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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ9725603
Regular
Nov 23, 2020

LUZ LOZA vs. GOLDBLATT GOLDBLATT/BAY AREA RESTAURANT MANAGEMENT, ARCH INSURANCE COMPANY, administered by YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's order finding the applicant entitled to pre-authorization for their treating physician to issue a PR-4 report at the medical-legal billing rate. While affirming the applicant's right to obtain the report, the Board clarified that the defendant retains the right to object to or raise defenses regarding the physician's billing. The Board reasoned that treating physicians are permitted to provide comprehensive medical-legal evaluations, and such reports are governed by specific medical-legal fee schedules, not the Official Medical Fee Schedule.

PR-4 reportmedical-legal billing ratepre-authorizationprimary treating physician (PTP)Qualified Medical Evaluator (QME)comprehensive medical evaluationOfficial Medical Fee SchedulePetition for ReconsiderationFindings of Fact and Order (F&O)Labor Code
References
Case No. ADJ15763825
Regular
Sep 16, 2025

CLAUDIO CARDOZO vs. ROCK AND ROLL CAR WASH, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by Redwood Fire and Casualty Insurance Company dba Berkshire Hathaway Homestate Companies. The petition challenged a lien trial decision concerning a medical-legal evaluation performed by Dr. Michaels of Premier Psychological Services. The WCJ found that a medical dispute regarding psyche existed at the time of the evaluation, Dr. Michaels was validly designated as the Primary Treating Physician, and the evaluation was not barred by the 60-day rule for new claims as it was an amendment to an already accepted claim. The Appeals Board adopted the WCJ's reasoning and denied the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Adjudication NumberOpinion and Order Denying PetitionWCJ ReportEAMS TransmissionNotice of TransmissionProof of ServiceFindings and Order
References
Case No. ADJ2904305 (GOL 0095697) ADJ1827151 (GOL 0095698)
Regular
Aug 02, 2010

GUADALUPE CARRILLO vs. SAN ANTONIO VILLAGE HOA, STATE FARM INSURANCE COMPANIES

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration regarding a disallowed lien balance of $9,349.46. The claimant, a doctor, failed to obtain required written authorization for work hardening services billed under CPT Code 97545. Despite a claim of verbal authorization and a general request for multiple modalities, the Board found the lack of specific written authorization for the disputed services to be determinative. Therefore, the administrative law judge's disallowance of the lien balance was upheld.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationCompromise and ReleaseWork hardeningWork conditioningCPT Code 97545Prior authorizationVerbal authorizationWritten authorization
References
Case No. MON 0325089 MON 0325090
Regular
Oct 05, 2007

NORA MEDEARIS vs. COUNTY OF LOS ANGELES

This case concerns the denial of an applicant's petition for reconsideration of a workers' compensation award. The applicant sought further temporary disability benefits beyond the 104-week limit imposed by Labor Code § 4656(c)(1). The Workers' Compensation Appeals Board denied the petition, finding the applicant failed to prove equitable estoppel against the defendant's application of the statutory limit, despite the defendant's initial refusal to authorize shoulder surgery. The Board adopted the WCJ's reasoning that the applicant did not demonstrate reliance on any conduct by the defendant that prevented her from timely pursuing authorization for the surgery.

Workers' Compensation Appeals BoardNora MedearisCounty of Los AngelesPermissibly Self-InsuredMON 0325089MON 0325090Opinion and Order Denying Petition for ReconsiderationInterim Joint Findings and AwardCentral Services TechnicianIndustrial Injury
References
Case No. ADJ2444225 (GRO 0016225) ADJ811699 (GRO 0016226) ADJ4137711 (GRO 0016352)
Regular
Aug 04, 2009

DWIGHT SMITH vs. STATE OF CALIFORNIA, CALIFORNIA YOUTH AUTHORITY, legally uninsured, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES, adjusting agency

This case involves a California Supreme Court decision that reversed an award of attorney's fees to the applicant's counsel. The Court found that Labor Code section 4607 did not authorize such fees, overturning previous decisions by the WCJ and the Appeals Board. Consequently, the Appeals Board reinstated its original order denying reconsideration and attorney's fees.

Workers' Compensation Appeals BoardRemittiturAttorney's feesLabor Code section 4607ReconsiderationDenying ReconsiderationCalifornia Supreme CourtCourt of AppealLegally uninsuredAdjusting agency
References
Case No. ADJ4639220 (MON 0324133)
Regular
Nov 03, 2014

ARMAND LA COUNT vs. LOS ANGELES COUNTY METROPOLITAN TRANSIT AUTHORITY

In *La Count v. Los Angeles County Metropolitan Transit Authority*, the Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration. This action was taken due to the WCAB's belief that further study of the factual and legal issues was necessary for a just and reasoned decision. The Board granted reconsideration to allow sufficient opportunity to fully understand the case record and potentially conduct further proceedings. Consequently, all future filings are to be submitted in writing to the WCAB Commissioners in San Francisco, not to district offices or via e-filing.

Petition for ReconsiderationWorkers' Compensation Appeals BoardLos Angeles County Metropolitan Transit AuthorityPermissibly Self-InsuredDecision After ReconsiderationElectronic Adjudication Management SystemStatutory time constraintsFactual and legal issuesJust and reasoned decisionCommissioners
References
Case No. ADJ7630224
Regular
Nov 29, 2012

TINA SPERBER vs. LAW OFFICES OF LISA M. PACIONE

This case involves Tina Sperber's workers' compensation claim against her employer, Law Offices of Lisa M. Pacione. The applicant, a legal assistant, sustained an injury while investigating a property related to a case, claiming implied authorization. The Workers' Compensation Appeals Board denied reconsideration, upholding the judge's finding that the applicant was not a credible witness regarding her authority. The Board agreed that the applicant lacked permission for the investigation and that the information gathered provided no benefit to the defendant.

Workers' Compensation Appeals BoardDenying ReconsiderationLegal AssistantLaw OfficesInvestigationImplied AuthorizationCredibilityBenefit to DefendantFamily Law ProceedingsAdministrative Law Judge
References
Case No. GRO 0021432
Regular
Apr 28, 2008

Theodore Maiso vs. State of California, Department of Mental Health, State Compensation Insurance Fund, State Contract Services

This case involves a petition for reconsideration by applicant Theodore Maiso against the State of California, Department of Mental Health. The Workers' Compensation Appeals Board denied reconsideration, adopting the WCJ's report and reasoning. The Board also corrected a technicality by ordering the substitution of "State of California, Division of Workers' Compensation, Workers' Compensation Appeals Board" in place of "State of California, Division of Workers' Compensation" in the WCJ's decision headings to accurately reflect the judicial authority.

WORKERS' COMPENSATION APPEALS BOARDTheodore MaisoState of California Department of Mental HealthLegally UninsuredState Compensation Insurance FundAdjusting AgencyOrder Denying ReconsiderationWorkers' Compensation Administrative Law JudgeJudicial AuthorityOriginal Jurisdiction
References
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