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Case Law Database

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

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ9625407
Regular
Sep 12, 2018

KEITH FIELD vs. CITY OF PINOLE

This case involves a firefighter who sustained bilateral carpal tunnel syndrome after retirement. The Appeals Board reversed the trial judge, holding that Labor Code section 4458.5 applies, entitling the applicant to permanent disability benefits calculated at the maximum indemnity rate. This applies regardless of the applicant's actual earnings or the fact that carpal tunnel syndrome is not a specifically enumerated presumptive injury. The case is remanded for determination of the precise date of injury to calculate the benefit rate.

Workers' Compensation Appeals BoardKeith FieldCity of PinolePermissibly Self-InsuredMunicipal Pooling AuthorityADJ9625407Opinion and Decision After Reconsiderationindustrial injuryfirefighterbilateral upper extremities
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ3849140 (RDG 0119253)
Regular
Apr 04, 2011

THEMAS TRESLER vs. MOUNTAIN SATELLITE, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over workers' compensation jurisdiction regarding a left shoulder injury. The defendant, SCIF, sought reconsideration of a WCJ's award of treatment for the shoulder, arguing lack of jurisdiction. The Appeals Board granted reconsideration, rescinded the prior award, and returned the matter for further proceedings. This decision acknowledges that the left shoulder claim may not have been definitively resolved by prior stipulations and requires the WCJ to determine if Labor Code section 5815 applies, potentially leading to a full hearing on the shoulder injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryLeft Shoulder InjuryStipulation with Request for AwardDeclaration of Readiness to ProceedContinuing JurisdictionLabor Code Section 5909
References
Case No. ADJ10029050
Regular
Mar 11, 2016

MARIBEL SANCHEZ vs. GRAPEVINE CATERING, SECURITY NATIONAL INSURANCE COMPANY

The Board dismissed the Defendant's Petition for Reconsideration because it was not taken from a final order, as only final orders are subject to reconsideration under Labor Code section 5900(a). The WCJ's order concerning the invalidity of a QME panel and the issuance of a new one was deemed an interlocutory discovery matter, not a final decision. Even if considered a petition for removal, the Board would have denied it on the merits because the Medical Unit misinterpreted QME Regulation 30(d)(1) by limiting QME panel requests to defendants, which conflicts with Labor Code sections 4060 and 4062.2. The Board expressed no opinion on the appropriateness of the pain management specialty, noting the Defendant could dispute it separately.

QME panelMedical Unitpain managementorthopedicsPetition for Reconsiderationfinal orderLabor Code section 5900Maranian v. Workers' Comp. Appeals Bd.removalLabor Code section 5310
References
Case No. ADJ10021120 ADJ8949346
Regular
Apr 14, 2017

ANTHONY BERNARD EDWARDS (Dec'd), CANDACE EDWARDS (Widow), ASHLEY EDWARDS (Daughter), ANTHONY EDWARDS, JR. (Son) vs. CITY OF LOS ANGELES; LOS ANGELES WORLD AIRPORTS, Permissibly Self-Insured

This case involves a workers' compensation death benefit claim for Anthony Bernard Edwards, who died in the course of his employment. The dependents seek death benefits and burial expenses, which were initially awarded by the WCJ. The employer, City of Los Angeles, sought reconsideration, arguing it should receive credit for a third-party settlement the dependents obtained from Kaiser Permanente. The Board agreed to reconsider the issue of credit, specifically whether Civil Code section 3333.1 bars such credit. The Board ultimately deferred the credit issue, affirming the death benefit award and returning the matter for further proceedings to determine the applicability of Civil Code section 3333.1 and potential employer negligence.

Workers' Compensation Appeals BoardADJ10021120ADJ8949346death benefitsLabor Code section 4702burial expensesCivil Code section 3333.1Medical Injury Compensation Reform ActMICRAthird-party settlement
References
Case No. ADJ613558 (LBO 0358811)
Regular
Nov 04, 2011

IRMA LARA vs. JAY AND ELLEN KAUFMAN, STATE FARM INSURANCE

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration regarding payment for interpreter services. The Board found that the lien claimant waived certain claims by failing to serve the petition on the applicant and her attorney, and by not explicitly claiming fees under Labor Code section 5710(b)(5). Regarding a contested payment, the Board noted evidence of a payment that should satisfy the outstanding amount, and denied sanctions for alleged late payment, as the lien claimant did not sufficiently prove the defendant failed to contest liability within the prescribed timeframe.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantStipulations and AwardInterpreter ServicesLabor Code Section 5811(b)No-Show FeesDeposition PreparationWCJ Report and RecommendationProof of Service
References
Case No. ADJ14297412; ADJ14297399
Regular
Sep 29, 2025

DAVID OLIVAS vs. ECKLES AUTO BODY, INC.; PREFERRED PROFESSIONAL INSURANCE COMPANY

The case involves David Olivas, an auto body worker, who sustained specific and cumulative trauma injuries and settled his claims via a Joint Compromise and Release. The defendant, Eckles Auto Body, Inc. and Preferred Professional Insurance Company, denied payment for interpreting services provided by Marjorie Martinez, citing untimely submission under Labor Code section 4603.2(b). The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Reconsideration. The Board affirmed that Labor Code section 4603.2(b) does not apply to interpreting services for Compromise and Release settlement documents, as it is limited to medical treatment-related services, concluding such services fall under a different regulatory framework for costs which lacks the 12-month billing requirement.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5909Electronic Adjudication Management System (EAMS)transmission date60-day deadlinenotice of transmissionReport and RecommendationState Comp. Ins. Fund v. Workers' Comp. Appeals Bd. (Dorsett)Labor Code section 4663
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
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