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

Case No. ADJ1371205 (VNO 0557310)
Regular
Mar 10, 2011

VICTOR LOPEZ vs. GREYSTONE MANAGEMENT, ZENITH INSURANCE COMPANY

This case concerns a lien claimant, Unicare Diagnostic Center, seeking payment for sleep studies related to an applicant's claimed industrial injuries. The applicant settled their primary claim via Compromise and Release, but Unicare's lien remained unresolved. The trial judge ruled against the lien claimant, finding the insomnia claim non-industrial and the sleep studies medically unnecessary. The Appeals Board affirmed this decision after reconsideration, adopting the trial judge's reasoning.

Compromise and ReleaseLien ClaimantUnicare Diagnostic CenterIndustrial InjuryChestEarNoseHandsWristsHeadaches
References
Case No. ADJ8212510
Regular
Feb 19, 2013

SANTOS ARIN RODRIGUEZ vs. JK FARMS PARTNERSHIP, INSURANCE COMPANY OF THE WEST\EXPLORER

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, rescinded the prior Findings and Award, and returned the case for further development of the record. The Board found that the second opinion physician's report was incomplete due to the defendant's refusal to authorize recommended diagnostic tests. This refusal prevented the physician from rendering a definitive opinion on the necessity of spinal surgery. The Board admonished the defendant for this delay and gamesmanship, emphasizing the need for authorized further testing.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal SurgeryUtilization ReviewSecond OpinionNerve Conduction StudyEMG StudiesLumbar FusionDynamic Radiographic StudiesDeclaration of Readiness to Proceed
References
Case No. ADJ10087317
Regular
Apr 11, 2016

Clark Fowler vs. Lompoc Unified School District

This case involves a worker's compensation appeal by Lompoc Unified School District challenging a 5% permanent disability award for applicant Clark Fowler. The employer argued the award was unsubstantiated due to the applicant's failure to undergo diagnostic testing. The Workers' Compensation Appeals Board denied reconsideration, upholding the award. The Board found the employer failed to prove applicant refused any evaluation and that even if one component of the disability rating was excluded, the applicant would still qualify for the same award based on another unimpaired physical function.

Workers' Compensation Appeals Boardpermanent disabilitysubstantial medical evidencediagnostic testingPetition for ReconsiderationFindings and Awardadministrative law judgeaccepted industrial injuryprimary treating physiciancarpal tunnel syndrome
References
Case No. ADJ1934243 (FRE 0221043)
Regular
Apr 25, 2011

MARIA RAYOS vs. WALGREENS, ZURICH INSURANCE COMPANY

This case concerns a dispute over a second Qualified Medical Examiner (QME) for an applicant with a work-related knee, back, and hip injury. The defendant sought removal, arguing that allowing a second QME without striking the first QME's reports violated due process and would taint the new evaluation. The Appeals Board granted removal, amended the prior order, and clarified that a new QME is allowed. However, the admissibility of the first QME's reports is deferred to the trial judge, and those reports, unlike diagnostic study results, are not to be provided to the new evaluator.

Petition for RemovalQualified Medical Evaluator (QME)Admissibility of ReportsDue ProcessWorkers' Compensation Appeals Board (WCAB)Administrative Law Judge (WCJ)Industrial InjuryMedical EvaluationsDiscoveryMandatory Settlement Conference (MSC)
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. LAO 774696
Regular
Apr 01, 2008

RICARDO TRUJILLO vs. HILTON TORRANCE / SOUTH BAY, CRAWFORD & COMPANY

The Appeals Board granted reconsideration and reversed the WCJ's decision, allowing the lien claimant's claim for diagnostic services. The Board found that the medical record, admitted into evidence by a prior compromise and release order, demonstrated the services were reasonable and necessary to prove a contested claim and for medical treatment. Jurisdiction was reserved on penalties and interest.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationSupplemental FindingsCompromise and ReleaseContested ClaimReasonable and Necessary ServicesMedical TreatmentDiagnostic StudiesBurden of Proof
References
Case No. ADJ9313543; ADJ3093632
Regular
Sep 24, 2025

JAIME ORTIZ vs. CITY AUTO BODY, STATE COMPENSATION INSURANCE FUND

This case involves lien claimants seeking reconsideration of a Workers' Compensation Appeals Board decision regarding industrial injuries sustained by the applicant. The Board affirmed the disallowance of Dr. Mirza's lien for diagnostic services due to a lack of demonstrated medical necessity under the MTUS. The lien for chiropractic visits was affirmed, applying statutory visit limitations and postsurgical allowances. However, the issue of interpreter Mario Corzo's lien was deferred and returned to the trial level for further proceedings to determine his certification status under relevant guidelines.

ReconsiderationLien ClaimantsFindings of Fact and OrderChiropractic VisitsOfficial Medical Fee ScheduleMedically NecessaryCertified InterpreterLabor Code Section 4604.5Medical Treatment Utilization ScheduleDiagnostic Testing
References
Case No. ADJ7587936
Regular
Oct 16, 2012

KAREN GODDARD vs. MARIE CALLENDER'S, ESIS, INC. C/O ACE INSURANCE COMPANY

The Appeals Board dismissed the applicant's petition for reconsideration. They granted removal on their own motion, rescinded the WCJ's order striking the PQME's report, and returned the matter for further development of the record. This action was taken because the record was unclear as to who performed diagnostic testing, potentially violating Labor Code section 4628. The Board directed parties to first obtain a supplemental report from the PQME to clarify this issue.

WCABPQMEAMEIMELabor Code 4628Nerve Conduction StudyMedical Record DevelopmentPetition for ReconsiderationRemovalFindings Order Opinion
References
Case No. ADJ8118127
Regular
Apr 24, 2015

JUANA PONCE DE MAULEON vs. HARRIS WOOLF CALIFORNIA ALMONDS, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior finding. The WCAB determined that EMG/NCS diagnostic testing requested by the applicant's primary treating physician constitutes medical treatment. Therefore, this testing is subject to Utilization Review (UR) and subsequent Independent Medical Review (IMR), rather than being classified as a medical-legal expense adjudicated by the WCAB. The employer's petition for reconsideration was granted on this basis.

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewElectromyographyNerve Conduction StudyPrimary Treating PhysicianMedical TreatmentMedical-Legal ExpensesFindings & OrderPetition for Reconsideration
References
Case No. ADJ6550105; ADJ6777358 ADJ6777361; ADJ6976802
Regular
Jun 24, 2014

ESTHER GARCIA vs. ANTELOPE VALLEY UNION HIGH SCHOOL DISTRICT, YORK INSURANCE SERVICES GROUP

This case involves an applicant with multiple workers' compensation claims. At a mandatory settlement conference, the judge ordered a sleep study, which the defendant challenged. The Appeals Board granted the defendant's petition for removal, finding the order for the sleep study premature. The Board rescinded the sleep study order, stating that such an order cannot be made before the case is tried or submitted, and before it's established that specific medical opinions are deficient.

Petition for RemovalDecision After RemovalMandatory Settlement ConferenceSleep StudyDiscovery OrderMedical Record AugmentationPanel Qualified Medical EvaluatorThreshold MatterDevelop the RecordAdmission of Evidence
References
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