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

Case No. ADJ9743291
Regular
Nov 06, 2018

CDWARD DE LA ROSA vs. ALL AREA PLUMBING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) dismissed applicant Edward De La Rosa's removal petition, finding the WCAB lacks jurisdiction over his claim. De La Rosa failed to timely dispute his claim denial through the mandatory Alternative Dispute Resolution (ADR) process, as required by his union's agreement. Specifically, he did not request a Qualified Medical Evaluator within the prescribed 30-day period after receiving notice of denial. This failure to follow the ADR procedures, including timely dispute resolution steps, bars the WCAB from adjudicating the merits of his injury claim.

RemovalLabor Code section 5301Petition for RemovalDue ProcessJurisdictionADR ProgramCertified RecordApplication for AdjudicationPetition to DismissQualified Medical Evaluator
References
Case No. ADJ14547470
Regular
Apr 17, 2025

RICHARD LYNN vs. CONTRA COSTA ELECTRIC, AMERICAN CASUALTY COMPANY OF READING, PA

The Workers' Compensation Appeals Board granted reconsideration to applicant Richard Lynn, who challenged a Workers' Compensation Arbitrator's (WCA) denial of his right to a Qualified Medical Evaluator (QME) examination. The WCA had found that Lynn forfeited this right by not attending a scheduled QME exam, citing an Alternate Dispute Resolution (ADR) agreement. The Board determined that the ADR section did not mandate forfeiture and that the WCA, like a WCJ, possessed discretion to appoint a medical examiner to ensure due process and fully adjudicate issues, especially given the lack of medical-legal reporting on industrial causation. Consequently, the Board rescinded the WCA's Findings and Order and returned the matter for further proceedings consistent with its decision.

ADR ProgramQMELabor Code Section 3600(a)(10)NECA/IBEWsubstantial justicedue processmedical-legal evaluationrescindedreturnedarbitraton
References
Case No. SFO 0499272
Regular
Jul 07, 2008

Helen Miller vs. Green Gulch Farm and Zen Center, EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board affirmed the administrative law judge's finding that Helen Miller was an employee of Green Gulch Farm and Zen Center and sustained an industrial injury to her left ankle. The Board found Miller was not a volunteer due to the extensive benefits received and the employer's control, and her jogging injury during a lunch break was a reasonable expectancy of employment, not barred by Labor Code section 3600(a)(9). Therefore, her injury arose out of and occurred in the course of her employment.

Workers' Compensation Appeals BoardHelen MillerGreen Gulch Farm and Zen CenterEverest National InsuranceGallagher BassettSFO 0499272Opinion and Decision After ReconsiderationLabor Code Section 3351Labor Code Section 3352(i)Employee definition
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. ADJ11364300
Regular
May 24, 2019

JOHN MANNING vs. ORANGE COUNTY FIRE AUTHORITY

This case involves a dispute over an applicant's entitlement to an Independent Medical Examiner (IME) under an Alternative Dispute Resolution (ADR) agreement governing workers' compensation claims. The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration, finding the original order was not a final decision. However, the WCAB granted the petition for removal, rescinded the administrative law judge's finding that no IME was warranted, and returned the case for further proceedings. The WCAB determined it was unclear whether it had jurisdiction to rule on the medical-legal discovery dispute, as parties cannot confer jurisdiction by stipulation, and ordered the trial judge to determine if the ADR program or the WCAB has jurisdiction.

ADR agreementCalifornia Labor Code §3201.7Independent Medical Examiner (IME)removalreconsiderationWorkers' Compensation Appeals Board (WCAB)specific injurycumulative traumafire captainskin cancer
References
Case No. ADJ1403472
Regular
Dec 29, 2008

ALEKSANDER YAMNITSKIY vs. MORROW-MEADOWS CORP., ST. PAUL TRAVELERS

The Workers' Compensation Appeals Board denied the defendant's petition for removal, which sought dismissal of the applicant's claim based on a collective bargaining agreement's alternative dispute resolution (ADR) provisions. The Board found insufficient evidence regarding the operative eligibility letter for the ADR plan at the time of the applicant's injury. The case is returned to the trial level to determine if the defendant can provide the necessary documentation to establish the ADR plan's applicability and warrant dismissal.

