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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ9627339, ADJ9627342
Regular
Mar 26, 2018

Esteban Escobar vs. PRN AMBULANCE, INSURANCE COMPANY OF THE WEST

This case concerns whether the defendant's Medical Provider Network (MPN) met access standards for a chiropractor as a primary treating physician. The Appeals Board granted the applicant's petition for removal, overturning the WCJ's decision. The Board found the MPN must provide three chiropractors within 30 minutes or 15 miles of the applicant's residence or workplace. Since the MPN did not meet this closer standard, the applicant is authorized to select a chiropractor outside the MPN.

MPNchiropractorsprimary treating physicianaccess standardsreconsiderationremovalWCJAdministrative Director's Ruleexpedited hearingstipulate
References
Case No. ADJ7692623
Regular
Sep 07, 2012

ANTHONY FAGONE vs. CITY OF FRESNO

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board upheld the finding that the applicant sustained industrial injuries and that the defendant lost control of medical treatment due to failing to process the applicant's pre-designated physician form. The defendant's argument that the applicant could not pre-designate a chiropractor was rejected, as the employer's inaction estopped them from benefiting from their processing failure. Therefore, the applicant is entitled to treatment by his chosen chiropractor during the period of the employer's processing error.

Workers' Compensation Appeals BoardIndustrial InjuryNeck InjuryChest Wall InjuryMedical Provider Network (MPN)Pre-designation of Treating PhysicianChiropractorLabor CodeEstoppelFindings and Award
References
Case No. ADJ9884969
Regular
Aug 07, 2015

FERNANDO RUIZ-LUCERO vs. GCA SERVICES GROUP, INC.; ACE AMERICAN INSURANCE COMPANY, administered by ESIS FREMONT

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that the applicant could treat outside the defendant's Medical Provider Network (MPN). The MPN failed to meet access standards by not having three primary treating chiropractors within a 15-mile or 30-minute radius of the applicant's residence. This failure constitutes good cause for the applicant to seek treatment outside the MPN, as required by regulations ensuring timely access to appropriate medical care. The Board agreed with the WCJ's reasoning that the defendant's inadequate MPN access justified the applicant's out-of-network treatment.

MPNAccess StandardsPrimary Treating PhysicianMedical Provider NetworkChiropractorAdministrative Director RuleWCJReconsiderationLabor CodeSpecialty
References
Case No. ADJ7348056, ADJ8808882
Regular
Feb 17, 2015

DIANA AGUAYO vs. GROSSMONT UNION HIGH SCHOOL DISTRICT, CORVEL CORPORATION

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The defendant argued that the applicant's chiropractor's reports were inadmissible and not the sole basis for an award, and that cervical spine injury lacked substantial medical evidence. The Board found the chiropractor's reports were properly admitted, even if obtained after the statutory visit limit, as the applicant paid for them. Furthermore, evidence from other physicians supported the cervical spine injury finding, meeting the substantial evidence standard. Therefore, the Board upheld the original award.

Workers Compensation Appeals BoardPetition for ReconsiderationJoint Findings Award and OrderPermanent Partial DisabilityApportionmentTreating ChiropractorLabor Code Section 4600(c)Labor Code Section 4064.5(c)(1)Admissibility of EvidenceLabor Code Section 4605
References
Case No. ADJ9066751
Regular
Aug 10, 2015

CONSTANZA MEDINA VARGAS vs. BARRETT BUSINESS SERVICES, INC.

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Removal, treating it as a Petition for Reconsideration, and denied that petition. The Board affirmed the administrative law judge's finding that the defendant failed to comply with Medical Provider Network (MPN) access standards. Specifically, the defendant did not have the required number of available chiropractors within the specified distance at the relevant time. Therefore, the applicant is not required to seek treatment within the defendant's MPN and may seek treatment elsewhere at the defendant's expense.

