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

Case No. ADJ3891253 (SAC 0350473)
Regular
Jan 20, 2010

, MAURICIO CASTRO vs. , RODOLFO GUTIERREZ; ALLSTATE INSURANCE c/o SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board granted the applicant's petition for removal due to the assigned judge's reported threat to refer him to the District Attorney if he continued testifying. While the judge did not deny the threat, she stated it was to ensure attorneys observed the applicant's demeanor. The Board found this action created an appearance of bias and prejudiced the applicant's right to a fair hearing. Therefore, the case was transferred to a new judge to ensure substantial justice and an unbiased determination of the merits.

Petition for RemovalWCJ ThreatDistrict Attorney ReferralAppearance of BiasDue Process ViolationCode of Civil Procedure Section 641(f)Labor Code Section 5310Robbins v. Sharp HealthcareWCAB Rule 10452Disqualification
References
Case No. ADJ12511409
Regular
Jun 18, 2025

JOSE LOPEZ FRANCO vs. JDMC MEDINA CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

Applicant Jose Lopez Franco sought reconsideration of a WCJ's decision finding that his Request for Authorization (RFA) did not qualify for expedited review and was timely decided, thus precluding WCAB jurisdiction over a medical treatment dispute. The Appeals Board granted reconsideration, finding that the evaluation of whether an RFA requires expedited review is an inherently medical determination and must be made by a medical professional within the 72-hour expedited review timeframe. As defendant's Utilization Review provider failed to do so, the Board concluded that the UR decision was untimely, vesting the WCAB with jurisdiction. The matter was rescinded and returned to the trial level for a determination of medical necessity.

Request for AuthorizationExpedited ReviewUtilization ReviewTimelinessMedical NecessityImminent ThreatAdministrative Director RuleLabor CodeWorkers' Compensation Appeals BoardFindings of Fact
References
Case No. ADJ3415116 (LAO 0794342) ADJ581399 (LAO 0794343)
Regular
Jan 09, 2015

JESUS RODRIGUEZ vs. AIR EAGLE, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS FOR LEGION INSURANCE IN LIQUIDATION

This case concerns a dispute over the necessity and timeliness of 24/7 home health care for an injured worker. The Workers' Compensation Appeals Board (WCAB) affirmed the original findings but amended them to rule the defendant's utilization review (UR) decision was untimely, thus invalid. The WCAB found the worker had a valid prescription for home health care and was entitled to services starting October 22, 2013. However, one commissioner dissented, arguing there was insufficient evidence to support the indefinite need for the requested services based on current medical evaluations.

Workers' Compensation Appeals BoardUtilization ReviewHome Health CarePsychiatric BasisLicensed Vocational NursePsychiatric TechnicianPrescriptionImminent ThreatExpedited ReviewTimeliness
References
Case No. ADJ7426008
Regular
May 02, 2016

JOE TUCKER vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) denied the petition for reconsideration filed by the Department of Corrections and Rehabilitation. The WCAB adopted the reasoning of the administrative law judge (WCJ), which found that Joe Tucker, a Plumber II at Corcoran State Prison, was entitled to the heart presumption under Labor Code § 3212.2. The WCJ determined that Tucker's duties supervising inmate work crews, which involved daily threats and exposure to dangerous conditions, constituted "custodial duties" within the meaning of the statute. The WCAB specifically excluded certain paragraphs from the WCJ's report from incorporation in its order.

Labor Code § 3212.2heart presumptioncustodial dutiesPlumber IIinmate work crewscorrectional officersadministrative segregationsecurity housinginmate threatsextraction squad
References
Case No. ADJ4513629 (SAL 0120784)
Regular
Feb 18, 2010

RICHARD GALINDO vs. MV TRANSPORTATION, INC.; BROADSPIRE, a CRAWFORD COMPANY

This case concerns a bus driver who sustained a back injury after an altercation with a passenger. The employer denied the claim, asserting the employee was the initial physical aggressor, which would bar compensation. The Board reviewed videotape evidence and affirmed the WCJ's finding that the passenger's spitting and verbal threats constituted the initial physical aggression. Therefore, the employer failed to establish the exclusion under Labor Code section 3600(a)(7), and the injury is compensable.

WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONINDUSTRIAL INJURYBUS DRIVERCOMPENSABILITYINITIAL PHYSICAL AGGRESSORLABOR CODE SECTION 3600(a)(7)ALTERCATIONVIDEOTAPE EVIDENCETHREAT OF BODILY HARM
References
Case No. ADJ8844834
Regular
Nov 05, 2018

HECTOR GARCIA vs. BARRETT BUSINESS SERVICES, INC.

Applicant sustained industrial injury as a truck driver in 2013, resulting in multiple body part injuries and traumatic brain injury. The employer sought to overturn the WCJ's finding that their Utilization Review (UR) determination for applicant's continued inpatient care was untimely. The Appeals Board affirmed the WCJ's decision, finding the UR was indeed untimely under Labor Code section 4610(i) for failing to meet the 72-hour timeframe for concurrent review in cases of imminent health threats. Consequently, applicant's continued inpatient care at CNS was authorized.

Utilization ReviewLabor Code Section 4610(i)Concurrent ReviewTimelinessIndependent Medical ReviewInpatient CareCenter for Neuro SkillsRequest for AuthorizationPrimary Treating PhysicianMedical Treatment
References
Case No. ADJ7148195
Regular
Jan 03, 2020

KARIN SMITH vs. MARIN GENERAL HOSPITAL, ATHENS ADMINISTRATORS

This case concerns defendant's petition for reconsideration of an award for applicant's back surgery. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirmed the award, and corrected a clerical error in the case number. The WCAB found that while an initial surgery request was denied via Utilization Review (UR) and Independent Medical Review (IMR), the applicant's treating physician later submitted a new request supported by documented changes in material facts, including new neurological symptoms and an MRI showing critical stenosis and potential cauda equina syndrome. Because the second request indicated an imminent and serious threat to the applicant's health and was based on new medical evidence, the 12-month UR decision validity period did not apply.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardUtilization ReviewIndependent Medical ReviewLabor Code Section 4610(k)Documented Change in ConditionLumbar Spine SurgeryNurseCauda Equina Syndrome
References
Case No. ADJ9674255
Regular
Jul 10, 2017

YAN LIU vs. HAWAIIAN GARDENS CASINO, INSURANCE COMPANY OF THE WEST

This case concerns an applicant who alleges both orthopedic and psychiatric injuries from her employment as a casino dealer. While the Board affirmed the finding of orthopedic injury, it deferred the issue of psychiatric injury. The Board clarified that Labor Code § 4660.1(c) does not bar psychiatric claims arising directly from employment events, but it requires a medical apportionment of causation between direct psychiatric injury and injury as a consequence of physical injury. The matter was returned to the trial level for further development of the record regarding the psychiatric injury and its apportionment.

AOE/COELabor Code Section 4660.1(c)psychiatric injurycompensable consequenceviolent actsubstantial medical evidencetreating physicianQMEcontinuous traumaharassment
References
Case No. ADJ4417162 (VNO 0529182) ADJ1947867 (SBR 0327890)
Regular
Oct 27, 2009

UN CHU KO vs. COUNTY OF LOS ANGELES; PERMISSIBLY SELF-INSURED

The WCAB denied reconsideration, upholding the WCJ's finding that the applicant's psychological injury claim was barred due to lawful, nondiscriminatory, good-faith personnel actions.

Workers' Compensation Appeals BoardReconsideration DeniedLabor Code § 3208.3(h)Psychological InjuryRacial DiscriminationNational Origin DiscriminationPersonnel ActionsAggravationPre-existing Psychiatric DisorderCredibility Determination
References
Case No. ADJ9453899
Regular
Dec 06, 2016

DAVID CERONSKY vs. CSP KINGS COUNTY AT CORCORAN, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision finding applicant sustained a psychological injury due to workplace stress. The WCAB found the original decision mistakenly applied a cardiac presumption instead of the correct statute and lacked sufficient evidence for the identified cumulative trauma period. The Board also determined that relevant evidence regarding the defendant's good faith personnel actions was improperly excluded. The case was returned to the trial level for further proceedings to develop a complete record and issue a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings of FactAwardOrderOpinion on DecisionCumulative TraumaPsycheLabor Code Section 3208.3(h)Good Faith Personnel Action Defense
References
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