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

Case No. ADJ4028210 (SJO 0251585)
Regular
Apr 06, 2009

What Happened in Felix vs. Weber Metals Reconsideration?

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 The Board rescinded the decision and returned the case for further development of the medical record to determine if the treatment complied with the ACOEM Guidelines.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
3
Case No. ADJ1798944 (LBO 0326931)
Regular
Jun 13, 2018

How Did the WCAB Rule in Hardgrove vs. Intercon Security?

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 The Appeals Board rescinded the WCJ's decision, finding the claimant's petition timely due to defective service.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
3
Case No. STK 0209780 STK 0209781
Regular
Feb 08, 2008

What Did the WCAB Decide in Cuadra vs. Community Home Care?

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
9
Case No. ADJ15329380
Regular
Oct 31, 2025

How Were Death Benefits Handled in Bocanegra vs. Sun-Gro Commodities?

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
10
Case No. MISSING
Regular Panel Decision

Can a WCJ Be Disqualified for Appearance of Bias?

This Order addresses challenges by six defendants to the constitutionality of the Sentencing Reform Act of 1984 and the Sentencing Guidelines. District Judge Nowlin found that the Act violates the separation of powers doctrine and Article I, Section 7 of the U.S. Constitution, particularly concerning the composition and authority of the Sentencing Commission and the lack of presidential presentment for the Guidelines. The Court further ruled that the Sentencing Guidelines infringe upon defendants' due process rights by unduly restricting judicial discretion in sentencing and limiting the consideration of individual circumstances. While concluding the unconstitutional provisions could be severed, the Court directed that, pending appellate review, sentences for offenses committed after November 1, 1987, should be determined as if committed before that date, accounting for the absence of parole.

Sentencing Reform ActSentencing GuidelinesConstitutional LawSeparation of PowersArticle IDue ProcessJudicial DiscretionFederal Criminal JusticeJudicial IndependencePresentment Clause
References
42
Case No. MISSING
Regular Panel Decision

What Were the Key Rulings in Torrez vs. SuperShuttle?

This is a dissenting opinion challenging the majority's conclusion that an association of New York Certified Registered Nurse Anesthetists (CRNAs) lacks standing to sue the Commissioner of Health. The CRNAs challenged new 'Guidelines' which stipulate that CRNAs should provide services in office-based surgery only under supervision by a physician, dentist, or podiatrist 'qualified by law, regulation or hospital appointment to perform and supervise the administration of the anesthesia.' The dissent argues that the Guidelines, though presented as recommendations, are effectively regulations that will severely injure CRNAs' employment opportunities by requiring the presence of an anesthesiologist, making CRNAs redundant due to cost-prohibitive duplication of services. The dissenting judge criticizes the majority for deeming the CRNAs' evidence of economic harm as 'speculation' despite extensive factual showings from affidavits, asserting that precedent supports standing in such cases.

CRNA supervisionStandingGuidelines as regulationsEconomic injuryNurse anesthetistsAnesthesiologist supervisionOffice-based surgeryHealthcare regulationsJudicial dissentPhysician qualification
References
4
Case No. ADJ6524043, ADJ5825490
Regular
Mar 17, 2014

Why Was Removal Denied in Rush vs. California Correctional Institution?

This case concerns Dr. Svastits' lien claim for medical treatment provided to the applicant. The Workers' Compensation Appeals Board (WCAB) denied Dr. Svastits' petition for reconsideration, upholding the WCJ's decision. The WCJ awarded payment only for the new patient consultation and evaluations between July 10, 2008, and September 17, 2011, finding other treatments inconsistent with ACOEM Guidelines. Dr. Svastits' argument that lack of utilization review excused his burden of proof was rejected, as lien claimants must independently prove treatment reasonableness and necessity, consistent with guidelines.

RuvalcabaSvastitsZurichGallagher BassettWCABPetition for ReconsiderationJoint Findings and AwardUtilization ReviewACOEM GuidelinesLabor Code 3202.5
References
3
Case No. ADJ9694948
Regular
Feb 01, 2016

What Did the WCAB Clarify in Ontiveros vs. Savers Stores?

The Workers' Compensation Appeals Board denied San Diego Unified School District's petition for reconsideration of an award finding applicant entitled to right shoulder surgery. The defendant argued that the medical opinions supporting the surgery were not substantial evidence because they didn't cite MTUS/ACOEM guidelines or explain non-compliance. The Board affirmed the original finding, agreeing with the WCJ that citing the MTUS is not strictly required if the medical evidence is otherwise compelling and consistent with the guidelines. While one commissioner concurred, he disagreed with the majority's assertion that MTUS citation is not necessary for compliance with Labor Code section 4604.5.

Workers' Compensation Appeals BoardSan Diego Unified School DistrictYork Risk Services GroupPetition for ReconsiderationFindings Award and OrderIndustrial InjuryFurther Medical TreatmentRight Shoulder SurgeryMedical Treatment Utilization ScheduleACOEM guidelines
References
0
Case No. ADJ3172768 (SRO 0138288)
Regular
Nov 30, 2009

Why Was Reconsideration Denied in Gomez vs. Dorothy Stevens?

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
0
Case No. LAO 0833666, VNO 0481174
Regular
Jan 07, 2008

Why Was Reconsideration Dismissed in Sabino vs. Johnson Pump Company?

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
5
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