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Case Law Database

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

Case No. ADJ7329727

Regular

Oct 10, 2014

KRISSY KORN vs. ENTERTAINMENT PARTNERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of an award for back surgery. The Board adopted the WCJ's report, except for a comment regarding the defendant's burden of proof on MTUS compliance. The Board clarified that the applicant bears the burden of proving the reasonableness of requested treatment. The employer's argument for denying the surgery based on lack of substantial medical evidence was rejected.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationWCJ reportDubon v. World RestorationApplicant burden of proofmedical treatment utilization schedulelow backright shoulderCraft Services Personanterior lumbar interbody fusion

References

Case No. ADJ9081819

Regular

Jul 21, 2025

JORGE ALVARADO vs. BMW OF MURIETTA, HENDRICK AUTOMOTIVE GROUP, THE HARTFORD ACCIDENT AND INDEMNITY

The Workers' Compensation Appeals Board denied the defendants' petition for reconsideration of a Findings and Award (F&A) from April 14, 2025. The F&A found applicant sustained an industrial injury resulting in 38% permanent disability without apportionment. Defendants contended the WCJ erred in failing to apportion disability to non-industrial factors, but the Board affirmed the WCJ's conclusion that the applicant's disability was entirely caused by medical treatment for the industrial injury, thus precluding apportionment under established legal precedent. The Board also confirmed that its decision was timely issued in accordance with Labor Code section 5909.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardInjury AOE/COEApportionmentPermanent DisabilityLumbar SpineThoracic SpineRight HipLabor Code Section 5909

References

Case No. SAL 0107786

Regular

Oct 16, 2007

MOLLY KIRKPATRICK vs. DOMINICAN SANTA CRUZ HOSPITAL, PSI ADMINISTERED BY OCTAGON RISK SERVICES

This case concerns an injured worker who had cervical spine surgery involving diskectomy, vertebrectomy, decompression, and fusion. The defendant sought reconsideration of an award granting temporary disability benefits beyond the statutory 104-week limit, arguing the surgery was not an amputation. The Appeals Board rescinded the prior award and returned the matter for further proceedings, as the definition of "amputation" in precedent excludes internal body parts like those removed during spinal fusion.

Workers' Compensation Appeals BoardDominican Santa Cruz HospitalOctagon Risk ServicesMolly KirkpatrickIndustrial InjuryCervical Spine SurgeryTemporary Disability IndemnityLabor Code Section 4656(c)AmputationDiskectomy

References

Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)

Regular

Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns applicant Dennis Timmons' petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Appeals Board reversed a prior award, finding applicant failed to prove a pre-existing permanent partial disability from a 1991 cervical fusion surgery prior to his 2000 industrial injury. Applicant argued the fusion itself constituted a previous impairment and that SB 899's apportionment changes should apply, but the Board affirmed its decision. The Board reiterated that contemporaneous medical evidence is required for SIBTF eligibility, and that SB 899 did not alter SIBTF's established requirements.

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751

References

Case No. ADJ6619207 ADJ6736606

Regular

May 24, 2010

ALBERTO ALVAREZ vs. AKT DEVELOPMENT CORPORATIONS, INSURANCE OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration of a decision awarding lumbar fusion surgery, finding the WCJ erred by solely relying on the *Cervantes* decision regarding timely utilization review. The Board determined that the defendant's utilization review timeliness was unclear, and the parties had agreed to an Agreed Medical Examiner (AME) to resolve the surgery dispute before *Cervantes* was issued. Furthermore, the Board held that the treating physician's recommendation for surgery must constitute substantial evidence, which was not definitively established here. Therefore, the matter was returned for further development of the record, requiring the treating physician to address the AME's concerns regarding the necessity of fusion surgery.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationJoint Findings Award and OrderIndustrial InjuryLumbar FusionUtilization ReviewCervantes v. El Aguila Food ProductsSubstantial Medical EvidenceExpedited Hearing

References

Case No. ADJ4695633 (OXN 0133122)

Regular

Oct 14, 2013

DEBRA CHELI vs. CHICO'S; HARTFORD INSURANCE, administered by BROADSPIRE

The Workers' Compensation Appeals Board denied a petition for reconsideration, upholding the findings of the administrative law judge. The judge's decision relied heavily on the credibility of the applicant and the opinion of an agreed medical examiner who found no apportionment to prior or subsequent injuries. The Board agreed with the judge that the medical examiner's opinion was persuasive, noting that the petitioner failed to provide sufficient evidence to challenge it. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical ExaminerApportionmentSubstantial EvidencePermanent Total DisabilityWCJMedical ReportLumbar FusionCumulative Trauma

References

Case No. ADJ1010087 (FRE 0250087)

Regular

Nov 22, 2008

TAMMY BALDRIDGE vs. VONS, a SAFEWAY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to rescind a prior award of spinal surgery for Tammy Baldridge. The Board found that the defendant timely denied the surgery through utilization review and that the applicant failed to meet her burden of proof. Specifically, the applicant did not demonstrate that the recommended surgery was medically reasonable and necessary, particularly in light of the ACOEM Guidelines and conflicting medical opinions.

Workers' Compensation Appeals BoardTammy BaldridgeVonsSafeway CompanyReconsiderationFindings and AwardSpinal SurgeryAnterior Cervical DiscectomyInterbody FusionInstrumentation

References

Case No. ADJ1489633 (SBR 0317521)

Regular

Dec 11, 2008

STEPHANIE ROECKER vs. MONO LAKE FOUNDATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and affirmed an award, but amended the finding on temporary disability. The Board agreed with the defendant that the applicant was adequately compensated for temporary disability per stipulation. However, the Board upheld the use of the pre-2005 permanent disability rating schedule, finding substantial medical evidence existed prior to January 1, 2005, supporting this determination.

WCABPermanent Disability Rating ScheduleTemporary Total DisabilityFindings and AwardOrder of CommutationPost Fusion RadiculopathyIndustrial InjuryMedical TreatmentStipulationReconsideration

References

Case No. ADJ7951527

Regular

Oct 03, 2016

RONALD COYLE vs. DANE COYLE CUSTOM HOMES, INC.

The defendant sought reconsideration of an award for an applicant's industrial back injury, challenging the timeliness of the utilization review (UR) denial and the necessity of proposed spinal surgery. The Board denied reconsideration, affirming that the defendant failed to prove timely communication of the UR denial as required by law. Furthermore, substantial evidence, including reports from the treating physician and Agreed Medical Evaluator, supported the necessity of the lumbar fusion surgery. The Board found the defendant's arguments insufficient to rebut the expert medical opinions presented.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryUtilization Review (UR) DenialTimelinessFurther Medical TreatmentSpinal SurgeryLumbar FusionRequest for Authorization (RFA)

References

Case No. ADJ8033181

Regular

Jun 04, 2013

MARCIA MATTHEWS vs. NEIMAN MARCUS, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board granted the applicant's Petition for Removal, overturning a prior order to select an Agreed Medical Evaluator. The Board found that the applicant's physician, Dr. Chambi, provided substantial evidence supporting the need for spinal surgery. Conversely, the defense's second opinion physician, Dr. Ma, failed to adequately explain his non-surgical recommendation and his initial report was untimely due to the defense's failure to provide complete medical records. Therefore, the Board ordered the defendant to provide the requested spinal surgery.

Petition for RemovalAgreed Medical EvaluatorRegular PhysicianLabor Code Section 5701Spinal SurgeryNeurosurgical ConsultationUtilization Review DenialSecond Opinion EvaluatorFormer Labor Code Section 4062(b)Expedited Hearing

References

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Updated Daily

Case Law Database

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

Case No. ADJ7329727

Regular

Oct 10, 2014

KRISSY KORN vs. ENTERTAINMENT PARTNERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

References

Case No. ADJ9081819

Regular

Jul 21, 2025

JORGE ALVARADO vs. BMW OF MURIETTA, HENDRICK AUTOMOTIVE GROUP, THE HARTFORD ACCIDENT AND INDEMNITY

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardInjury AOE/COEApportionmentPermanent DisabilityLumbar SpineThoracic SpineRight HipLabor Code Section 5909

References

Case No. SAL 0107786

Regular

Oct 16, 2007

MOLLY KIRKPATRICK vs. DOMINICAN SANTA CRUZ HOSPITAL, PSI ADMINISTERED BY OCTAGON RISK SERVICES

References

Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)

Regular

Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751

References

Case No. ADJ6619207 ADJ6736606

Regular

May 24, 2010

ALBERTO ALVAREZ vs. AKT DEVELOPMENT CORPORATIONS, INSURANCE OF THE WEST

References

Case No. ADJ4695633 (OXN 0133122)

Regular

Oct 14, 2013

DEBRA CHELI vs. CHICO'S; HARTFORD INSURANCE, administered by BROADSPIRE

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical ExaminerApportionmentSubstantial EvidencePermanent Total DisabilityWCJMedical ReportLumbar FusionCumulative Trauma

References

Case No. ADJ1010087 (FRE 0250087)

Regular

Nov 22, 2008

TAMMY BALDRIDGE vs. VONS, a SAFEWAY COMPANY

Workers' Compensation Appeals BoardTammy BaldridgeVonsSafeway CompanyReconsiderationFindings and AwardSpinal SurgeryAnterior Cervical DiscectomyInterbody FusionInstrumentation

References

Case No. ADJ1489633 (SBR 0317521)

Regular

Dec 11, 2008

STEPHANIE ROECKER vs. MONO LAKE FOUNDATIONS, STATE COMPENSATION INSURANCE FUND

WCABPermanent Disability Rating ScheduleTemporary Total DisabilityFindings and AwardOrder of CommutationPost Fusion RadiculopathyIndustrial InjuryMedical TreatmentStipulationReconsideration

References

Case No. ADJ7951527

Regular

Oct 03, 2016

RONALD COYLE vs. DANE COYLE CUSTOM HOMES, INC.

References

Case No. ADJ8033181

Regular

Jun 04, 2013

MARCIA MATTHEWS vs. NEIMAN MARCUS, LIBERTY MUTUAL INSURANCE COMPANY

References

Showing 1-10 of 84 results

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