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

Case No. ADJ9625407
Regular
Sep 12, 2018

KEITH FIELD vs. CITY OF PINOLE

This case involves a firefighter who sustained bilateral carpal tunnel syndrome after retirement. The Appeals Board reversed the trial judge, holding that Labor Code section 4458.5 applies, entitling the applicant to permanent disability benefits calculated at the maximum indemnity rate. This applies regardless of the applicant's actual earnings or the fact that carpal tunnel syndrome is not a specifically enumerated presumptive injury. The case is remanded for determination of the precise date of injury to calculate the benefit rate.

Workers' Compensation Appeals BoardKeith FieldCity of PinolePermissibly Self-InsuredMunicipal Pooling AuthorityADJ9625407Opinion and Decision After Reconsiderationindustrial injuryfirefighterbilateral upper extremities
References
Case No. ADJ8829857 ADJ8829856
Regular
Apr 18, 2016

DULCE ESPINOZA vs. JENCO PRODUCTIONS, INC., FIRST NATIONAL INSURANCE COMPANY OF AMERICA

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because the appealed finding, deferring development of the record on psychiatric injury, was not a final order. The Board then treated the petition as one for removal, granted it, and rescinded the deferral. Ultimately, the Board found that the applicant failed to prove industrial injury to her psyche, citing a lack of objective evidence and inconsistencies in her reporting, as well as a conflicted medical opinion.

WORKERS' COMPENSATION APPEALS BOARDDULCE ESPINOZAJENCO PRODUCTIONSINC.FIRST NATIONAL INSURANCE COMPANY OF AMERICAADJ8829857ADJ8829856Petition for ReconsiderationPetition for RemovalDecision After Removal
References
Case No. ADJ16528931
Regular
Apr 25, 2025

Marisa Kelly vs. Sacramento County Child Protective Services, PSI, County of Sacramento

Defendant sought reconsideration of a Findings of Fact, Awards and Orders (F&O) issued on February 5, 2025, which found that the applicant, Marisa Kelly, sustained a work-related psychiatric injury. The defendant contended that the medical evidence supporting this finding, specifically from the Panel Qualified Medical Examiner (PQME), was not substantial. The Workers' Compensation Appeals Board, after reviewing the petition and the WCJ's report, determined that the PQME's reasoning clearly supported the causation of the applicant's temporary disability and need for medical treatment. The Board concluded that the PQME's use of 'exacerbation' instead of 'aggravation' was immaterial, and therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardSacramento County Child Protective ServicesMarisa KellyPetition for ReconsiderationFindings of Fact Awards and OrdersInjury Arising Out of and Occurring in the Course of EmploymentAOE/COEPsycheMedical EvidencePanel Qualified Medical Examiner
References
Case No. ADJ2046608 (VNO 0502368)
Regular
Mar 07, 2012

NOE PEREZ vs. HERRICK CORPORATION

The Workers' Compensation Appeals Board granted Herrick Corporation's Petition for Removal, rescinding a WCJ order. The Board is now intending to dismiss Herrick's Petition for Contribution against SCIF. This is because Herrick's contribution claim is barred by the one-year statute of limitations under Labor Code section 5500.5(e). The Order Approving Compromise and Release was dated August 31, 2006, and Herrick's petition was filed over two and a half years later.

Petition for RemovalContributionCarve-out JurisdictionLabor Code Sections 3201.53201.7State Compensation Insurance Fund (SCIF)Alexander BuggyCompromise and ReleaseArbitratorJoint and Several Award
References
Case No. ADJ2154380 (SAC 0363541)
Regular
Jul 21, 2010

Spencer Davis vs. Clark & Sullivan, Inc., LWP Claims Sacramento, Berkshire Hathaway San Francisco, Berkshire Hathaway Pasadena

The defendant sought to disqualify the Qualified Medical Evaluator (QME) due to their unavailability for deposition within the regulatory 120-day timeframe. The Workers' Compensation Appeals Board (WCAB) denied the petition for removal, affirming the lower order. The WCAB found that Administrative Director (AD) Rule 31.5, concerning replacement panels, does not apply to QME unavailability for deposition. Furthermore, the Board found no demonstrable prejudice or irreparable harm, noting the defendant's own rescheduling of the deposition.

