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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ1994450 (VNO 0491612)
Regular
Jan 14, 2009

NOEL VEGA vs. EMPLOYER FREEDOM SERVICES, STATE COMPENSATION INSURANCE FUND

"The Appeals Board grants the petition for reconsideration, rescinds the Order Disallowing Liens, and returns the matter to the trial level for further proceedings and a new decision."

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOrder Disallowing LiensLien ClaimantsBahar Gharib-Danesh ChiropracticPain Relief Health Centermedical evidenceinadequate recordpoorly organized filelist of exhibits
References
Case No. ADJ2513573
Regular
Jun 02, 2010

SUSAN PORTER vs. SHERROD CHIROPRACTIC, INC., dba PLACER CHIROPRACTIC

The Workers' Compensation Appeals Board denied Susan Porter's petition for reconsideration of the arbitrator's decision. The Board adopted and incorporated the arbitrator's report as the basis for its denial. The specific reasons for the denial are contained within the arbitrator's report, which was not provided in this excerpt. Therefore, the original decision stands.

Workers' Compensation Appeals BoardReconsideration DeniedArbitrator's ReportApplicantDefendantSherrod ChiropracticPlacer ChiropracticADJ2513573SAC 0369934Petition for Reconsideration
References
Case No. ADJ8492547
Regular
Oct 18, 2019

HECTOR ACEVEDO vs. SUN HO CORPORATION dba TREIU CHAU RESTAURANT, FARMERS TRUCK INSURANCE EXCHANGE

The Workers' Compensation Appeals Board rescinded the prior findings that National Script Pharmacy's lien was stayed under Labor Code section 4615. This case, along with others involving National Script Pharmacy, has been consolidated into a master file to address common factual and legal issues regarding the applicability of section 4615. The matter is returned to the trial level for further proceedings consistent with the consolidation order, allowing all parties to be heard. This decision ensures consistent rulings and judicial economy given the complex ownership and criminal proceeding issues surrounding the lien claimant.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantLabor Code Section 4615ConsolidationMaster FileNational Script PharmacyBahar Danesh GharibCriminal ProceedingsJudicial Economy
References
Case No. ADJ3084855 (SDO 0317515)
Regular
Aug 18, 2015

Ella Sanchez vs. Sharp Healthcare, California Insurance Guarantee Association by its servicing facility Broadspire Services, Inc. for American Manufacturers Mutual Insurance Company, In Liquidation

This case concerns a workers' compensation lien claim for chiropractic treatment. The Appeals Board granted reconsideration and found the lien claimant failed to meet its burden of proving the treatment was reasonable and necessary. Specifically, the claimant's reports lacked documentation of the industrial injury and were inconsistent with the Agreed Medical Evaluator's findings. Consequently, the Board rescinded the prior award and ordered the lien claimant to take nothing for the balance of its claim.

Workers Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAResendez Chiropractic CenterLien ClaimantOfficial Medical Fee ScheduleOMFSMedical Provider NetworkMPNPetition for Reconsideration
References
Case No. ADJ10912079
Regular
Aug 21, 2018

BENEDICT LOZADA vs. UNITED TECHNOLOGIES CORPORATION, AIG

This case involves a dispute over the appropriate specialty for a Qualified Medical Evaluator (QME). The applicant requested a chiropractic QME, while the defendant argued it was inappropriate for a hand injury and sought a replacement panel. The WCJ initially found chiropractic to be appropriate, but the Appeals Board granted removal. The Board rescinded the WCJ's order and returned the matter to the trial level, emphasizing that the Medical Director must first rule on the specialty dispute, and any appeal of that decision can then proceed.

Petition for RemovalQualified Medical EvaluatorQME panel specialtychiropractichand injuryMedical Directoradministrative remediesreplacement panelsubstantial evidenceFindings Award and Order
References
Case No. ADJ8182717, ADJ8253375, ADJ8253377
Regular
May 18, 2018

VICTOR MCGILL vs. COUNTY OF FRESNO

This case involves a workers' compensation applicant seeking reconsideration of a judge's decision invalidating a chiropractic QME panel. The Appeals Board dismissed the petition for reconsideration as the judge's order was not a final determination. However, the Board granted removal, finding that an orthopedic QME panel was necessary for the applicant's foot and Achilles tendon injuries, as chiropractic was not the appropriate specialty. The decision rescinds the judge's order and returns the matter for further proceedings to obtain an additional orthopedic QME evaluation.

WCABRemovalReconsiderationQMEMedical DirectorChiropracticOrthopedic SurgeryPanelFindings of Fact and OrderMedical Unit
References
Case No. ADJ12575364
Regular
Nov 25, 2020

MIGUEL SOLIS vs. KONICA MINOLTA BUSINESS SOLUTIONS, SOMPO AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a WCJ's decision that overturned the Medical Unit's denial of a specialty change for a Qualified Medical Evaluator (QME) panel. The WCAB found that while they have jurisdiction to review Medical Unit decisions, the applicant did not meet the standard for vacating the chiropractic QME panel. The WCAB held that a chiropractor can evaluate disputed medical issues, even with referrals to other specialists, as long as they stay within their scope of practice and report any issues outside their expertise. Therefore, the WCAB rescinded the WCJ's order and directed the parties to utilize the original chiropractic QME panel.

QME panelMedical Unitspecialty disputeorthopedic surgerychiropracticAdjudication NumberPetition for ReconsiderationFindings and OrderLabor Codesubstantial evidence
References
Case No. ADJ11595561 ADJ11602485
Regular
Jun 27, 2019

CINTIA LEMUS vs. MOTEL 6/G6 HOSPITALITY, LIBERTY MUTUAL

In this case, the applicant sustained work-related injuries to her mid and low back. The defendant disputed the applicant's request for a chiropractic Qualified Medical Evaluator (QME) panel, arguing an orthopedic-spine specialist was more appropriate. The Medical Director initially agreed, citing the use of prescription medication outside a chiropractor's scope. However, the Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, finding that the Medical Director's rationale was insufficient. The Board affirmed the Workers' Compensation Judge's decision to overrule the Medical Director and allow a chiropractic QME, citing precedent that QMEs cannot provide treatment or opine on disputed treatment issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrderAdministrative Law Judge (WCJ)Qualified Medical Evaluator (QME)Medical DirectorQME Panel SpecialtyChiropracticOrthopedic-Spine
References
Case No. ADJ11426145
Regular
Aug 16, 2019

MARIA RESENDIZ vs. TAMBRO, INC., INSURANCE CO. OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, reversing a WCJ's finding and ruling that a chiropractic QME panel, not an orthopedic one, is appropriate for this claim. The Board found the Medical Director's basis for invalidating the chiropractic panel was insufficient, as QMEs cannot provide treatment or opine on disputed treatment issues. The case now requires the parties to utilize the chiropractic QME panel for evaluation. This decision aligns with persuasive reasoning from a prior panel decision regarding specialty disputes.

QME panelchiropractic specialtyorthopedic surgeryspecialty disputeMedical Directorutilization reviewpermanent and stationary statusscope of practicescope of evaluationAD Rule 31.1(b)
References
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