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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ7532885
Regular
Aug 01, 2016

DAVID AREVALO vs. THE MILLARD GROUP, AIG/NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding prior findings. The Board found the initial decision lacked substantial evidence and failed to address crucial issues like the MPN's validity and the employer's loss of medical control. The case is returned to the trial level for further proceedings to determine these issues and whether the employer refused, delayed, or denied medical treatment. The initial finding of denied treatment was based on insufficient evidence to establish liability for self-procured treatment.

MPNMedical Provider NetworkRefusal of TreatmentDelay of TreatmentDenial of TreatmentLoss of Medical ControlPanel Qualified Medical ExaminerPQMELien ClaimantsPrimary Treating Physician
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ9957492 ADJ9957588 ADJ10160287
Regular
Jul 14, 2017

JULIO NUNEZ vs. BARRETT BUSINESS SERVICES, INC., ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a petition for reconsideration by Barrett Business Services, Inc. and Ace American Insurance Company. The defendants sought to overturn a finding that the applicant, Julio Nunez, was entitled to choose his own psychotherapy provider due to a delay in treatment authorization. The Board agreed with the WCJ that the defendant's failure to authorize treatment with a chosen MPN provider after receiving proper notification established the applicant's right to seek care outside the MPN. This entitlement arose from specific instances of delayed and denied authorization for psychotherapy.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and OrderPsychotherapy treatmentMedical Provider NetworkMPNProvider of choiceAuthorizationDelay of treatmentDenial of treatment
References
Case No. ADJ8035089, ADJ8033530, ADJ8033513
Regular
Jun 27, 2012

Linda Barajas vs. First Group America, Chartis

The Appeals Board overturned a WCJ's denial of reimbursement for a self-procured gym membership. The applicant's claim was in delay status when her physician prescribed the membership, and she notified the adjuster without objection before purchasing it. The Board found the gym membership reasonable and consistent with ACOEM guidelines for shoulder treatment, though limited to six months. Therefore, the applicant is awarded one-half the cost of her 12-month membership as reasonable self-procured medical treatment.

Workers' Compensation Appeals BoardReconsiderationSelf-procured medical treatmentGym membershipTreating physicianDelay statusACOEM guidelinesLabor Code 5402(c)Utilization reviewIndustrial injury
References
Case No. GRO 0032684
Regular
Aug 28, 2007

LUIS CONTRERAS vs. NORTH AMERICAN FIRE HOSE, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision finding an industrial injury and a penalty for unreasonable delay in medical treatment, but denied the applicant's request to go outside the Medical Provider Network (MPN). Although a four-month delay occurred, the Board found that the employer's good-faith efforts to secure treatment within the MPN meant there was no "neglect or refusal" to justify going outside the network. Therefore, the applicant remains within the MPN for treatment.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Unreasonable DelayLabor Code Section 5814Self-Procured TreatmentNeglect or RefusalKnight v. United Parcel ServiceAndrade v. State Comp. Ins. FundPhysician Choice
References
Case No. ADJ8290263
Regular
May 05, 2025

JONATHAN LAOZI LI vs. AMERICAN TIRE DEPOT ATV, ZURICH NORTH AMERICA

Defendant sought reconsideration of a finding that it unreasonably delayed medical treatment to the applicant. The Appeals Board denied the petition, concluding that the issues raised were interlocutory and did not warrant removal. The Board affirmed the WCJ's finding of unreasonable delay, citing the applicant's unrefuted testimony. The matter was returned to the trial level for further proceedings regarding the cost of medical treatment and applicable penalties.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderUnreasonable DelayMedical TreatmentFuture Medical TreatmentLabor Code Section 5814Labor Code Section 5814.5PenaltiesAttorney's Fees
References
Case No. SJO 0233656
Regular
Sep 25, 2007

CHRIS IRVIN vs. ABTECH SYSTEMS, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration as he was not aggrieved by the original award. The Board granted the defendant's petition, finding that they unreasonably delayed authorizing the applicant's pain management program. The original award was affirmed with amendments to reflect the unreasonable delay in treatment and to reserve jurisdiction for determining the penalty amount.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentLabor Code Section 5814PenaltyMedical Treatment1997 Schedule2005 Schedule
References
Case No. ADJ1226686 (WCK 60788)
Regular
Oct 29, 2008

CATHY BAKER vs. JAMES H. KHOE, D.D.S., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board corrected a clerical error in a prior decision, specifically changing a finding from "Defendant did unreasonably delay or refuse medical treatment" to "Defendant did *not* unreasonably delay or refuse medical treatment." This correction was made after the defendant alerted the Board to the mistake, and the Board exercised its authority to correct clerical errors at any time. Consequently, the defendant's petition for reconsideration was dismissed as moot.

WORKERS' COMPENSATION APPEALS BOARDCLERICAL ERRORPETITION FOR RECONSIDERATIONLABOR CODE § 5814MEDICAL TREATMENTDELAYREFUSALDECISION AFTER RECONSIDERATIONCORRECTINGDISMISSAL
References
Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
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