Workers Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationMedical Provider NetworkMPN access standardsLabor Code section 4616Administrative Director Rule 9767.5primary treating physicianchiropractorsMinutes of Hearing
References
Case No. ADJ16120106
Regular
Sep 29, 2025

DARRELL TOLE vs. ZURICH AMERICAN INSURANCE COMPANY, COTTINGHAM AND BUTLER CLAIMS SERVICES, BIAGI BROTHERS INCORPORATED

Defendant filed a Petition for Reconsideration of the Findings, Award and Orders (FA&O) issued July 2, 2025, which found a closed period of temporary disability for applicant Darrell Tole, a truck driver who sustained injury to bilateral knees on February 18, 2022. The defendant argued that the finding of temporary disability required contemporaneous medical reporting. The Workers' Compensation Appeals Board (WCAB) denied the petition, agreeing with the WCJ's report that PQME chiropractor Michaels' medical opinion, supported by medical and testimonial evidence, constituted substantial evidence for the temporary disability period. The WCAB also noted the WCJ's credibility determination was given great weight.

WORKERS' COMPENSATION APPEALS BOARDDARRELL TOLEZURICH AMERICAN INSURANCE COMPANYBIAGI BROTHERS INCORPORATEDPetition for ReconsiderationFindings Award and Orderstemporary disabilitycontemporaneous medical reportingWCJ Report and RecommendationLabor Code section 5909
References
Case No. ADJ9115073
Regular
Jul 21, 2014

JOSE CANALES vs. MURRAY COMPANY, OLD REPUBLIC GENERAL INSURANCE

This case involves Jose Canales, an applicant for workers' compensation, who claimed cumulative trauma injury to his neck, arms, and back from his work as a warehouseman/tool maintenance. The defendant, Murray Company, contested the claim, arguing insufficient medical evidence of industrial causation and a post-termination filing defense under Labor Code section 3600(a)(10). The Appeals Board affirmed the WCJ's decision, finding that Canales sustained an industrial injury and that his claim was not barred. The Board concluded that Canales first suffered disability on May 10, 2013, after his termination, when he was diagnosed with temporary total disability by his chiropractor. Therefore, the post-termination affirmative defense was inapplicable, and the petition for reconsideration was denied.

Cumulative trauma injuryLabor Code section 3600(a)(10)Post-termination defenseIndustrial causationSubstantial medical evidenceTreating chiropractorIndustrial nature of injuryDate of injuryCompensable consequenceTemporary disability
References
Case No. SFO 0498433
Regular
May 15, 2008

ROGELIO VELASQUEZ vs. HEALTH CERAMICS, LTD., ACCA, INC.

This case concerns the dismissal of a chiropractor's lien for $\$ 12,428.35$ after the lien claimant failed to appear at a mandatory settlement conference. The WCJ dismissed the lien, but the claimant objected, arguing they were unaware of the conference due to an incorrect address on file. Although the WCJ's subsequent attempt to vacate the dismissal was procedurally flawed, the Appeals Board granted reconsideration on its own motion due to the claimant's substantial argument. The Board rescinded the dismissal order and returned the matter to the WCJ for a lien conference to ensure proper resolution.

Workers' Compensation Appeals BoardRogelio VelasquezHealth CeramicsLtd.ACCAInc.SFO 0498433ReconsiderationAppeals Board's MotionWCJ
References
Case No. ADJ8415524
Regular
Jun 26, 2015

SYLVIA FERRAR BALCOMBE vs. WEST END YMCA, UNITED STATE FIRE INSURANCE COMPANY

This case concerns an applicant's petition for reconsideration following a Workers' Compensation Appeals Board decision. The Board denied the petition, adopting the judge's report which found the applicant's attorney failed to follow proper procedure in requesting medical panels. The judge also determined that medical reports from specific doctors were inadmissible due to this procedural error and lack of persuasive medical evidence. Consequently, the Board denied reconsideration and admonished the applicant's attorney regarding future fee requests.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ ReportCal. Code Regs tit. 8 § 10778Attorney's FeesInjuriesGERDIBSSpineQME
References
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