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

Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Case No. ADJ1144741
Regular
Nov 14, 2008

QUENTIN FORD vs. UNITED PARCEL SERVICE, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board affirmed the WCJ's decision that applicant Quentin Ford is not entitled to treat outside of the defendant's Medical Provider Network (MPN). The Board found Dr. Joel's report inadmissible due to its timing and lack of explanation for its late submission. Furthermore, even if admitted, the report did not establish applicant's need to continue treatment with Dr. Joel outside the MPN, as the recommended treatment had been completed and no subsequent treatment plan was outlined.

Workers' Compensation Appeals BoardReconsiderationTemporary Disability IndemnityMedical Provider Network (MPN)Labor Code section 4616.2(d)(3)(b)Knight v. United Parcel ServiceSerious and Chronic ConditionContinuity of CareRadiofrequency AblationAgreed Medical Evaluator (AME)
References
Case No. ADJ14466153
Regular
Oct 21, 2025

JESSE CRUZ vs. BRISTOL INDUSTRIES, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Applicant Jesse Cruz sought reconsideration of a WCJ's June 3, 2022 Findings and Order (F&O), which found he did not sustain an industrial injury to his back, hips, legs, and feet while employed by Bristol Industries on June 17, 2020. The Appeals Board previously granted reconsideration to further study the case and found the applicant's petition for reconsideration was timely filed. Citing insufficient medical evidence on the issue of injury and a lack of clear analysis in the WCJ's credibility determination, the Board rescinded the F&O and remanded the matter to the trial level for further proceedings, including obtaining expert medical opinion on the injury and a more detailed credibility analysis by the WCJ.

AOE/COEPetition for ReconsiderationAdjudication NumberFindings and OrderWCJReconsiderationFurther ProceedingsBack PainPeripheral NeuropathyLumbar MRI
References
Case No. ADJ3265357
Regular
Sep 09, 2009

MARTHA MENDEZ vs. YMCA OF SAN FRANCISCO, TRAVELERS WALNUT CREEK

The Workers' Compensation Appeals Board granted reconsideration and remanded the case to the trial level for recalculation of the permanent disability award. The Board found that the Agreed Medical Evaluator's (AME) opinion of November 8, 2007, which attributed 50% of the applicant's increased permanent disability to non-industrial degenerative changes supported by MRI studies, constituted substantial evidence. This opinion superseded the previous award, which did not adequately account for these degenerative conditions. Therefore, the Workers' Compensation Judge must now recalculate the permanent disability award based on this 50% non-industrial apportionment.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPetition to ReopenIndustrial InjuryPermanent DisabilityApportionmentAgreed Medical EvaluatorDegenerative ChangesMRI Studies
References
Case No. ADJ7207861
Regular
May 06, 2011

STEVE TORDINI vs. JAMES DIEDRICH, PREFERRED EMPLOYERS INS. CO.

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contention that the WCJ erred in relying on the treating physician's opinion over the PQME's regarding permanent disability and apportionment. The Board found the treating physician's opinion unsubstantiated, as it included unqualified legal conclusions and improperly utilized AMA Guides criteria for apportionment. Consequently, the WCAB rescinded the prior award and returned the case for a new decision, directing the WCJ to base findings on the PQME's report. A dissenting opinion argued that both medical opinions were flawed and recommended further medical development.

PQMEWCJWPIapportionmentLabor Code sections 46634664Almaraz IIAMA GuidesDRE Lumbar Category IVdisc protrusion
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ351902 (OAK 310455) ADJ2725303 (OAK 324531)
Regular
Sep 30, 2008

PHILMORE KING vs. RANEY GEO TECHNICAL, ST. PAUL FIRE & MARINE INSURANCE COMPANY

The WCAB affirmed the WCJ's decision to apply the 1997 disability rating schedule because a treating physician's report indicated permanent disability before January 1, 2005, despite not stating the condition was permanent and stationary.

Workers' Compensation Appeals BoardPhilmore KingRaney Geo TechnicalSt. Paul Fire & Marine Insurance CompanyOpinion and Decision After ReconsiderationFindings Award & OrderWorkers' Compensation Administrative Law JudgeWCJIndustrial InjurySpine Injury
References
Case No. ADJ8240882; ADJ8240881; ADJ8615401
Regular
Apr 21, 2025

ROBERT S. HAPPENY vs. STATE OF CALIFORNIA, CALIFORNIA INSTITUTE FOR WOMEN

Applicant Robert S. Happeny sustained industrial injuries during his employment as a correctional officer, leading to a finding of permanent and total disability by the WCJ due to his inability for vocational retraining. The WCJ also issued an unapportioned award, concluding that apportionment to nonindustrial factors was not proven. Defendant challenged this decision via a petition for reconsideration, disputing the method of combining disabilities and the reliability of vocational reports. The Appeals Board granted reconsideration, affirming the WCJ's determination of permanent and total disability based on vocational infeasibility and the lack of established apportionment, ultimately rescinding the original decision and substituting new findings of fact.

ADJ8240882ADJ8240881ADJ8615401correctional officerindustrial injuryheartpsycheright wristrespiratory systemlumbar spine
References
Case No. ADJ8062477
Regular
Apr 08, 2025

ANTONIO MARTINEZ vs. BARODA FARMS, ZENITH INSURANCE COMPANY

Antonio Martinez sustained an industrial injury to his cervical, thoracic, and lumbar spine while working for Baroda Farms, resulting in a 66% permanent partial disability award. Defendant Zenith Insurance Company petitioned for reconsideration of the initial Findings and Award (F&A) concerning apportionment and the application of Labor Code section 4658(d). The Workers' Compensation Appeals Board granted reconsideration, affirming the F&A but amending it to defer the issues of Labor Code section 4658(d) and attorney fees. The case has been returned to the trial level for further proceedings to ensure all parties receive due process.

WCABPetition for ReconsiderationFindings and AwardPermanent Partial DisabilityApportionmentLabor Code Section 4658(d)Substantial Medical EvidencePQMEMedical OpinionReasonable Medical Probability
References
Case No. ADJ10658129
Regular
Sep 24, 2018

GUILLERMO LOPEZ vs. CLARK PACIFIC, ZURICH NORTH AMERICA

The Appeals Board granted reconsideration and rescinded the original Findings and Award due to significant inconsistencies between the applicant's testimony and the medical reports of Dr. Nkadi and Dr. Swartz regarding the alleged work injury. The Board found the trial record lacked substantial evidence to support an injury AOE/COE. Therefore, the case was returned to the WCJ to develop the record further, potentially through supplemental medical reports or a new evaluation, and to issue a new decision. If an injury is found, the decision must specify the injured body part(s).

AOE/COEPetition for ReconsiderationFindings and AwardPrimary Treating PhysicianQualified Medical ExaminerSubstantial EvidenceLumbar RadiculopathyLumbar Facet ArthropathySpecific InjuryCumulative Injury
References
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