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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
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 Consequently, the WCJ's Findings of Fact and Order were rescinded, and the matter was returned to the trial level for further proceedings consistent with this comprehensive disclosure mandate.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
Case No. ADJ425881 (MON 0349358) ADJ1664800 (MON 0330278)
Regular
Feb 23, 2009

Jerry Salmeron vs. COCA COLA ENTERPRISES

This case concerns an applicant's admitted industrial injuries to his low back, psyche, and hernias, and his subsequent permanent disability ratings. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes regarding the proper application of the 2005 Schedule for Rating Permanent Disabilities, particularly concerning diminished future earning capacity (DFEC). The WCAB rescinded the prior awards and remanded the cases to the trial level to allow the judge and parties to apply recent en banc decisions clarifying how the DFEC and AMA Guides portions of the schedule can be rebutted. The decision emphasizes that rebuttal must be consistent with Labor Code section 4660 and specific en banc rulings on evidence and methodology.

WCABSalmeronCoca Cola EnterprisesDecision After ReconsiderationFindings and Awardpermanent disabilityrebutted2005 Schedulediminished future earning capacityDFEC
References
Case No. ADJ3852255 (SRO 0128541)
Regular
Dec 02, 2014

DENISE SITTON vs. LOK GROUP OF COMPANIES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior order finding the employer's Utilization Review (UR) decisions procedurally defective, despite being timely. The WCAB rescinded the prior order based on its subsequent en banc decision in *Dubon v. World Restoration, Inc.*, which established that only untimely UR decisions are invalid. The case is returned to the WCJ for further proceedings and a new decision consistent with the *Dubon II* ruling.

Utilization ReviewFindings and OrderPetition for ReconsiderationWCJDubon IIen banc decisionprocedural defectreasonable and necessarymedical treatmentepidural injection
References
Case No. GRO 0032261
Regular
Jul 16, 2008

RAYMUNDO ARREOLA vs. JLG HARVESTING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision that denied injury to the applicant's left arm and hand, awarding 33% permanent disability. The WCAB affirmed the original decision regarding the injury and disability rating, noting that the 2005 Permanent Disability Rating Schedule was deemed valid in prior en banc decisions. However, the WCAB amended the award of costs for applicant's expert witness, increasing reimbursement for report preparation and testimony preparation, while reducing the hourly rate for travel time, resulting in a total award of $1,625.00. Finally, the WCAB corrected a technical heading error in the original decision to accurately reflect the Appeals Board's authority.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability Rating Schedule (PDRS)Diminished Future Earning Capacity (DFEC)Expert Witness TestimonyReimbursement of CostsWCJ DecisionEn Banc DecisionApportionmentLaborer
References
Case No. ADJ337399: MON 0297231
Regular
May 15, 2009

MARIA MEJIA vs. CEDARS-SINAI MEDICAL CENTER, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that awarded vocational rehabilitation maintenance allowance benefits. Defendant argued the WCJ lacked jurisdiction because the vocational rehabilitation statute was repealed effective January 1, 2009. The WCAB is holding this case pending its en banc decision in *Weiner v. Ralphs Company*, which addresses the same jurisdictional issue. The WCAB rescinded the prior award and returned the matter to the trial level for a new decision consistent with the forthcoming *Weiner* ruling.

Workers' Compensation Appeals BoardVocational RehabilitationLabor Code Section 139.5ReconsiderationEn Banc DecisionJurisdictional IssueRepeal of StatuteVocational Rehabilitation Maintenance AllowanceWCJAmicus Briefs
References
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
Case No. ADJ1124701 (OAK 0304697)
Regular
Jan 25, 2010

GENE THOMAS vs. SLEEP TRAIN MATTRESS CENTER, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision favoring the applicant's spinal surgery, finding that proper procedural steps were not followed. The employer's utilization review (UR) had denied the surgery, but neither party followed the required second-opinion process under Labor Code section 4062(b). The WCAB returned the case to the trial level, allowing the employer ten days from receipt of the decision to object to the surgery and initiate the second-opinion process. This decision aligns with the WCAB's en banc ruling in *Cervantes*, which clarified the procedures for handling spinal surgery disputes after UR denials.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code section 4062(b)Spinal SurgerySecond OpinionCervantes v. El Aguila Food ProductsACOEM GuidelinesExperimental TreatmentEn Banc DecisionAdministrative Director Rules
References
Case No. SJO 0245781
Significant

Michael A. Willette vs. Au Electric Corporation, State Compensation Insurance Fund

The Appeals Board, in an en banc decision, outlines the mandatory procedure for resolving post-utilization review medical treatment disputes for unrepresented employees, requiring the use of a panel Qualified Medical Examiner (QME). The prior decision was rescinded and the case was remanded to follow this new procedure.

Workers' Compensation Appeals BoardEn Banc DecisionReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryTailbone InjuryAlarm InstallerState Compensation Insurance FundUtilization Review Reports
References
Case No. ADJ9542328
Regular
Nov 14, 2019

ASHLEY COLAMONICO vs. SECURE TRANSPORTATION, NATIONAL UNION FIRE INSURANCE COMPANY, SEDGWICK CMS

This en banc decision clarifies that medical-legal providers, not defendants, bear the initial burden of proving their services were reasonable and necessary pursuant to Labor Code section 4621. Defendants do not waive objections based on sections 4620 or 4621 by failing to raise them in an Explanation of Review. The Appeals Board rescinded the WCJ's findings and remanded the case for further proceedings on the provider's burden of proof. This precedent applies to all future Appeals Board decisions.

Med-Legal PhotocopyExplanation of Review (EOR)Contested ClaimBurden of ProofReasonable and Necessary ExpensesLien ClaimantWaiver of ObjectionsSection 4620Section 4621Section 4622
References
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