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Case Law Database

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

Case No. ADJ11017003

Regular

May 19, 2025

ABEL VAZQUEZ vs. INOCENSIO RENTERIA, ZENITH INSURANCE CO.

The Appeals Board, in an en banc decision, addressed the replacement of a Qualified Medical Evaluator (QME) when unable to schedule a re-evaluation within 120 days. It clarified that while Administrative Director Rules provide guidance, the Appeals Board retains discretionary power to order QME replacement for good cause, based on factors like delay, prejudice, and efforts to remedy unavailability. The Board granted the applicant's petition for reconsideration, rescinded the prior Findings and Order by the WCJ, and returned the matter for further proceedings, applying its new interpretation prospectively.

WCABen bancQME replacementAD Rule 31.3good causeprocedural issueremoval standardreconsiderationthreshold issuepermanent impairment

References

Case No. ADJ2913113

Regular

Jul 21, 2025

OSCAR VILLALOBOS vs. J.V. INDUSTRIAL COMPANIES, LTD.; ZURICH AMERICAN INSURANCE COMPANY

This case involves Oscar Villalobos, the applicant, who sustained injuries while employed by J.V. Industrial Companies. The defendant, J.V. Industrial Companies and Zurich American Insurance Company, sought to suspend proceedings because the applicant refused a follow-up medical examination by an Agreed Medical Evaluator (AME), Dr. Newton. The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration. The WCAB rescinded the Workers' Compensation Judge's (WCJ) February 3, 2025 Findings of Fact and returned the matter to the trial level, citing due process concerns and the necessity of a complete evidentiary record regarding the substantiality of the AME's reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAgreed Medical EvaluatorLabor Code section 4053suspend proceedingssubstantial medical evidencedue processequitable tollingShipley doctrine

References

Case No. ADJ15251480

Regular

Jun 03, 2025

JACOB DIPIERO vs. CITY OF CAMPBELL, TRISTAR RISK MANAGEMENT

Applicant Jacob DiPiero sought reconsideration of a WCJ's decision regarding jurisdiction over advance disability pension payments (ADPP). The WCJ had initially found the Appeals Board lacked jurisdiction to determine ADPP entitlement under Labor Code section 4850.4. The Appeals Board, referencing Gage v. Workers' Comp. Appeals Bd., concluded that ADPP constitutes compensation under Division 4 of the Labor Code, thus granting it exclusive jurisdiction over the matter. Consequently, the Board granted the applicant's petition for reconsideration, rescinded the WCJ's March 12, 2025 Findings of Fact and Order, and returned the case to the trial level for further proceedings on the merits of ADPP entitlement.

Advance Disability Pension PaymentsLabor Code Section 4850.4Gage v. Workers' Comp. Appeals Bd.JurisdictionWorkers' Compensation Appeals BoardCumulative Trauma InjuryPolice OfficerIndustrial Disability RetirementCalPERSSkelly Hearing

References

Case No. ADJ15158069

Regular

Nov 04, 2025

MIGUEL PULIDO vs. GOLDEN STATE FOODS CORP, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Miguel Pulido, who sustained industrial injuries in 2019, filed a petition for reconsideration after a WCJ ruled that a request for a home health assessment was subject to Utilization Review. The Workers' Compensation Appeals Board reviewed the petition and determined that the record was not sufficiently developed to make a final decision. Consequently, the Appeals Board granted the petition for reconsideration, deferring a final decision for further review of the factual and legal issues in the case.

Petition for ReconsiderationUtilization ReviewHome Health AssessmentMedical TreatmentAdmitted InjuryAOE/COERishi Garg M.D.Primary Treating PhysicianRequest for AuthorizationExpedited Hearing

References

Case No. ADJ3547384; ADJ1113447

Regular

Jul 07, 2025

JOSE BERRIOS vs. JERRYS FAMOUS DELI, CALIFORNIA INSURANCE COMPANY, INTERCARE HOLDINGS INSURANCE SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CENTRE INSURANCE

The applicant's current attorney petitioned for reconsideration of a Workers' Compensation Administrative Law Judge's (WCJ) order that awarded the entire $90,000 attorney's fee to the applicant's prior counsel due to the current attorney's failure to file a timely disclosure statement. The Appeals Board found that the current attorney's initial disclosure statement did not comply with Labor Code § 4906(e) and that payment is precluded for services rendered before a compliant form is filed. However, the Board granted the petition for reconsideration to allow further review of the factual and legal issues, noting that the order is not a final decision on the merits and encourages mediation.

