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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7685567
Regular
Feb 12, 2015

KATHLEEN O'NEAL vs. HALE ALOHA/MARK ONE CORPORATION, CALIFORNIA SELF-INSURERS' SECURITY FUND

This case involves a dispute over authorization for cervical surgery for applicant Kathleen O'Neal. The defendant argued that Dr. McCormack, who recommended the surgery, was a one-time consultant, not a treating physician, and thus his request for authorization was not subject to utilization review (UR). The Workers' Compensation Appeals Board (WCAB) affirmed the judge's order, finding Dr. McCormack acted as a treating physician by undertaking to obtain authorization and proceed with the surgery. Therefore, the defendant's failure to submit Dr. McCormack's request for authorization to UR in a timely manner meant the UR denial was invalid. The WCAB concluded the defendant was obligated to provide the surgery as it was supported by substantial medical evidence and reasonably necessary.

Utilization ReviewAuthorization RequestTreating PhysicianConsulting PhysicianPrimary Treating PhysicianSecondary Treating PhysicianWorkers' Compensation Appeals BoardAdministrative Director's RuleTimelinessJurisdiction
References
Case No. ADJ8505079
Regular
May 11, 2016

MATTHEW LOPEZ vs. CITY AND COUNTY OF SAN FRANCISCO

This case concerns Matthew Lopez's claim for workers' compensation benefits for a back injury. The City and County of San Francisco, the defendant, denied a Request for Authorization (RFA) for disc replacement surgery recommended by Dr. Jones, a consulting physician. The Appeals Board held that Dr. Jones, acting at the primary treating physician's behest and possessing specialized expertise, qualified as a secondary treating physician authorized to submit an RFA. Because the defendant failed to timely perform utilization review (UR) on Dr. Jones' RFA or communicate its decision, the Board affirmed the award of medical treatment, finding jurisdiction to determine its necessity.

Workers' Compensation Appeals BoardUtilization ReviewRequest for AuthorizationSecondary Treating PhysicianPrimary Treating PhysicianMedical NecessityLabor Code section 4610DWC Form RFAAdministrative Director RulesPeer Review
References
Case No. ADJ18027061
Regular
Sep 10, 2025

HEATHER TILLER KELLEY vs. SACRAMENTO CITY UNIFIED SCHOOL DISTRICT

Defendant Sacramento City Unified School District sought reconsideration of a WCAB decision that found applicant Heather Tiller Kelley sustained industrial injuries and that reports from her treating physicians (Mark Zuber, D.C., Adrienne Pasek, Psy.D., and Kasra Maasumi, M.D.) were admissible. Defendant argued these physicians lacked a proper treatment relationship and that the reports were improperly obtained. The Workers' Compensation Appeals Board denied the petition for reconsideration, affirming that defendant relinquished medical control by denying liability, allowing applicant to self-procure treatment, and thus the treating physician reports were admissible in proceedings.

WCABPetition for ReconsiderationOpinion and Order Granting PetitionAdmissible EvidenceTreating PhysiciansMedical-Legal ReportsLabor Code Section 4062.2Self-Procured TreatmentRemoval StandardPermanent and Stationary Status
References
Case No. ADJ6948621 ADJ7946738
Regular
Apr 22, 2013

STEFANO MUSETTI vs. GOLDEN GATE DISPOSAL & RECYCLING dba RECOLOGY, permissibly self-insured, administered by CORVEL CORP.

In this workers' compensation case, the employer sought reconsideration of an award ordering a total knee replacement. The applicant's treating physician recommended the surgery, but the employer argued the award was premature as a panel qualified medical evaluator's report was pending and the treating physician's report lacked proper authorization markings. The Appeals Board denied reconsideration, finding the employer had sufficient time to obtain the PQME report and that the treating physician's report constituted substantial medical evidence supporting the surgery. The Board also noted that the employer failed to initiate utilization review despite being aware of the treatment request.

