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

Case No. ADJ6989761
Regular
Sep 30, 2013

ELVIN SALGUERO vs. CHARLES GEMEINER CABINETS, INSURANCE COMPANY OF THE WEST

This case involves an applicant seeking reconsideration of a denial for 24/7 home care. The applicant argues the denial was an abuse of discretion, as medical evidence supported the need for such care due to suicidal ideation and depression. The Workers' Compensation Appeals Board denied the petition, adopting the judge's report which found no support for 24/7 home care in relevant treatment guidelines. The judge concluded that the applicant failed to prove the requested care was reasonable and necessary beyond the requirements of existing guidelines.

WCABPetition for ReconsiderationHand Surgery EvaluationStellate Block ProceduresHome CarePsychiatric TechnicianLicensed Vocational NurseSuicidal IdeationPsychiatric HospitalizationLabor Code Section 4600(b)
References
Case No. ADJ4503926
Regular
Mar 18, 2013

IVAN GALAVIZ vs. HB PARCO CONSTRUCTION, INC., OLD REPUBLIC GENERAL INSURANCE

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant argued that due process was violated, evidence was not adequately discussed, and findings of fact did not support the decision. The Board adopted the WCJ's report, which found the applicant failed to submit timely briefs and objections to rating instructions. The WCJ also determined that the evidence did not support the application of Almarez/Guzman, and the strict application of AMA Guidelines was appropriate.

WORKERS' COMPENSATION APPEALS BOARDPETITION FOR RECONSIDERATIONDENIEDWCJ REPORTDUE PROCESSEVIDENCEFINDINGS OF FACTOPINION AND DECISIONAMEDEPOSITION
References
Case No. SBR 0325667
Regular
Apr 29, 2008

JAMES PERRINE vs. THE TIRE GUYS, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant who sustained an industrial injury to his right elbow and upper extremity, resulting in work restrictions despite a 0% whole person impairment rating under AMA guidelines. The Workers' Compensation Appeals Board affirmed the WCJ's decision that the applicant is a Qualified Injured Worker (QIW) entitled to vocational rehabilitation services. The Board found that the applicant's work restrictions constitute an impairment of earning capacity and a competitive handicap, thus qualifying him for benefits under former Labor Code section 4635(a).

Workers Compensation Appeals BoardFindings and AwardCompromise and Releasevocational rehabilitationqualified injured worker (QIW)VRMApermanent disabilityAMA GuidelinesLabor Code 139.5Labor Code 4635
References
Case No. ADJ4141215 (MON 0288595) ADJ4160601 (MON 0288596) ADJ2249717 (MON 0300098)
Regular
Dec 27, 2011

DOREEN LABOY vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, Legally Uninsured; STATE COMPENSATION INSURANCE FUND / STATE CONTRACT SERVICES, Adjusting Agency

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Reconsideration, finding their argument regarding AMA Guidelines irrelevant due to a prior stipulation to the 1997 Rating Schedule. The WCAB granted removal to issue notices of intention to impose sanctions and award attorney's fees/costs against the defendant and their counsel. This action is based on the defendant's frivolous and bad-faith tactics in raising an issue for the first time on reconsideration that was not previously litigated or argued. The defendant's petition is deemed without merit and solely intended to cause unnecessary delay.

LABOYDOREENSTATE OF CALIFORNIADEPARTMENT OF MENTAL HEALTHSTATE COMPENSATION INSURANCE FUNDJOINT FINDINGS AND AWARDPETITION FOR RECONSIDERATIONREMOVALNOTICES OF INTENTIONORDER TO PAY EXPENSES
References
Case No. ADJ1804234
Regular
May 26, 2009

Patrick MacAULEY vs. COUNTY OF VENTURA, CORVEL OXNARD

The Workers' Compensation Appeals Board granted reconsideration and rescinded a previous award finding the applicant sustained 66% permanent disability. The defendant employer argued the original award relied on an incorrect permanent and stationary date provided by the Agreed Medical Examiner (AME), who later admitted his initial report was in error. The Board agreed that the medical record needed further development due to the AME's admitted error and the resulting inaccurate permanent and stationary date. The case is returned to the trial level for further proceedings, including the defendant's opportunity to challenge the impairment rating under AMA Guidelines and diminished future earning capacity.

Workers' Compensation Appeals BoardPatrick MacAuleyCounty of VenturaCorvel Oxnardcumulative trauma injuryheart and circulatory systemdeputy sheriffpermanent disabilityAgreed Medical Examiner (AME)Dr. Ira Monosson
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. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
Case No. ADJ2068970 (STK 0167616)
Regular
Jul 21, 2016

Norman McAtee vs. Briggs & Pearson Construction, State Compensation Insurance Fund

The applicant seeks reconsideration of a WCJ's decision that dismissed his appeal of an Independent Medical Review (IMR) determination regarding pain medication. The IMR found the medication medically unnecessary, but the applicant argues this was based on a plainly erroneous finding of fact regarding the applicable treatment guidelines. The Appeals Board granted reconsideration, finding the IMR determination was indeed based on a plainly erroneous interpretation of the medical treatment guidelines. Consequently, the Board rescinded the WCJ's decision and remanded the case for a new IMR by a different reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewPlainly Erroneous Finding of FactLabor Code Section 4610.6Medical Treatment GuidelineOpioid TherapyPermanent DisabilityVocational RehabilitationAdministrative Law JudgeReconsideration
References
Case No. ADJ1530005 (AHM 0136961)
Regular
Jun 29, 2012

IRENE NAVARRO vs. ROWLAND UNIFIED SCHOOL DISTRICT; YORK

The Workers' Compensation Appeals Board (WCAB) denied a lien claimant's petition for reconsideration. The WCAB adopted the administrative law judge's report and found the petition unintelligible, failing to meet requirements for specific evidence references. Specifically, the lien claimant made unsupported allegations regarding physician referrals and guideline compliance. Therefore, the petition was denied.

WORKERS' COMPENSATION APPEALS BOARDIRENE NAVARROROWLAND UNIFIED SCHOOL DISTRICTYORKADJ1530005ORDER DENYING RECONSIDERATIONPetition for Reconsiderationworkers' compensation administrative law judgeWCJWCAB Rule 10842
References
Case No. ADJ9197803
Regular

CHRISTOPHER TORRES vs. CONTRA COSTA SCHOOLS INSURANCE GROUP, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Christopher Torres's petition for reconsideration of an Independent Medical Review (IMR) determination. The Board found that the applicant failed to prove, by clear and convincing evidence, any of the limited grounds for appeal specified in Labor Code section 4610.6(h). Specifically, the Board agreed with the WCJ that whether the IMR reviewer correctly applied medical guidelines involves expert opinion, not a matter of ordinary knowledge. Therefore, the Board upheld the IMR decision.

WCABPetition for ReconsiderationLabor Code Section 4610.6Administrative DirectorMedical ReviewIndependent Medical Reviewer (IMR)MTUS guidelinesACOEM guidelinesClear and convincing evidencePlainly erroneous finding of fact
References
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