Workers' Compensation Appeals BoardPetition for ReconsiderationAttorney's FeesLabor Code § 4906Disclosure StatementCompromise and ReleaseCIGACentre InsuranceWCJReconsideration Granted

References

Case No. ADJ19947925

Regular

May 19, 2025

Andres De Jesus Garcia vs. Slater's 50/50, Security National Insurance Company

Applicant, Andres De Jesus Garcia, sought reconsideration of a March 12, 2025 Findings and Award (F&A) which denied his request for a new primary treating physician (PTP) or a second opinion. The workers' compensation administrative law judge (WCJ) had found that the applicant reached maximum medical improvement (MMI) based on reports from his PTP and a panel qualified medical evaluator (PQME). Applicant contended he is entitled to a change of PTP or a second opinion within the medical provider network (MPN) under various Labor Code sections and WCAB Rules. The Appeals Board granted the Petition for Reconsideration, deferring a final decision after reconsideration to allow for further review of the factual and legal issues.

Petition for ReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Maximum Medical Improvement (MMI)Qualified Medical Evaluator (PQME)Labor Code sections 4616.3 and 4616.4WCAB Rules 9767.6(e) and 9767.7Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Labor Code section 5909Electronic Adjudication Management System (EAMS)

References

Case No. ADJ6840627; ADJ8645103

Regular

Mar 17, 2025

Dora Sosa, Gerardo Sosa vs. West Coast Computer Exchanges, Inc.; Everest National Insurance Company

Applicant Dora Sosa and Gerardo Sosa sought workers' compensation for injuries sustained on January 25, 2005, to the head, neck, right shoulder, and psyche while employed by West Coast Computer Exchanges, Inc., insured by Everest National Insurance Company. The Workers' Compensation Administrative Law Judge (WCJ) issued Findings of Fact, Awards and Orders on December 19, 2024, finding various points in favor of the applicant, including 65% permanent partial disability and temporary disability indemnity. Defendant petitioned for reconsideration, arguing against the WCJ's findings regarding the disability rating, temporary disability indemnity rate, duration of temporary disability, reimbursement for chiropractic treatment, and EDD's lien. The Appeals Board granted the defendant's petition for reconsideration, deferring a final decision pending further review of the merits and the entire record, citing several issues that require more examination.

ADJ6840627ADJ8645103Petition for ReconsiderationFindings of Fact Awards and OrdersCognitive impairmentPermanent partial disabilityTemporary disability indemnityQME reportingAMA GuidesLabor Code section 4656

References

Case No. ADJ10243805 ADJ10243806

Regular

Oct 20, 2025

ENELIA GARCIA vs. NORTHRIDGE HOSPITAL MEDICAL CENTER, SEDGWICK

Applicant Enelia Garcia filed a Petition for Removal (ADJ10243805) against minute orders setting a virtual trial and allowing a claims adjuster to appear virtually, citing due process violations and non-compliance with rules. Additionally, the applicant filed a Petition for Reconsideration (ADJ10243806) challenging a Findings and Order regarding new and further disability, occupational code, and the basis to reopen her case. The Workers' Compensation Appeals Board reviewed both petitions and granted them, rescinding the September 4, 2025 minute orders and the July 16, 2025 Findings and Order. The matters were returned to the WCJ for further proceedings consistent with the Board's opinion, emphasizing the importance of creating a proper record and ensuring due process.

RemovalReconsiderationVirtual TrialChicago DogsWCJMinute OrdersFindings and OrderStipulations and AwardNew and Further DisabilityOccupational Code

References

Case No. ADJ3776569, ADJ3927273

Regular

Apr 01, 2025

MARIA MARTINEZ vs. BOSS FASHION, INC.; CIGA for CALIFORNIA COMPENSATION INSURANCE COMPANY

Lien claimant The Dental Trauma Center sought reconsideration of a previous Workers' Compensation Administrative Law Judge (WCJ) order. The original order found that applicant Maria Martinez sustained industrial injuries but denied the lien claimant additional reimbursement for medical treatment. The Appeals Board granted the petition for reconsideration, citing potential errors by the WCJ regarding reimbursement entitlement and defendant's estoppel from denying reimbursement for dental reporting. However, the Board deferred a final decision after reconsideration, indicating further review of the merits and the entire record is required.