ADRLabor Code Section 3201.5collective bargaining agreementpetition for removalworkers' compensationapplication for adjudicationeligibility letterAdministrative DirectorWCJdismissal
References
Case No. ADJ7188251 ADJ7188272
Regular
Jan 29, 2010

Raymond Mark vs. City of Los Angeles

The Workers' Compensation Appeals Board granted reconsideration of an Arbitrator's award of temporary partial disability for a sleep disorder. The defendant argued that the case fell under an ADR "carve-out" provision and that the chosen Qualified Medical Evaluator found the sleep disorder non-industrial. The Board rescinded the Arbitrator's decision because the record lacked a proper Minutes of Hearing and Summary of Evidence, which is crucial for meaningful review of ADR cases. The matter was returned to the Arbitrator for further proceedings and a new decision.

ADRCarve-out caseQualified Medical EvaluatorAgreed Medical EvaluatorSleep disorderTemporary partial disabilityArbitrator's DecisionReconsiderationMinutes of Hearing and Summary of EvidenceDue process
References
Case No. ADJ10813026
Regular
May 27, 2025

Noureddine Manser vs. Return-to-Work Supplement Program

Applicant Noureddine Manser sought reconsideration of a November 9, 2023 finding that he was not entitled to a second Return-to-Work Supplement Program (RTWSP) benefit under Rule 17302(b), which prohibits a second benefit unless for a subsequent injury. Applicant contended the word "injury" should include a continuing injury. The Appeals Board affirmed the November 9, 2023 Findings of Fact, declining to interpret "injury" as a continuing injury and noting that the validity of Rule 17302(b) is subject to judicial review in the Superior Court, not the Appeals Board. The Board also asserted its jurisdiction to review the WCJ's denial despite arguments to the contrary.

Return-to-Work Supplement ProgramRTWSPRule 17302(b)vocational rehabilitationsubsequent injurySJDBVQMEtemporary total disabilityWCABLabor Code section 139.48
References
Case No. ADJ6634260
Regular
Aug 02, 2010

MELCHOR ELIZARRARAS vs. MIKE BUBALO CONSTRUCTION COMPANY, SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior finding that the parties were not subject to an Alternative Dispute Resolution (ADR) process. The Board found the original decision was based on unclear issues and the record may support a valid ADR process applicable to the applicant's injury. The case is returned to the trial level for further proceedings and a new decision on whether the applicant's injury is covered by a valid ADR system under Labor Code §3201.5.

Labor Code §3201.5Alternative Dispute ResolutionADR systemcollective bargaining agreementSouthern California District Council of LaborersMike Bubalo Construction CompanySeabright Insurance Companyindustrial injurylow back injuryright shoulder injury
References
Case No. ADJ8098049
Regular
Oct 01, 2013

SEZETTE DUBAY, as conservator for CARI PILLO on behalf of JOHN PILLO (deceased) vs. CONTRA COSTA ELECTRIC, INC., insured by AMERICAN CASUALTY COMPANY OF REDDING, PENNSYLVANIA, Adjusted by SEDGWICK CMS, et al.

This case concerns whether a deceased employee's death benefit claim falls under an Alternative Dispute Resolution (ADR) carve-out agreement. The defendant argued that arbitration agreements bind non-signatories and should apply to death benefits, likening them to derivative wrongful death claims. However, the Appeals Board affirmed the WCJ's decision, finding Labor Code section 3201.5 clearly limits ADR to disputes "between employees and employers." The Board reasoned that a dependent's claim for death benefits is an independent statutory right, not a dispute between an employee and employer, thus outside the scope of the ADR carve-out.

ADR carve-outnon-signatorywrongful death claimdependentsemployee definitionLabor Code 3201.5collective bargaining agreementinter vivos benefitsarbitrationWCJ
References
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