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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7148195
Regular
Jan 03, 2020

KARIN SMITH vs. MARIN GENERAL HOSPITAL, ATHENS ADMINISTRATORS

This case concerns defendant's petition for reconsideration of an award for applicant's back surgery. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirmed the award, and corrected a clerical error in the case number. The WCAB found that while an initial surgery request was denied via Utilization Review (UR) and Independent Medical Review (IMR), the applicant's treating physician later submitted a new request supported by documented changes in material facts, including new neurological symptoms and an MRI showing critical stenosis and potential cauda equina syndrome. Because the second request indicated an imminent and serious threat to the applicant's health and was based on new medical evidence, the 12-month UR decision validity period did not apply.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardUtilization ReviewIndependent Medical ReviewLabor Code Section 4610(k)Documented Change in ConditionLumbar Spine SurgeryNurseCauda Equina Syndrome
References
Case No. ADJ9585461
Regular
Feb 02, 2017

TONY DE LA GARZA vs. ROLL GLOBAL/DEL REY JUICE PLANT dba POM WONDERFUL, Permissibly Self-Insured, Administered by BROADSPIRE

The WCAB dismissed the defendant's Petition for Removal, treating it as a Petition for Reconsideration, and denied it. The Board affirmed the WCJ's order requiring the defendant to authorize surgical treatment. The defendant's initial challenge was based on a prior IMR denial, but the Board found a material change in facts occurred when the treating physician clarified the surgery's non-cosmetic, functional purpose. The Board concluded the subsequent UR certification was valid and the defendant must authorize the treatment.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderUtilization ReviewIndependent Medical ReviewMedical TreatmentSurgical ProcedureScar DeformityPainful Scar
References
Case No. ADJ10034122
Regular
Dec 22, 2017

CRYSTAL WYANT vs. AMERICAN MEDICAL RESPONSE, ACE AMERICAN INSURANCE COMPANY

This case concerns an applicant's industrial back injury requiring lumbar spinal fusion. Defendants sought to overturn a prior award granting ongoing medical treatment, arguing a subsequent Utilization Review (UR) certification was invalid. The Appeals Board denied reconsideration, finding the UR process was correctly followed. A second Request for Authorization (RFA) submitted by the applicant's physician included "Change in Material Facts," triggering a new review. This second UR decision, dated September 11, 2017, authorized the surgery as medically necessary, superseding the earlier denial.

Utilization ReviewIndependent Medical ReviewReconsiderationFindings and AwardAdministrative Law JudgeLabor Code Section 4610Request for AuthorizationLumbar Spinal FusionMedical TreatmentChange in Material Facts
References
Case No. ADJ15516233
Regular
Aug 04, 2025

JULIE GARTZ vs. UNITED CONTINENTAL HOLDINGS, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Applicant Julie Gartz sought reconsideration of a WCJ's May 5, 2025 Findings of Fact, which found her primary treating physician's report lacked substantial evidence for a functional restoration program and deemed Utilization Review unnecessary for a second Request for Authorization. The applicant argued the defendant delayed treatment and that the WCJ erred on UR requirements and WCAB jurisdiction. The Workers' Compensation Appeals Board granted the Petition for Reconsideration, deferring a final decision for further review of the merits and the complete record, while highlighting its continuing jurisdiction and relevant legal principles.

Petition for ReconsiderationFunctional Restoration ProgramUtilization ReviewRequest for AuthorizationMedical NecessityChange of Material FactsTimelinessWCAB JurisdictionDubon IILabor Code Section 4610
References
Case No. ADJ8750816
Regular
Jul 31, 2014

KAMIKA BEASLEY vs. SECURITAS, SEDGWICK

The Workers' Compensation Appeals Board granted the applicant's petition for removal, reversing the prior denial of a change of venue. The applicant demonstrated good cause by residing in Vallejo, her injury occurring in Sacramento, and no longer having an attorney in the original Anaheim venue. Therefore, the case venue was changed to the Oakland district office, and the trial was continued.

Petition for RemovalChange of VenueWorkers' Compensation Appeals BoardPresiding Workers' Compensation Administrative Law JudgePetition to Change VenuePetition for Change of VenueGood CauseMandatory Settlement ConferenceApplication for Adjudication of ClaimIndustrial Injury
References
Case No. ADJ10929229
Regular
Feb 26, 2018

Oscar Lopez vs. EMPLOYBRIDGE, LLC formerly known as SELECT STAFFING, XL INSURANCE AMERICA, INC.

The Workers' Compensation Appeals Board dismissed Oscar Lopez's Petition for Reconsideration of an approved Compromise and Release agreement. The Board will treat the petition as a request to set aside the agreement and will return it to the trial level. The judge will then schedule a hearing for Mr. Lopez to present evidence supporting his claim of error. A decision will be made based on the evidence presented at that hearing.

Petition for ReconsiderationOrder Approving Compromise and ReleaseWorkers' Compensation Appeals BoardWCJIn pro perDismissing PetitionUntimelinessMeritsPetition to set asideContinuing jurisdiction
References
Case No. ADJ247666 (AHM 0049425) ADJ2739663 (AHM 0049426)
Regular
Jul 11, 2017

STEVE CHEGWIN vs. SBC/PACIFIC BELL TELEPHONE; Permissibly Self-Insured, Administered By SEDGWICK CLAIMS SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Reconsideration. Although the WCJ initially recommended dismissal as untimely, the WCAB found the petition timely because the amended award, correcting a date for permanent disability indemnity, constituted a material change extending the reconsideration period. Despite finding the petition timely, the WCAB adopted the WCJ's reasoning for denying reconsideration on the merits. The WCAB found that the amendment regarding the start date of permanent disability indemnity was a substantial change, and the issue was sufficiently interwoven with the overall award to extend the reconsideration deadline.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeJoint Findings and AwardAmended Joint Findings and AwardPermanent Disability IndemnityClerical ErrorMaterial ChangeJudicial FunctionInterwoven Award
References
Case No. ADJ11509125, ADJ11509591, ADJ13194436
Regular
Dec 15, 2020

ALEX MEJIA vs. LINEAGE LOGISTICS, CORVEL

The Appeals Board granted Lineage Logistics' petition for removal, rescinding an order that changed venue for claim ADJ13194436 to Long Beach. The Board found the record procedurally confused, noting conflicting actions by different district offices and an order that incorrectly stated parties jointly agreed to the venue change despite an objection. The matter is returned to the trial level to address consolidation and proper venue for all three applicant claims.

Petition for RemovalChange of VenueConsolidation of ClaimsProcedural ConfusionAdjudication NumbersDistrict OfficeWorkers' Compensation Appeals BoardCumulative TraumaPetition to ConsolidateNotice of Intention to Change Venue
References
Case No. ADJ10149777
Regular
Dec 31, 2015

TIMOTHY PRATT vs. SOUTHERN MARIN FIRE PROTECTION DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied the applicant's petition for removal, upholding a prior order changing the venue from Oakland to Redding. The change was granted because the applicant resides in Grass Valley, and the Redding District Office is the closest Appeals Board office to that location. The applicant failed to demonstrate factual prejudice stemming from the venue change. Therefore, the original venue change order is affirmed.

Petition for RemovalVenue ChangeLabor Code Section 5501.5Workers' Compensation Appeals BoardAdministrative Law JudgeOakland District OfficeRedding District OfficeApplicant ResidenceAttorney Principal Place of BusinessCumulative Trauma
References
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