Workers' Compensation Appeals Boardindustrial injuryright kneegarbage collectortotal knee replacementsupplemental reportpanel qualified medical evaluator (PQME)treating physiciansubstantial medical evidencePetition for Reconsideration
References
Case No. ADJ71 43769
Regular
May 11, 2016

CURTIS KLEIN vs. WARNER BROS. STUDIO

This case involves a dispute over reimbursement for medical treatment provided by Dr. Marina Russman and other lien claimants. The defendant, Warner Bros. Studio, argued that Dr. Russman's treatment requests should not have been authorized because they were not submitted by the applicant's primary treating physician and therefore did not trigger the utilization review (UR) process. The Appeals Board affirmed the original award, holding that requests for authorization from secondary treating physicians do trigger the UR process. The Board also found substantial evidence supported the reasonableness and necessity of Dr. Russman's treatment, rejecting the defendant's argument that the applicant's condition was due to a pre-existing injury. Finally, a clerical error in the original order regarding a lien claimant was corrected.

Workers' Compensation Appeals BoardCurtis KleinWarner Bros. StudioPermissibly Self-InsuredOpinion and Decision After ReconsiderationPetition for ReconsiderationFindings of Fact Orders and AwardAdministrative Law Judge (WCJ)Lien ClaimantsDr. Marina Russman
References
Case No. ADJ1581964 (MON 0344940) ADJ3113707 (MON 0344944) ADJ1018953 (MON 0344941)
Regular
May 10, 2018

JORGE ALVARADO vs. WARNER BROS. STUDIOS, AIG CLAIMS

The Workers' Compensation Appeals Board (WCAB) dismissed Warner Bros. Studios' Petition for Reconsideration and denied their Petition for Removal. The WCAB found that the challenged order, requiring authorization of secondary treating physicians, was procedural and not a final order subject to reconsideration. Furthermore, the WCAB found no basis for the defendant's claims of irreparable harm or prejudice, upholding the applicant's right to select his treating physicians under Labor Code Section 4600. The defendant's arguments regarding bypassing Utilization Review and duplicative treatment were also rejected.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalSecondary Treating PhysicianPrimary Treating PhysicianCumulative Trauma InjuryLabor Code Section 4600Utilization ReviewRequest for AuthorizationMedical Provider Network
References
Case No. SAC 342547
Regular
Jun 06, 2008

CLIFFORD J. FARIA vs. BEST BUY COMPANY, ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior order, returning the case to the trial level for further proceedings. This decision addresses disputes regarding the applicant's right to change treating physicians, the defendant's Medical Provider Network (MPN) obligations, and the calculation of the applicant's average weekly earnings. The Board requires further development of the record on these key issues.

Workers' Compensation Appeals BoardBest Buy CompanyAce American Insurance CompanyClifford FariaOpinion and Order Granting ReconsiderationDecision After ReconsiderationAdministrative Law Judge (WCJ)Treating PhysicianMedical Provider Network (MPN)Temporary Disability Indemnity
References
Case No. ADJ7160976
Regular
Sep 25, 2012

ANTONETTA WILLIAMS vs. CLAIRE'S STORES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded the prior award and returned the case for further proceedings because the administrative law judge improperly relied on a secondary treating physician's report. The judge failed to establish that the requested attendant care was authorized or constituted substantial medical evidence. The Board emphasized that the primary treating physician must issue opinions on medical issues and the record needs further development to determine entitlement to attendant care.

Attendant carePrimary treating physicianSecondary treating physicianMedical treatment authorizationUtilization reviewSubstantial medical evidenceWorkers' Compensation Appeals BoardFindings and AwardReconsiderationAgreed Medical Examiner
References
Case No. ADJ3908100 (FRE 0232929) ADJ716050 (FRE 0232930)
Regular
May 02, 2013

HORTENCIA MATA-KLINE vs. SAVEMART SUPERMARKETS, Permissibly Self-Insured

Here's a summary for a lawyer: The Workers' Compensation Appeals Board granted reconsideration regarding a disallowed lien claim by Schroeder Chiropractic North (SCN). The original decision disallowed SCN's lien, in part due to a statute of limitations issue on one injury, and because SCN failed to prove it was the authorized primary treating physician. The Board found the WCJ's reasoning unclear regarding SCN's status as an authorized physician and the applicant's treatment choices under Labor Code sections 4600 and 4601, especially concerning Medical Provider Networks. Therefore, the matter was returned to the trial level for redetermination with a clearer explanation of the facts and law.

Lien claimantReconsiderationPrimary treating physicianAuthorized treating physicianMedical provider networkLabor Code section 4600Labor Code section 4601Statute of limitationsCompromise and ReleaseIndustrial injuries
References
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