CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. LBO 0340807
En Banc
Jun 17, 2005

LISA SIMMONS vs. STATE OF CALIFORNIA, DEPT. OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND

The Appeals Board holds that a utilization review report is admissible for the limited purpose of showing a dispute over industrial causation has arisen, but not to determine causation itself; the defendant must then follow the AME/QME process to resolve the causation dispute.

Workers' Compensation Appeals BoardReconsiderationEn Banc DecisionUtilization ReviewMedical NecessityCausationLabor Code section 4610Labor Code section 4062Agreed Medical EvaluatorQualified Medical Evaluator
References
Case No. ADJ10788598
Regular
Jul 19, 2019

Shanai King vs. Food 4 Less

This case involves a claimant alleging a psychiatric injury due to workplace stress. The administrative law judge (WCJ) denied the claim, finding the applicant's testimony not credible and the medical evaluations insufficient. The Appeals Board granted reconsideration, rescinded the WCJ's findings, and returned the case for further proceedings. This decision stems from deficiencies in the medical evaluator's analysis of causation, conflating injury causation with permanent disability causation, and the need to develop the medical record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderPsyche InjuryQualified Medical EvaluatorIndustrial CausationPredominant CauseGood Faith Personnel ActionSubstantial EvidenceMedical Opinion
References
Case No. ADJ1411734 (MON 0361062) MF ADJ130407 (MON 0361061) ADJ4416246 (MON 0361065) ADJ1320492 (MON 0361064) ADJ3297635 (MON 0361063) ADJ7166968 ADJ8574761 ADJ9019769 ADJ9045920
Regular
Jul 28, 2017

MARTHA IBRAHIM vs. THE STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION, legally uninsured; STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to review the defendant's contention that the Agreed Medical Examiner (AME) did not properly address causation and apportionment of the applicant's permanent disability. The Board found that the AME reports lacked substantial evidence regarding causation and apportionment across the applicant's multiple claimed injuries. Consequently, the Board rescinded the previous award and returned the matter for further proceedings to develop the record in compliance with relevant Labor Code sections and case law. The goal is to ensure proper determination of disability causation and apportionment among the various industrial injuries.

Workers' Compensation Appeals BoardReconsiderationJoint Findings of Fact and AwardAgreed Medical ExaminerApportionmentCausationPermanent DisabilityLabor Code section 4663Benson v. The Permanente Medical GroupInextricably Intertwined
References
Case No. ADJ11026657
Regular
Feb 27, 2020

Monnie Wright vs. California Public Employees' Retirement System, State Compensation Insurance Fund

The Workers' Compensation Appeals Board (WCAB) affirmed the finding that collateral estoppel prevents them from determining industrial causation for applicant Monnie Wright's injury under Government Code section 21166. A prior jury found Wright's injury arose out of employment but not in the course of employment. The WCAB has jurisdiction to determine industrial causation for CalPERS disability claims, applying procedural rules and factual findings. However, collateral estoppel, being a hybrid substantive/procedural issue, means the prior jury's determination on "arising out of" but not "in the course of" employment precludes the WCAB from making a new finding of industrial causation (AOE/COE).

WORKERS' COMPENSATION APPEALS BOARDCALIFORNIA PUBLIC EMPLOYEES' RETIREMENT SYSTEMLegally UninsuredSTATE COMPENSATION INSURANCE FUNDClaims AdministratorOPINION AND DECISION AFTER RECONSIDERATIONGovernment Code section 21166collateral estoppelindustrial causationarising out of and in the course of employment
References
Case No. ADJ7143993
Regular
Jun 29, 2015

GILBERT ORTIZ vs. CITY OF FULLERTON; Permissibly SelfInsured, Administered By ADMINSURE

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior order, finding that res judicata and collateral estoppel did not apply to determine industrial causation for a Public Employees' Retirement System (PERS) disability retirement. The stipulated workers' compensation award was expressly limited and the Labor Code section 3212 presumption is inapplicable to PERS matters. Furthermore, the Board found the agreed medical examiner's opinions too speculative and lacking in substantial evidence to establish causation for the disability retirement claim. The case is remanded for further development of the record to determine industrial causation under the correct legal standard without the section 3212 presumption.

Workers' Compensation Appeals BoardGilbert OrtizCity of Fullertonheart injuryindustrial causationres judicatacollateral estoppelstipulated awardAgreed Medical Examiner (AME)Gerald Markovitz
References
Case No. ADJ1244874
Regular
Apr 19, 2010

ENRIQUE ROJAS vs. COSTCO

This case involves a meat cutter/wrapper's claim for an industrial injury to his respiratory system, diagnosed as hypersensitivity pneumonitis. The defendant contested the finding of industrial causation, arguing the medical evidence was insufficient. The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board affirmed the administrative law judge's decision, finding that the agreed medical examiner, Dr. Markovitz, established a reasonable medical probability of industrial causation, despite not identifying the precise causative agent. The Board relied on Dr. Markovitz's expert opinion, which utilized a process of elimination and epidemiological considerations to conclude the condition was likely work-related.

Hypersensitivity PneumonitisIndustrial CausationAgreed Medical EvaluatorPulmonologistMeat CutterMeat WrapperRespiratory System InjuryCumulative TraumaProcess of EliminationReasonable Medical Probability
References
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
Case No. LBO 0340807
Significant
Jun 17, 2005

Lisa Simmons vs. State of California, Department of Mental Health (Metropolitan State Hospital), State Compensation Insurance Fund (Adjusting Agent)

This case clarifies that a utilization review report cannot determine industrial causation. If a UR physician finds a treatment medically necessary but questions if it's work-related, the employer must either approve it or timely initiate the AME/QME process to resolve the causation dispute.

Utilization reviewACOEM guidelinesEn banc decisionCausation issueMedical necessityLabor Code section 4610AME/QME processTreating physicianAdmissibility of evidenceIndustrial injury
References
Case No. GRO 0029816, GRO 0029817
En Banc

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision, holding that under Labor Code section 4663 as amended by SB 899, apportionment of permanent disability is based on causation and may include pre-existing, non-industrial conditions like degenerative arthritis, provided there is substantial medical evidence to support the percentage of non-industrial causation.

SB 899ApportionmentCausationPermanent DisabilityPreexisting ConditionDegenerative ArthritisSubstantial Medical EvidenceMedical ProbabilityLabor Code Section 4663Compensable Consequence
References
Case No. ADJ11834433
Regular
Feb 05, 2020

DIETRICK TURNER vs. SUTTER AUBURN FAITH HOSPITAL

The Workers' Compensation Appeals Board granted the applicant's Petition for Reconsideration to amend a Finding of Fact and the order regarding record development. The Board affirmed the original Findings and Award but clarified that there is insufficient medical evidence to establish causation for the applicant's torn scapholunate ligament. The case is remanded for further development of the record specifically on the issue of causation for this injury.

Scapholunate ligamentWorkers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMedical evidenceCausationAggravationJob dutiesPre-existing conditionDevelopment of the record
References
Showing 1-10 of 538 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational