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

Case No. ADJ8415524
Regular
Jun 26, 2015

SYLVIA FERRAR BALCOMBE vs. WEST END YMCA, UNITED STATE FIRE INSURANCE COMPANY

This case concerns an applicant's petition for reconsideration following a Workers' Compensation Appeals Board decision. The Board denied the petition, adopting the judge's report which found the applicant's attorney failed to follow proper procedure in requesting medical panels. The judge also determined that medical reports from specific doctors were inadmissible due to this procedural error and lack of persuasive medical evidence. Consequently, the Board denied reconsideration and admonished the applicant's attorney regarding future fee requests.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ ReportCal. Code Regs tit. 8 ยง 10778Attorney's FeesInjuriesGERDIBSSpineQME
References
Case No. ADJ1806161 (LBO 0392151)
Regular
Jun 22, 2009

TRACY SPENCER vs. CITY OF INGLEWOOD

The applicant sought reconsideration of a decision denying workers' compensation benefits for alleged psychiatric injury. The Appeals Board denied reconsideration, finding the applicant failed to meet her burden of proof for a psychiatric injury due to a lack of substantial medical evidence. Furthermore, the Board determined that the applicant was afforded due process, receiving proper notice and opportunity to be heard, despite her failure to appear at trial. The WCJ's decision was upheld, as the applicant did not respond to opportunities to show good cause or present further evidence.

Workers' Compensation Appeals BoardTracy SpencerCity of InglewoodPermissibly Self-InsuredADJ1806161LBO 0392151Opinion and Order Denying Reconsiderationindustrial injuryadministrative analystcumulative period
References
Case No. ADJ1988913
Regular
Aug 31, 2009

MATTHEW CLAPSADDLE vs. CITY OF SAN BUENAVENTURA, CORVEL OXNARD

The Workers' Compensation Appeals Board granted reconsideration to further develop the medical record regarding temporary disability for Matthew Clapsaddle. The Board affirmed the finding of industrial injury to the chest, permanent disability, and need for further medical treatment. However, the issues of temporary disability and the permanent and stationary date were deferred for future determination. This decision corrects an apparent lack of substantial evidence supporting the initial temporary disability findings.

Workers' Compensation Appeals BoardMatthew ClapsaddleCity of San BuenaventuraCorvel Oxnardfirefighter/paramediccumulative injurynon-cardiac chest paintemporary disabilitypermanent disabilityqualified medical evaluator
References
Case No. SDO 0322942
Regular
Jan 31, 2008

ROBERT WEIS vs. VULCAN MATERIALS COMPANY, ZURICH NORTH AMERICA

The applicant claims an admitted industrial spinal injury caused his umbilical hernia, but the WCJ denied benefits for the hernia, finding it nonindustrial. The applicant argues the Qualified Medical Evaluator's opinion supports industrial causation for the hernia, contradicting the defense. The Appeals Board granted reconsideration to obtain a report from the WCJ regarding this contested issue.

Workers' Compensation Appeals BoardVulcan Materials CompanyZurich North AmericaRobert Weisindustrial injuryspineherniaumbilical herniatruck driverqualified medical evaluator
References
Case No. ADJ7073718
Regular
Mar 08, 2016

RECARD ON GONZALES vs. PHILIP SERVICES CORPORATION, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to correct a typographical error in a prior award. The original decision found the applicant sustained an industrial injury to his right lower extremity, resulting in temporary disability and a 55% permanent disability rating after apportionment. The employer sought reconsideration, arguing for a lower rating based on a QME's opinion attributing 90% of the disability to non-industrial factors. The WCJ recommended amending the award to remove the erroneous reference to the QME's 90% apportionment and to simply state that 45% of the impairment existed prior to the industrial injury. The Board affirmed the substance of the original decision but amended Finding No. 10 as recommended.

WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATION GRANTEDDECISION AFTER RECONSIDERATIONTRUCK DRIVERINDUSTRIAL INJURYRIGHT LOWER EXTREMITYTEMPORARY DISABILITYPERMANENT DISABILITYAPPORTIONMENTLABOR CODE SECTION 4663
References
Case No. ADJ18210611
Regular
May 08, 2025

ELENITA JOVER vs. COUNTY OF SAN BERNARDINO DEPARTMENT OF PUBLIC HEALTH

Elenita Jover, a licensed vocational nurse, sought reconsideration of a Findings and Award that denied her request for additional Qualified Medical Evaluation (QME) panels. The initial F&A found injuries to her cervical and lumbar spine, shoulders, and right thumb, but not to other claimed body parts like stress, psyche, or internal systems. The Appeals Board granted the petition, rescinded the original F&A, and ordered additional QME panels for pulmonology, internal medicine (diabetes), ophthalmology, ENT, and neurology, returning the case to the trial level for further proceedings. This decision was based on the original QME's recommendation for further evaluations and the need to develop the evidentiary record to ensure substantial justice.

Petition for ReconsiderationQualified Medical EvaluationLicensed Vocational NurseArising out of and in the course of employmentPermanent DisabilityDue ProcessPulmonologistInternistOphthalmologistOtolaryngologist
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ1700987
Regular
Nov 03, 2010

RAY WRIGHT vs. MITCHELL CONCRETE, APPLIED RISK OMAHA

The defendant sought removal of a WCJ's finding that an orthopedic QME was not authorized to select an internal medicine QME, arguing Administrative Director Rule 32 permitted it. The Appeals Board denied the petition for removal. Removal is an extraordinary remedy granted only upon a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. The Board adopted the WCJ's reasoning and concluded reconsideration would be an adequate remedy.

QME panelAMEAdministrative Director Rule 32AD Rule 31.7petition for removalsubstantial prejudiceirreparable harmreconsiderationWorkers' Compensation Appeals BoardWCJ
References
Case No. ADJ8185753
Regular
Jul 23, 2015

JUAN ZEPEDA vs. BERBERIAN NUT COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES. INC.

The Workers' Compensation Appeals Board denied the defendant's petition for removal. The defendant sought to remove a finding and order requiring a new medical evaluation by an internist, arguing it was unnecessary and prejudicial. The Board found that the applicant demonstrated good cause for the additional evaluation, supported by prior medical reports and testimony indicating the need for an internist to assess specific industrial complaints. The Board concluded the defendant failed to show substantial prejudice or irreparable harm.

Petition for RemovalFinding and OrderQualified Medical Evaluator (QME)Internal MedicineDisputed Medical IssueDWC Regulation 31.7(b)Substantial PrejudiceIrreparable HarmWCJ Report and RecommendationMedical Record Development
References
Case No. ADJ3855232 (LAO 0400735)
Regular
Apr 01, 2015

Roberto Barrero vs. Knudsen Dairy Corporation, Fireman's Fund Insurance Company

This case involves a dispute over the compensability of cardiovascular injury and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) following a 1975 industrial injury. The Workers' Compensation Appeals Board (WCAB) affirmed the findings that the applicant failed to prove CIDP was work-related but sustained his burden that cardiovascular treatment is a compensable consequence of the industrial injury. The WCAB clarified that enforcing medical treatment for the cardiovascular condition, which arose during authorized back surgery, falls under its continuing jurisdiction, not a prohibited amendment of the original award more than five years post-injury. Medical opinions regarding causation were found to constitute substantial evidence, resolving conflicting expert testimony.

Workers' Compensation Appeals BoardRoberto BarreroKnudsen Dairy CorporationFireman's Fund Insurance CompanyADJ3855232Van Nuys District OfficeOpinion and Decision After ReconsiderationFindings of FactWCJindustrial injury
References
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