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

Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Case No. ADJ4028210 (SJO 0251585)
Regular
Apr 06, 2009

JENNY PHAM vs. SANMINA-SCI CORPORATION, SENTRY CLAIMS SERVICE

This case concerns a dispute over the reasonableness and necessity of chiropractic and acupuncture treatment provided to an applicant for an industrial injury. The defendant argues the treatment exceeded the ACOEM Guidelines and was not evidence-based. The Appeals Board granted reconsideration, finding the WCJ's prior decision allowing the lien premature. The Board rescinded the decision and returned the case for further development of the medical record to determine if the treatment complied with the ACOEM Guidelines. The defendant's petition for removal was dismissed as moot.

Petition for RemovalPetition for ReconsiderationFindings and OrderCompromise and ReleaseIndustrial InjuryNeck InjuryBilateral ShouldersReasonable and Necessary TreatmentACOEM GuidelinesLabor Code Section 4600
References
Case No. STK 0209780 STK 0209781
Regular
Feb 08, 2008

TAMARA JEAN STAFFORD vs. LODI UNIFIED SCHOOL DISTRICT, ALTERNATIVE SERVICE CONCEPTS

The Workers' Compensation Appeals Board denied the Lodi Unified School District's petition for reconsideration, affirming the administrative law judge's award of pain medications and trigger-point injections to applicant Tamara Jean Stafford. The Board found the defendant's utilization review physician improperly applied ACOEM guidelines, which primarily address acute injuries, to the applicant's chronic condition. The Board clarified that while ACOEM guidelines are presumptively correct, variances are permissible when reasonably required to cure and relieve an employee's injury effects, as demonstrated by the applicant's treating physician's recommendations.

Workers' Compensation Appeals BoardLodi Unified School DistrictAlternative Service ConceptsTamara Jean StaffordPetition for ReconsiderationFindings and AwardMedical TreatmentPrimary Treating PhysicianACOEM GuidelinesUtilization Review
References
Case No. ADJ15329380
Regular
Oct 31, 2025

BERTHA VALERIO vs. KIMCO STAFFING SERVICES, INC.; XL INSURANCE

Defendant sought reconsideration of a Findings and Award (F&A) from August 5, 2025, concerning an injury sustained by applicant Bertha Valerio on September 9, 2021. The F&A found that applicant's injury was AOE/COE, defendant failed to prove improper treatment outside the Medical Provider Network (MPN), and lien claimant Joyce Altman Interpreting, Inc. established their market rate for interpreting services. Defendant contended that medical treatment and interpreter services were unreasonable due to treatment outside the MPN and failure to adhere to MTUS/ACOEM guidelines, and that the market rate for interpreter services was not properly established. The Appeals Board denied the petition, agreeing with the WCJ that defendant failed to sustain its burden of proof on the MPN issue, the MTUS/ACOEM guideline issue was not raised at trial, and lien claimant properly established their market rate.

WCABPetition for ReconsiderationFindings and AwardMedical Provider NetworkMPNRequests for AuthorizationRFAsLien ClaimantMarket RateLabor Code Section 4600
References
Case No. ADJ1798944 (LBO 0326931)
Regular
Jun 13, 2018

MARIA FIGUEROA vs. HELP NET, INC., STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant's petition for reconsideration of a WCJ's decision disallowing his lien for chiropractic services provided between 2001 and 2005. The Appeals Board rescinded the WCJ's decision, finding the claimant's petition timely due to defective service. Crucially, the Board determined that the Medical Treatment Utilization Schedule (MTUS) was improperly applied; instead, the American College of Occupational and Environmental Medicine (ACOEM) guidelines, in effect during the treatment period, should govern the determination of reasonable and necessary care. The matter is remanded to the WCJ for further proceedings consistent with the ACOEM guidelines.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderMedical Treatment Utilization Schedule (MTUS)American College of Occupational and Environmental Medicine (ACOEM)Labor Code Section 4600(b)SB 899Compromise and ReleaseAgreed Medical Examiner (AME)
References
Case No. ADJ3172768 (SRO 0138288)
Regular
Nov 30, 2009

MATTIE WALKER-STRIPLIN vs. SONOMA COUNTY OFFICE OF EDUCATION, REDWOOD EMPIRE SCHOOLS INSURANCE GROUP

The WCAB denied defendant's petition for reconsideration of the WCJ's September 10, 2009 order awarding applicant additional psychotherapy sessions. The board found sufficient evidence that the applicant was still suffering from disabling depression and that the requested treatment was consistent with ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationPsyche InjuryCompensable ConsequencePsychotherapy SessionsACOEM GuidelinesUtilization ReviewIndustrial InjuryPermanent DisabilityAgred Medical Evaluator
References
Case No. LAO 0833666, VNO 0481174
Regular
Jan 07, 2008

JUANA HERNANDEZ vs. FORESTON TRENDS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a lien claimant's denied claim for diagnostic testing expenses. The Board found the initial denial by the judge was based on grounds not raised by the defendant and that pre-authorization rules were misapplied. The case is returned to the trial level to develop the medical record regarding the reasonableness and necessity of the diagnostic testing under ACOEM guidelines.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationMedical Treatment ExpensesAdministrative Director's RuleReasonableness and NecessityCompromise and ReleaseUpper and Lower Extremity NCVSomatosensory/Dermatormal Evoked PotentialOfficial Medical Fee Schedule
References
Case No. ADJ1010087 (FRE 0250087)
Regular
Nov 22, 2008

TAMMY BALDRIDGE vs. VONS, a SAFEWAY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to rescind a prior award of spinal surgery for Tammy Baldridge. The Board found that the defendant timely denied the surgery through utilization review and that the applicant failed to meet her burden of proof. Specifically, the applicant did not demonstrate that the recommended surgery was medically reasonable and necessary, particularly in light of the ACOEM Guidelines and conflicting medical opinions.

Workers' Compensation Appeals BoardTammy BaldridgeVonsSafeway CompanyReconsiderationFindings and AwardSpinal SurgeryAnterior Cervical DiscectomyInterbody FusionInstrumentation
References
Case No. SAC 0330818
Regular
Sep 10, 2007

Corey Chatman vs. Sierra Pacific Industries

The WCAB granted reconsideration to amend the award to reimburse chiropractic treatment by Dr. Kinney only through October 18, 2003, based on ACOEM guidelines for neck and upper back injuries. The Board reduced a previously imposed penalty for untimely notice to 10% and denied the employer's untimely cost bill. Jurisdiction was reserved for further proceedings to determine the exact reimbursement amount for the limited period of treatment.

ACOEM guidelinesSB 899Labor Code section 4603.2(b)Rule 9792.5(d)(4)lien claimantPCSCcost billpenaltyattorney feessection 5813
References
Case No. MON 0230199
Regular
Dec 07, 2007

Paula Letherblaire vs. Leigh & Associates, Inc., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Paula Letherblaire's petition for reconsideration, affirming the administrative law judge's report. The Board found that the applicant's constitutional arguments against the application of utilization review and ACOEM guidelines to her existing medical award were outside the WCAB's jurisdiction. Furthermore, the Board determined that the carrier's delayed utilization review was not sanctionable, and the applicant was not entitled to compensation for her personal paralegal time.

WCABPetition for ReconsiderationFindings and AwardUtilization ReviewCumulative Trauma InjuryFuture Medical Care AwardLabor Code § 4610ACOEM GuidelinesSanctionsPenalty
References
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