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Case Law Database

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

Case No. OAK 234515, OAK 239085, OAK 240882
Significant

Victoria Gomez vs. Casa Sandoval, Golden Eagle Insurance Company, California Compensation (in liquidation), California Insurance Guarantee Association, Risk Enterprise Management

An en banc opinion clarifying that the California Insurance Guarantee Association (CIGA) is generally relieved of liability in cases with a solvent carrier, unless liability was already apportioned and finalized before the original carrier's insolvency.

California Insurance Guarantee AssociationCIGAcovered claimsother insuranceinsolvencyapportionment of liabilitysuccessive injuriescumulative traumamedical treatmentadministration of award
References
17
Case No. ADJ7445107
Regular
Oct 13, 2025

JILLIAN DIFUSCO vs. HANDS ON SPA, EMPLOYERS COMPENSATION INSURANCE GROUP

The Appeals Board, en banc, granted reconsideration of a WCJ's decision regarding disclosure requirements for defendants. The WCJ had ruled that the defendant only needed to disclose the name of its insurance carrier as per WCAB Rule 10390. The Board determined that its prior en banc decisions, Coldiron I and II, are binding precedent and require defendants to disclose all entities liable for payment and any insurance policy provisions affecting liability. Consequently, the WCJ's Findings of Fact and Order were rescinded, and the matter was returned to the trial level for further proceedings consistent with this comprehensive disclosure mandate.

En Banc DecisionWCAB Rule 10390Coldiron IColdiron IIDiscovery RequestInsurance Carrier DisclosureSelf-Insured RetentionLarge DeductibleEntity Liable for CompensationThird-Party Administrator
References
25
Case No. ADJ7232076
Significant
Nov 04, 2011

TSEGAY MESSELE vs. PITCO FOODS, INC.; CALIFORNIA INSURANCE COMPANY

The Appeals Board grants reconsideration on its own motion to clarify that its prior en banc decision regarding the timeline for selecting a Qualified Medical Evaluator (QME) will apply prospectively to panel requests made after September 26, 2011, to avoid disrupting ongoing cases.

AME proposalQME panelLabor Code section 4062.2(b)prospective applicationclerical error correctionreconsideration on motionen banc decisionDWC NewslineCalifornia Applicants' Attorneys Associationprematurity objection
References
6
Case No. GRO 0031810
En Banc
Dec 07, 2006

JOEY M. COSTA vs. HARDY DIAGNOSTIC, STATE COMPENSATION INSURANCE FUND

The Appeals Board, in an en banc decision, holds that the applicant has not met the burden of proving the new Permanent Disability Rating Schedule (PDRS) invalid and affirms that rebuttal evidence to a rating is permissible under the new schedule.

PDRSSB 899Labor Code section 4660en bancrebuttal evidencecosts of rebuttal evidenceRAND Reportfuture earnings capacityempirical dataAMA Guides
References
18
Case No. ADJ1078163, ADJ3341185
En Banc
Sep 03, 2009

MARIO ALMARAZ, JOYCE GUZMAN vs. ENVIRONMENTAL RECOVERY SERVICES, STATE COMPENSATION INSURANCE FUND, MILPITAS UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

This en banc decision clarifies that a permanent disability rating established by the Schedule is rebuttable, but any evidence to rebut the Whole Person Impairment (WPI) component must be based within the four corners of the AMA Guides.

AlmarazGuzmanWorkers' Compensation Appeals Boarden bancprecedentAMA Guides2005 Schedulepermanent disabilityrebuttableprima facie evidence
References
49
Case No. GRO 0031810
Significant
Dec 07, 2006

Joey M. Costa vs. Hardy Diagnostic, State Compensation Insurance Fund

The Appeals Board held en banc that the applicant failed to prove the new Permanent Disability Rating Schedule (PDRS) was invalid, but affirmed that ratings under the new schedule can be rebutted with evidence, the costs of which may be allowable.

Permanent Disability Rating ScheduleSB 899Labor Code section 4660En Banc DecisionRebuttal EvidenceDiminished Future Earning CapacityEmpirical DataRAND ReportAMA GuidesVocational Rehabilitation
References
20
Case No. ADJ4274323, ADJ1601669
Significant
Oct 06, 2014

Jose Dubon vs. World Restoration, Inc., State Compensation Insurance Fund

This en banc decision holds that a utilization review (UR) decision is invalid and not subject to independent medical review (IMR) only if it is untimely. Timeliness disputes are resolved by the WCAB, while all other disputes about a UR decision must be resolved by IMR.

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewTimelinessMedical NecessityLabor Code Section 4610Labor Code Section 4610.5Senate Bill 863En Banc DecisionAdministrative Director
References
37
Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
En Banc
Feb 03, 2009

MARIO ALMARAZ, JOYCE GUZMAN vs. ENVIRONMENTAL RECOVERY SERVICES, STATE COMPENSATION INSURANCE FUND, MILPITAS UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

In a consolidated en banc decision, the Appeals Board holds that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable and remands two separate cases to their respective WCJs to determine if the standards for rebuttal have been met.

AMA Guides2005 Schedulerebuttablepermanent disabilityinequitable awarddisproportionate awardfair and accurate measuremedical opinionsadministrative law judgeWCJ
References
61
Case No. ADJ7048296
En Banc
Sep 27, 2011

Elayne Valdez vs. Warehouse Demo Services, Zurich North America

The Appeals Board affirms its prior en banc decision, holding that medical reports obtained from non-MPN physicians are inadmissible for awarding benefits if the treatment was unauthorized and occurred outside a validly established Medical Provider Network (MPN).

Workers' Compensation Appeals BoardEn Banc DecisionMedical Provider Network (MPN)Non-MPN TreatmentInadmissibility of ReportsLabor Code Section 4616.6Primary Treating Physician (PTP)Utilization Review (UR)Qualified Medical Evaluator (QME)Substantive Due Process
References
17
Case No. GRO 024430
Significant
Dec 08, 2004

Myron Abney vs. AERA ENERGY, LIBERTY MUTUAL INSURANCE COMPANY

This en banc decision holds that the revised Labor Code section 5814, operative June 1, 2004, applies to unreasonable delays in compensation payments that occurred prior to its operative date, provided the finding of unreasonable delay is made on or after that date.

SB 899Labor Code Section 5814En Banc DecisionReconsiderationTemporary Disability IndemnityPenaltyUnreasonable DelayOperative DateStatute of LimitationsConclusive Presumption
References
26
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