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

Case No. ADJ9876617
Regular
Nov 09, 2016

JANET MAUS-SCHAD vs. LAW OFFICES OF JAVIER A. ALABART, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to review a prior decision finding applicant sustained injury AOE/COE and rejecting defendants' statute of limitations and other defenses. The Board rescinded the prior decision and returned the matter to the WCJ for further development of the record. Specifically, the Board found that while the defendants' argument that a prior settlement barred the current claim was legally unsupported, the medical evidence on causation was insufficient and inconsistent, requiring further development. The Board also noted that the issue of injury AOE/COE was not explicitly submitted for decision at trial, despite the WCJ's finding.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Order OpinionInjury AOE/COEStatute of LimitationsCumulative Trauma InjuryCompromise and ReleaseLabor Code Section 5005Res JudicataSubstantial Evidence
References
4
Case No. ADJ16007451
Regular
Aug 25, 2025

MINA RADJABI vs. CENTURY COMMUNITIES, INC./INSPIRE HOME LOAN; BERKSHIRE HATHAWAY HOMESTATE INSURANCE COMPANY dba BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The applicant, Mina Radjabi, alleged a cumulative trauma injury to multiple body parts from July 2019 to February 2022 while employed by Century Communities, Inc./Inspire Home Loan. The case initially settled by Compromise and Release in March 2023, with the defendant maintaining a denial of injury AOE/COE. A lien claimant, Woodland Psyche Center, represented by PureMD Group Lomita, filed a petition for reconsideration after its lien for treatment was denied by a Workers' Compensation Administrative Law Judge (WCJ). The WCJ denied the lien because Woodland Psyche Center failed to prove injury arising out of and in the course of employment (AOE/COE) and its medical reports did not comply with regulatory requirements for proving a contested claim. The Appeals Board, after reviewing the petition and the WCJ's report, adopted the WCJ's findings and denied the petition for reconsideration, concluding that the lien claimant did not establish causation or due process violations, and that the treatment provided was outside the employer's Medical Provider Network.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5909TimelinessTransmission Date60-Day RuleNotice of TransmissionElectronic Adjudication Management System (EAMS)Report and RecommendationLien Claimant
References
10
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
7
Case No. ADJ398757 (LBO 0393631)
Regular
Dec 24, 2010

GARY E. MORGAN vs. REYNOLDS BUICK, GMC & PONTIAC, ICW GROUP

The applicant sought removal, arguing that proceeding to trial on injury arising out of and occurring in the course of employment (AOE/COE) without a Qualified Medical Evaluator (QME) opinion would be prejudicial. The defendants asserted factual defenses and their due process rights. The Appeals Board granted removal, finding that the applicant carries the burden of proof for AOE/COE. Therefore, the Board amended the trial order to exclude AOE/COE, allowing only the issue of travel expenses for a QME evaluation to be tried.

Petition for RemovalAOE/COEQualified Medical EvaluatorPQMECompensabilityTravel ExpensesLabor Code Section 4060Burden of ProofIndustrial InjuryMedical-Legal Evaluation
References
0
Case No. ADJ6751788
Regular
Aug 16, 2010

MOISES ROBLES GARCIA vs. ABLE BUILDING MAINTENANCE, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration of a finding of industrial injury for applicant Moises Robles Garcia. Defendant Able Building Maintenance argued the applicant failed to prove injury arising out of and occurring in the course of employment (AOE/COE) and raised affirmative defenses of intoxication and material deviation. The Board rescinded the original decision and returned the case to the trial level for further proceedings, specifically to determine AOE/COE and consider the applicant's credibility and deposition transcripts. The WCJ must now make a determination on AOE/COE and potentially other defenses.

AOE/COEintoxication defensematerial deviationexcluded evidencedeposition transcriptswitness demeanorcredibilitypreponderance of the evidencecausal connectionrational incident of work
References
6
Case No. ADJ6875445
Regular
Aug 02, 2010

JOSE RIVAS vs. NNC MANAGEMENT, LLC/ADP TOTAL SOURCE, SPECIALTY RISK SERVICES

Defendant NNC Management, LLC/ADP Total Source sought removal of a WCJ's order to proceed to trial on both AOE/COE and temporary disability. The applicant claimed an injury in January 2009, and the employer denied it based on a post-termination defense. The defendant argues they were denied due process by being forced to litigate temporary disability without prior notice, as the initial proceedings focused solely on AOE/COE. The Appeals Board granted the petition for removal, amending the order to limit the August 4, 2010 trial to the AOE/COE issue only.

Petition for RemovalPost-termination defenseAOE/COETemporary DisabilityDue ProcessDeclaration of Readiness to ProceedPriority ConferenceMandatory Settlement ConferenceDiscoverySubstitution of Attorneys
References
0
Case No. ADJ10810340
Regular
Jan 04, 2018

DUSTIN RAMIREZ vs. VIASYSTEMS/TTM TECHNOLOGIES, TRAVELERS PROPERTY AND CASUALTY

This case concerns a Petition for Reconsideration by the defendant, Viasystems/TTM Technologies, challenging a Workers' Compensation Judge's (WCJ) findings. The WCJ's decision addressed statute of limitations, lack of prejudice, and date of injury, but not the ultimate issue of whether the applicant's injury arose out of and in the course of employment (AOE/COE). The Appeals Board denied the petition because it was filed from an interlocutory order, not a final decision on AOE/COE. While the Board agreed that the WCJ's findings on the statute of limitations, notice, and date of injury were appealable, it ultimately denied reconsideration based on the WCJ's report, which found that the record required further development on the crucial AOE/COE issue.

WCABPetition for ReconsiderationDenying PetitionWCJ ReportFinal OrderSubstantive RightsThreshold IssueStatute of LimitationsLabor Code Section 5405Date of Injury
References
8
Case No. ADJ12294911
Regular
Apr 14, 2025

KHADIJAH BROWN vs. REGINALD AJAKWE, MD, RAYMOND TATEVOSSIAN, MD, MID-CENTURY INSURANCE COMPANY

Applicant Khadijah Brown sought reconsideration of a WCJ's decision that she did not sustain a psychiatric injury arising out of and occurring in the course of employment (AOE/COE) and that a good faith personnel action defense was established. The Appeals Board granted reconsideration, finding that the WCJ erroneously concluded applicant did not sustain injury to her psyche AOE/COE and failed to recognize objective evidence of harassment. The Board rescinded the original findings and substituted new findings, determining that applicant did sustain injury to her psyche AOE/COE and that this injury resulted from actual events of employment. The issue of the defendant's good faith personnel action defense was deferred for further proceedings.

AOE/COEpsychiatric injuryLabor Code Section 3208.3(b)(1)actual events of employmentharassmentgood faith personnel actionVerga v. Workers' Comp. Appeals Bd.racial epithetsuspensiontermination
References
8
Case No. ADJ11145478
Regular
Mar 11, 2020

Belen Ramirez vs. SATE OF CLALIFORNIA, DEPARTMENT OF CORRECTIONS/HEMAN STARK YOUTH CORRECTIONAL FACILITY

The Appeals Board granted reconsideration of the WCJ's decision that the applicant failed to prove injury arising out of and in the course of employment (AOE/COE). The Board found that the Qualified Medical Examiner's (QME) reports and deposition testimony lacked substantial evidence due to inconsistencies regarding causation of the applicant's sarcoidosis and exposure to asbestos. Consequently, the Board rescinded the WCJ's order and returned the case for further development of the record. This further development should include clarifying the QME's opinions on causation and potentially obtaining a new medical evaluation if necessary.

SarcoidosisQualified Medical Examiner (QME)AOE/COESubstantial evidenceMedical opinionRecord developmentAsbestos exposurePulmonary medicineOccupational exposureEtiology
References
0
Case No. ADJ10959526
Regular
Sep 02, 2025

BILLY JOHN JONES, JR. vs. DRC INTERIORS, SUITSUPPLY, CHUBB, BUILDING CORPORATION (STEP CONSTRUCTION SERVICES), VALLEY FORGE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a Findings and Order from August 30, 2021, which had found that applicant Billy John Jones, Jr. did not sustain an injury arising out of and in the course of employment (AOE/COE) to his foot and toes and ordered a take nothing. The Appeals Board determined that the WCJ's finding was not supported by medical evidence concerning causation for the alleged injury, especially for a diabetic individual, and noted the absence of evaluation by a medical-legal evaluator or treating physician on this issue. Consequently, the Board rescinded the original Findings and Order and returned the case to the trial level, instructing the parties to further develop the medical record by obtaining a medical opinion from a Panel Qualified Medical Evaluator addressing causation.

AOE/COEReconsiderationFindings and OrderPetition for ReconsiderationWCJSubstantial EvidenceMedical EvidenceCausationPanel Qualified Medical EvaluatorDevelop the Record
References
17
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