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

Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. VNO 348369 VNO 348370 VNO 348371 VNO 348372
Regular
Feb 13, 2008

RUBEN C. GONZALEZ vs. L.A.C.M.T.A.

The Workers' Compensation Appeals Board (WCAB) denied LACMTA's Petition for Removal, adopting the Workers' Compensation Administrative Law Judge's (WCJ) report. The WCJ recommended denial because LACMTA failed to demonstrate significant prejudice or irreparable harm, and the medical record needed further development regarding the applicant's new diabetes diagnosis and its potential industrial relation. Therefore, the petition was formally denied by the WCAB.

WORKERS' COMPENSATION APPEALS BOARDLACMTAMedical Record DevelopmentDiabetes DiagnosisIndustrially Related ConditionReasonable Medical ProbabilityPetition for RemovalWCAB Rule 10843Significant PrejudiceIrreparable HarmWorkers' Compensation Administrative Law Judge
References
Case No. ADJ8501790
Regular
Jul 29, 2015

Kelly Chase vs. St. Louis Blues Hockey Club, Federal Insurance Company

The Workers' Compensation Appeals Board (WCAB) reversed a prior finding of industrial injury for a professional hockey player against the St. Louis Blues. The WCAB found insufficient connection to California for jurisdiction, citing the player's limited games in the state compared to his overall career. This decision followed the precedent set in *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*, which requires a legitimate and substantial connection to the state for jurisdiction. The WCAB concluded that 21 games out of 485 did not meet this standard for a cumulative injury claim.

WCABSt. Louis Blues Hockey ClubFederal Insurance CompanyADJ8501790Opinion and Decision After Reconsiderationcumulative industrial injuryprofessional hockey playersubject matter jurisdictionstatute of limitationssubstantial medical evidence
References
Case No. ADJ9712319
Regular
Jun 20, 2025

ELEANOR DIAZ NEVAREZ vs. ELK GROVE UNIFIED SCHOOL DISTRICT, SCHOOLS INSURANCE AUTHORITY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by defendant Elk Grove Unified School District. The Board affirmed the WCJ's decision that the utilization review (UR) was untimely and procedurally defective, specifically regarding a Request for Authorization (RFA) for an H-Wave device. The defendant had argued the RFA was incomplete, but the Board found it procedurally complete, thus triggering UR obligations. The Board concluded that the defendant's failure to issue a timely conditional denial, as required by regulations, rendered the UR invalid and untimely. Additionally, the Board confirmed its decision was issued in compliance with the 60-day timeframe stipulated by Labor Code section 5909.

WCABPetition for ReconsiderationLabor Code section 5909TransmissionElectronic Adjudication Management SystemEAMSReport and RecommendationUtilization ReviewURRequest for Authorization
References
Case No. ADJ7503292
Regular
Mar 26, 2013

RIGOBERTO MENDOZA vs. PIZZA MIZZA, GUARD INSURANCE GROUP

The Workers' Compensation Appeals Board denied Rigoberto Mendoza's petition for reconsideration, upholding the Workers' Compensation Administrative Law Judge's (WCJ) finding that Mendoza did not sustain the alleged industrial injury. The WCJ's decision was based on an evaluation of witness credibility and inconsistencies in Mendoza's account of the injury. Specifically, the WCJ found the employer's testimony more credible regarding the timing and nature of the reported injury. The Board gave great weight to the WCJ's credibility determination, leading to the denial of reconsideration.

WCABPetition for ReconsiderationDenialCredibilityGarza v. Workers' Comp. Appeals Bd.ApplicantEmployerIndustrial InjuryBack InjuryLeg Injury
References
Case No. ADJ11320525
Regular
Jul 01, 2019

LOURDES OCAMPO vs. SWEETWATER UNION HIGH SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration of the initial decision, finding the orthopedic QME's opinions did not constitute substantial evidence. Applicant contended the QME's opinions were inconsistent with medical literature regarding the acceleration of pre-existing conditions. The Board agreed that the QME seemed to conflate causing arthritis with aggravating a pre-existing condition. Therefore, the Board rescinded the original findings and returned the case for further development of the record, specifically regarding the extent of applicant's walking and a clearer medical opinion on causation.

AOE/COEQualified Medical Examiner (QME)Petition for ReconsiderationFindings and Order (F&O)substantial evidenceorthopedichip arthritisdegenerative joint diseaseindustrial causationacceleration of condition
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ11425394
Regular
Sep 27, 2019

BOBBY BURTON vs. JINYA HOLDINGS, INC.; AMTRUST

This case involves a petition for reconsideration of a denied workers' compensation claim for a psychiatric injury. The Workers' Compensation Appeals Board denied reconsideration, adopting the administrative law judge's report. The decision hinges on Labor Code section 3208.3(d), which requires at least six months of employment for psychiatric injury claims unless caused by a "sudden and extraordinary" employment condition. The applicant failed to meet the burden of proving their injury resulted from such an event, as defined by case law to mean something uncommon, unusual, and unexpected.

Labor Code 3208.3(d)psychiatric injurysix months employmentsudden and extraordinary employment conditionuncommonunusualunexpectedWCJ reportpetition for reconsiderationdenial
References
Case No. GOL 0096107
Regular
Mar 05, 2008

MIGUEL ANGEL CRUZ vs. EARL CLARK, FARMERS INSURANCE EXCHANGE, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns Miguel Angel Cruz's petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Workers' Compensation Appeals Board affirmed the denial, finding no evidence that Mr. Cruz's pre-existing degenerative spinal condition was "labor disabling" prior to his industrial injury. Crucially, the Board held that a retroactive prophylactic work restriction by a physician after the injury does not establish a pre-existing labor-disabling condition for SIBTF eligibility.

Subsequent Injuries Benefits Trust Fundpre-existing conditionlabor disablingpermanent disabilityapportioned disabilityindustrial injuryprimary treating physiciandegenerative changeslumbar spineprophylactic work restriction
References
Case No. ADJ7525978
Regular
Jun 07, 2013

CLADYS ROBERTSON vs. MORENO VALLEY UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured

This case involves Gladys Robertson's workers' compensation claim against Moreno Valley Unified School District. The Workers' Compensation Appeals Board dismissed Robertson's petition for reconsideration because it was filed late. Even if timely, the petition would have been denied on the merits. The Administrative Law Judge found Robertson's testimony not credible, citing inconsistencies with contemporaneous medical records that indicated pre-existing bilateral foot pain and a denial of trauma. Therefore, the judge recommended denial of the petition.

Petition for ReconsiderationDismissalTimelinessSkeletal PetitionWCJ ReportAOE-COECredibilityAME ReportKaiser RecordsTrauma Denial
References
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