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

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 Consequently, the WCJ's Findings of Fact and Order were rescinded, and the matter was returned to the trial level for further proceedings consistent with this comprehensive disclosure mandate.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. 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. ADJ1735018
En Banc
Jun 03, 2010

CYNTHIA BLACKLEDGE vs. BANK OF AMERICA, ACE AMERICAN INSURANCE COMPANY

An en banc decision clarifying the respective roles of the evaluating physician, the workers’ compensation administrative law judge (WCJ), and the disability rater in determining whole person impairment (WPI). The Appeals Board amended the WCJ's decision and remanded the matter for further proceedings.

AMA GuidesWhole Person ImpairmentPhysician's RoleWCJ's RoleRater's RoleFormal Rating InstructionsSubstantial Medical EvidenceDisability Evaluation UnitNon-Formal RatingsEx Parte Communication
References
32
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
26
Case No. SDO 244774
En Banc
Dec 11, 2003

Walter Faust vs. City of San Diego

The Appeals Board, in an en banc decision, clarifies the burden of proof under Labor Code §3212.1 for cancer claims by firefighters, holding that once exposure to a carcinogen is shown, the burden shifts to the defendant to prove no reasonable link. The prior decision was rescinded and the case returned for re-evaluation under this standard.

Labor Code section 3212.1en bancreconsiderationcumulative industrial injurycancerfirefighterpresumptionrebutting presumptionqualified medical evaluator (QME)Prakash Jay
References
16
Case No. ADJ7232076
Regular
Nov 22, 2011

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

This case concerns a prior en banc decision that clarified timelines for selecting Agreed Medical Evaluators (AMEs) and Qualified Medical Evaluator (QME) panels. Due to confusion and potential for reopening cases, the Appeals Board granted reconsideration on its own motion. The Board ultimately modified its prior decision to apply prospectively from September 26, 2011, preventing challenges to previously obtained QME panels based on prematurity unless timely objected to before that date. This modification aims to avoid widespread reopening and preserve settlements based on prior interpretations.

WCABen bancreconsiderationprospective applicationQME panelagreed medical evaluatorAMEprematurityLabor Code section 4062.2(b)DWC Newsline
References
3
Case No. ADJ7232076
Significant
Sep 26, 2011

Tsegay Messele, Applicant vs. Pitco Foods, Inc., California Insurance Company

The Appeals Board, in an en banc decision, held that the timeframe for seeking agreement on an Agreed Medical Evaluator (AME) under Labor Code section 4062.2(b) is extended by five calendar days when the initial proposal is served by mail. Consequently, it found that both the applicant's and the defendant's requests for a Qualified Medical Evaluator (QME) panel were premature and rescinded the prior finding.

QME panelagreed medical evaluatorLabor Code 4062.2Code of Civil Procedure 1013WCAB Rule 10507service by mailtime computationremovalen banc decisionmedical evaluation
References
24
Case No. SJO 0251644
Significant
Apr 06, 2007

Joseph Baglione vs. Hertz Car Sales, AIG, Cambridge Integrated Services

The Workers' Compensation Appeals Board, in an en banc decision, reconsiders and reverses its prior ruling, holding that for pre-2005 injury claims, the 1997 Schedule for Rating Permanent Disabilities applies only if a pre-2005 comprehensive medical-legal report or a treating physician's report explicitly indicates the existence of permanent disability. The Board affirmed the original judge's decision to apply the 2005 Schedule in this case.

Workers Compensation Appeals BoardJoseph BaglioneHertz Car SalesAIGCambridge Integrated ServicesSJO 0251644Opinion and Order Granting ReconsiderationEn Banc1997 Schedule2005 Schedule
References
27
Case No. GRO 0029816, GRO 0029817
Significant

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision to apportion 50% of the applicant's permanent disability to a preexisting degenerative arthritis, holding that Labor Code section 4663, as amended by SB 899, permits apportionment based on causation from non-industrial factors supported by substantial medical evidence.

SB 899apportionmentcausationpermanent disabilitypreexisting arthritismedical evidencesubstantial evidenceLabor Code section 4663compensable consequenceQME
References
58
Case No. GRO 0029816, GRO 0029817
En Banc

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision, holding that under Labor Code section 4663 as amended by SB 899, apportionment of permanent disability is based on causation and may include pre-existing, non-industrial conditions like degenerative arthritis, provided there is substantial medical evidence to support the percentage of non-industrial causation.

SB 899ApportionmentCausationPermanent DisabilityPreexisting ConditionDegenerative ArthritisSubstantial Medical EvidenceMedical ProbabilityLabor Code Section 4663Compensable Consequence
References
56
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