Petition for RemovalQualified Medical EvaluatorQME UnavailabilityDeposition SchedulingAdministrative Director RulesAD Rule 35.5(f)AD Rule 31.5(a)(5)AD Rule 33PrejudiceIrreparable Harm
References
Case No. ADJ1384238 (SAC 0366460)
Regular
Oct 09, 2017

ROSA VIRGEN vs. MACY'S WEST, MACY'S CORPORATE SERVICES-RISK MANAGEMENT DEPARTMENT

The Workers' Compensation Appeals Board denied Macy's West's petition for removal, upholding the WCJ's decision not to grant a replacement Qualified Medical Evaluator (QME). The Board found that a late supplemental report alone does not mandate a replacement QME under LC 4062.5 or AD Rule 31.5(a)(12). Granting a replacement QME for untimely supplemental reporting is discretionary and requires a showing of good cause, which Macy's failed to demonstrate. The Appeals Board retains exclusive jurisdiction over the validity of replacement panels.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluationPQMEReplacement PanelMedical DirectorTimelinessSupplemental ReportGood CausePrejudice
References
Case No. ADJ10348591 ADJ10349019
Regular
Jan 07, 2019

MIGUEL VELAZQUEZ, SERVANDO VELAZQUEZ vs. ARTEMIO ARCE, SOLOMON MARTINEZ

The Workers' Compensation Appeals Board denied a defendant's petition for reconsideration, upholding a prior finding that liens for interpreting services were not barred by AD rule 9792.5.5. This rule, requiring a second review request for fee schedule disputes, did not apply because the interpreter services were not subject to an applicable fee schedule at the time of service. Therefore, the lien claimant's failure to request a second review did not preclude the WCAB from adjudicating the lien dispute. The Board reasoned that AD rule 9792.5.5 and associated statutes only mandate the second review process for disputes concerning amounts under an "applicable fee schedule."

Workers' Compensation Appeals BoardAD Rule 9792.5.5Official Medical Fee ScheduleIndependent Bill ReviewExplanation of ReviewLabor Code section 4603.2Senate Bill 863Threshold IssueFee Schedule DisputeInterpreter Services
References
Case No. ADJ7643460
Regular
May 01, 2017

Tracy Lee vs. XCHANGING, GRANITE STATES INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case concerns Defendant's Petition for Removal seeking a new Qualified Medical Evaluator (QME) panel due to a QME's untimely supplemental report. The Appeals Board denied the petition, finding Defendant failed to demonstrate substantial prejudice or irreparable harm. While the QME's report was late, Labor Code Section 4062.5 and Rule 31.5(a)(12) do not mandate replacement for untimely supplemental reports, making the decision discretionary. The WCJ's decision not to order a replacement was reasonable given the QME's extensive involvement and the lack of a mandatory replacement provision.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorQME panelsupplemental reportuntimelysubstantial prejudiceirreparable harmLabor Code section 4062.5Rule 31.5(a)(12)
References
Case No. ADJ1884066
Regular
Nov 19, 2008

RICHARD REED vs. BAYSIDE INSULATION AND CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of an Order Approving Compromise and Release where the settlement expressly excluded future Labor Code section 139.5 benefits. The defendant argued this exclusion was an error, as they intended to settle vocational rehabilitation benefits. The Board found the exclusion unnecessary and legally inconsequential as Labor Code section 139.5 did not apply to this applicant's injury date, and job displacement benefits are covered under a different section.

Compromise and ReleaseOrder Approving Compromise and ReleaseLabor Code section 139.5vocational rehabilitationsupplemental job displacement benefitsLabor Code section 4658.5future benefitsindustrial injuryupper extremitiesinsulator
References
Case No. ADJ6671169
Regular
Oct 16, 2013

Christian Fauria vs. Carolina Panthers, Great Divide Insurance Co., Berkley Specialty Underwriting Managers, LLC, Washington Redskins, ESIS Insurance, New England Patriots, Liberty Mutual Insurance Co., Travelers Indemnity Co., Golf Insurance Co., Seattle Seahawks

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award finding California jurisdiction over Christian Fauria's claim due to lack of "regular employment" in California, as defined by Labor Code Section 3600.5(a). The case was remanded to the trial level to determine if jurisdiction exists based on injuries sustained within California or if the contract of hire was made in California, as per Labor Code Section 5305. The WCAB also instructed the judge to address all issues, including apportionment and liability periods under Labor Code Section 5500.5. The decision highlights the need for substantial evidence to establish jurisdiction and injury contribution within the state.

Workers' Compensation Appeals BoardChristian FauriaProfessional AthleteIndustrial InjuryPermanent DisabilityFurther Medical TreatmentLabor Code Section 3600.5(a)Statute of LimitationsLabor Code Section 5500.5Jurisdiction
References
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