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

Case No. ADJ3225136 (OAK 0345446)
Regular
Aug 28, 2012

MICHAEL GIAMMONA vs. FISHER DEVELOPMENT AND TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves defendant Travelers Property and Casualty's repeated attempts to disqualify a Qualified Medical Examiner (PQME) due to alleged conflicts of interest and the PQME's review of a prior PQME's report. The Appeals Board dismissed the defendant's petition for reconsideration, as the underlying order was an interim procedural matter, not a final decision. The Board also denied the petition for removal, finding it was inappropriately filed for the same reasons previously addressed in a prior ruling. The Board admonished the defendant for ignoring prior guidance on the proper procedural avenues.

Petition for ReconsiderationPetition for RemovalPanel Qualified Medical ExaminerPQME conflict of interestRule 41.5 disqualificationinterim procedural orderfinal ordermedical-legal discoveryworkers' compensation benefitsOakland District Office
References
Case No. ADJ8734182
Regular
Dec 17, 2018

JONATHAN MCINTYRE vs. COUNTY OF SAN DIEGO

This case involves an applicant, Jonathan McIntyre, a deputy sheriff, claiming bladder cancer as a work-related injury. The Workers' Compensation Appeals Board (WCAB) rescinded the prior decision, finding that the medical evidence regarding the latency period of the applicant's bladder cancer was insufficient. The WCAB determined further development of the medical record is required to accurately assess when the cancer "developed" and "manifested" relative to the statutory presumption period. Therefore, the case is returned to the trial level for further proceedings and a new decision by the Workers' Compensation Judge.

Workers' Compensation Appeals BoardDeputy SheriffBladder CancerLabor Code section 3212.1Presumption of CompensabilityLatency PeriodAgreed Medical EvaluatorManifestation of DiseaseDevelopment of CancerStatutory Presumption
References
Case No. MON 254928
Significant
Feb 25, 2002

James McDuffie, Applicant vs. Los Angeles County Metropolitan Transit Authority, Permissibly Self-Insured, c/o Constitution State Service Company

The Board holds that where the medical record requires further development after trial, the preferred procedure is to first seek supplemental opinions from the physicians who have already reported in the case before considering the appointment of a new medical examiner.

En Banc DecisionMedical Record DevelopmentSupplemental OpinionsAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Court Appointed Medical EvaluatorFurther DevelopmentApportionmentPermanent DisabilityBus Operator
References
Case No. ADJ8269580
Regular
Nov 30, 2015

RALPH LARUE vs. SANTA CLARA VTA, permissibly self-insured; administered by TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, rescinding the prior award that allowed the Employment Development Department (EDD) a $2,300 lien. The WCAB found the record lacked sufficient evidence to establish EDD's lien, as defendant argued EDD failed to prove benefits were for the same industrial injury. The Board clarified that EDD's lien attaches to permanent disability caused solely by the industrial injury, not to the apportionment of disability. The case is remanded for further proceedings to develop the record on EDD's lien claim.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardEmployment Development Department (EDD)Lien ClaimPermanent Disability IndemnityApportionmentLabor Code 4904(b)Causation of InjuryCausation of Disability
References
Case No. ADJ1283525
Regular
May 17, 2010

ANTOONIO OLIVERA (Decedent), MARIA GOMEZ OLIVERA (Surviving Spouse) vs. RICK PLANO STABLES, UNINSURED EMPLOYERS BENEFIT TRUST FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision and returned the case for further proceedings due to insufficient evidence regarding the decedent's employer. The WCAB found conflicting testimony and lack of clear evidence establishing employment with Rick Plano Stables on the alleged date of injury. The matter was remanded to properly substitute the surviving spouse as the applicant and to develop the record on the employer's identity and the date of injury.

Workers' Compensation Appeals BoardDecedent's spouseReconsiderationFindings and OrderSubstantial evidenceDevelop the recordInsufficient evidenceConstitutional mandateDevelop the recordUninsured Employers Benefit Trust Fund
References
Case No. ADJ10469262 ADJ9725605
Regular
Dec 21, 2017

MARIA GALERA vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES; IN-HOME SUPPORTIVE SERVICES; YORK RISK SERVICES GROUP

This case involves a defendant's petition for removal from a WCJ's order admitting deposition extracts and vacating submission. The defendant argued the WCJ failed to provide reasoning for the order to develop the record. However, the WCJ's subsequent report explained the necessity of record development due to insufficient medical evidence. A status conference confirmed the need for further development, rendering the removal petition moot. Consequently, the Workers' Compensation Appeals Board dismissed the Petition for Removal.

Petition for RemovalDeposition ExtractsVacating SubmissionFurther DevelopmentWorkers' Compensation Administrative Law JudgeReport and RecommendationPetition for ReconsiderationSubstantial Medical EvidenceStatus ConferenceOff Calendar
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ9076930
Regular
Aug 11, 2015

Lorenzo Ramirez vs. Los Altos Food Products, Inc., Sampo Japan Nipponkoa America

The Appeals Board granted reconsideration, amending the original award to exclude the right arm as a compensable body part due to insufficient medical evidence. The Board found that the original finding on temporary total disability lacked substantial evidence and deferred this issue, along with credit for EDD payments, for further development at the trial level. The case was remanded for a new decision by the WCJ on these deferred issues. The original finding of injury to the right elbow, right shoulder, and neck was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Findings of Fact and Award and OrdersTemporary Total DisabilityPermanent and Stationary DateSubstantial EvidenceQualified Medical ExaminerMedical OpinionReasonable Medical ProbabilityDeveloping the Record
References
Case No. ADJ11062244
Regular
Sep 25, 2018

MIKE RIZZO vs. PROPARK INC.; NOVA CASUALTY, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding the judge's order denying a new Qualified Medical Evaluator (QME) panel. This decision stems from the applicant's ex parte communication with the existing QME, which violated Labor Code section 4062.3. The Board found this violation warrants a new QME panel to ensure impartiality, as prejudice need not be shown. The parties are now ordered to select a new QME, with all other issues deferred.

Ex parte communicationQualified Medical Evaluator (QME)Petition for RemovalRescind OrdersNew QME panelLabor Code section 4062.3Temporary Disability (TD)Medical-legal discoveryAdjudication Management System (EAMS)Employment Development Department (EDD)
References
Case No. ADJ6968292
Regular
Jul 19, 2013

ANDRES CASTILLO vs. C. W. HORTON GENERAL CONTRACTOR, MAJESTIC INSURANCE COMPANY, AMTRUST AMERICA

The Workers' Compensation Appeals Board granted reconsideration to further develop the medical record regarding the applicant's permanent disability rating for a left thumb injury. The Board found discrepancies between the treating physician's and QME's reports concerning the applicant's functional limitations and impairment rating. While the Board affirmed the denial of additional temporary disability, it deferred the permanent disability award and attorney fees pending further medical evaluation, specifically addressing whether to deviate from strict AMA Guides application per *Almaraz/Guzman*.

Workers Compensation Appeals BoardAndres CastilloC. W. Horton General ContractorMajestic Insurance CompanyAmtrust AmericaADJ6968292Stockton District OfficeOpinion and Order Granting ReconsiderationDecision After Reconsiderationpermanent disability
References
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