guides. Therefore, the petition for reconsideration was denied, upholding the original decision that while future complications could arise, there was no current permanent impairment.

Petition for ReconsiderationDeniedPermanent ImpairmentLeft Eye InjuryGlaucomaVision LossAMA GuidesPrimary Treating PhysicianBilateral Vision LossMyopic Astigmatism
References
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