Lien ClaimantPetition for ReconsiderationUtilization ReviewDental Treatment ReimbursementDental ReportingEstoppelSubstantial EvidenceBurden of ProofPrimary Treating PhysicianQualified Medical Evaluator

References

Case No. ADJ10955805; ADJ10963100

Regular

Oct 20, 2025

DAVID SCHUPP vs. MAGIC MOUNTAIN LLC, PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORD

David Schupp, the applicant, filed workers' compensation claims for injuries to his right ankle, bilateral wrists, and knees while employed by Magic Mountain LLC. The defendant, Magic Mountain LLC, petitioned for removal challenging a Workers' Compensation Judge's (WCJ) findings regarding the Qualified Medical Evaluator (QME) process in pain management. The Appeals Board treated the petition as one for reconsideration, granted it under the removal standard, affirmed the WCJ's findings on employment, injury, and parts of the body, but deferred other interlocutory issues. The case is returned to the WCJ for further proceedings to address the validity of the QME panels, the timeliness and nature of the applicant's objection to a medical report, and potential prejudice to the defendant.

Workers Compensation Appeals BoardPetition for ReconsiderationRemovalJoint Findings and OrderQualified Medical EvaluatorPQMEPain ManagementLabor Code Section 4062.2Agreed Medical EvaluatorMedical Evaluation

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. ADJ11017003

Regular

May 19, 2025

ABEL VAZQUEZ vs. INOCENSIO RENTERIA, ZENITH INSURANCE CO.

WCABen bancQME replacementAD Rule 31.3good causeprocedural issueremoval standardreconsiderationthreshold issuepermanent impairment

References

Case No. ADJ2913113

Regular

Jul 21, 2025

OSCAR VILLALOBOS vs. J.V. INDUSTRIAL COMPANIES, LTD.; ZURICH AMERICAN INSURANCE COMPANY

References

Case No. ADJ15251480

Regular

Jun 03, 2025

JACOB DIPIERO vs. CITY OF CAMPBELL, TRISTAR RISK MANAGEMENT

References

Case No. ADJ15158069

Regular

Nov 04, 2025

MIGUEL PULIDO vs. GOLDEN STATE FOODS CORP, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Petition for ReconsiderationUtilization ReviewHome Health AssessmentMedical TreatmentAdmitted InjuryAOE/COERishi Garg M.D.Primary Treating PhysicianRequest for AuthorizationExpedited Hearing

References

Case No. ADJ3547384; ADJ1113447

Regular

Jul 07, 2025

JOSE BERRIOS vs. JERRYS FAMOUS DELI, CALIFORNIA INSURANCE COMPANY, INTERCARE HOLDINGS INSURANCE SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CENTRE INSURANCE

Workers' Compensation Appeals BoardPetition for ReconsiderationAttorney's FeesLabor Code § 4906Disclosure StatementCompromise and ReleaseCIGACentre InsuranceWCJReconsideration Granted

References

Case No. ADJ19947925

Regular

May 19, 2025

Andres De Jesus Garcia vs. Slater's 50/50, Security National Insurance Company

References

Case No. ADJ6840627; ADJ8645103

Regular

Mar 17, 2025

Dora Sosa, Gerardo Sosa vs. West Coast Computer Exchanges, Inc.; Everest National Insurance Company

References

Case No. ADJ10243805 ADJ10243806

Regular

Oct 20, 2025

ENELIA GARCIA vs. NORTHRIDGE HOSPITAL MEDICAL CENTER, SEDGWICK

RemovalReconsiderationVirtual TrialChicago DogsWCJMinute OrdersFindings and OrderStipulations and AwardNew and Further DisabilityOccupational Code

References

Case No. ADJ3776569, ADJ3927273

Regular

Apr 01, 2025

MARIA MARTINEZ vs. BOSS FASHION, INC.; CIGA for CALIFORNIA COMPENSATION INSURANCE COMPANY

References

Case No. ADJ10955805; ADJ10963100

Regular

Oct 20, 2025

DAVID SCHUPP vs. MAGIC MOUNTAIN LLC, PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORD

References

Showing 1-10 of 6,812 results

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