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

Case No. ADJ11114421
Regular
Jun 05, 2025

FELIX CABRERA vs. OAA INVESTMENTS, INC.; CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

Defendant California Restaurant Mutual Benefit Corporation (CRMBC) sought reconsideration of a February 19, 2021 Findings and Order (F&O) which found CRMBC liable for coverage of applicant Felix Cabrera's injury, ruling that CRMBC's policy cancellation was premature. CRMBC contended it had no coverage obligations as the applicant was employed by OAA Investments, Inc., not insured by CRMBC, and argued against the applicability of Insurance Code section 676.8. The Appeals Board affirmed the WCA's F&O, treating the petition as one for reconsideration, and found that under Insurance Code section 676.8 and equitable principles, CRMBC was liable for coverage. The Board reasoned that due to a material change in ownership, CRMBC's cancellation notice required 30 days' notice, making January 27, 2018, the earliest effective cancellation date, which was after the November 22, 2017 injury date.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPolicy CancellationInsurance Code Section 676.8Material Change in OwnershipEquitable EstoppelAffiliate Certificate of Consent to Self-InsureGroup Self-InsurerAD Rule 15480
References
Case No. ADJ7148195
Regular
Jan 03, 2020

KARIN SMITH vs. MARIN GENERAL HOSPITAL, ATHENS ADMINISTRATORS

This case concerns defendant's petition for reconsideration of an award for applicant's back surgery. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirmed the award, and corrected a clerical error in the case number. The WCAB found that while an initial surgery request was denied via Utilization Review (UR) and Independent Medical Review (IMR), the applicant's treating physician later submitted a new request supported by documented changes in material facts, including new neurological symptoms and an MRI showing critical stenosis and potential cauda equina syndrome. Because the second request indicated an imminent and serious threat to the applicant's health and was based on new medical evidence, the 12-month UR decision validity period did not apply.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardUtilization ReviewIndependent Medical ReviewLabor Code Section 4610(k)Documented Change in ConditionLumbar Spine SurgeryNurseCauda Equina Syndrome
References
Case No. ADJ8750816
Regular
Jul 31, 2014

KAMIKA BEASLEY vs. SECURITAS, SEDGWICK

The Workers' Compensation Appeals Board granted the applicant's petition for removal, reversing the prior denial of a change of venue. The applicant demonstrated good cause by residing in Vallejo, her injury occurring in Sacramento, and no longer having an attorney in the original Anaheim venue. Therefore, the case venue was changed to the Oakland district office, and the trial was continued.

Petition for RemovalChange of VenueWorkers' Compensation Appeals BoardPresiding Workers' Compensation Administrative Law JudgePetition to Change VenuePetition for Change of VenueGood CauseMandatory Settlement ConferenceApplication for Adjudication of ClaimIndustrial Injury
References
Case No. ADJ247666 (AHM 0049425) ADJ2739663 (AHM 0049426)
Regular
Jul 11, 2017

STEVE CHEGWIN vs. SBC/PACIFIC BELL TELEPHONE; Permissibly Self-Insured, Administered By SEDGWICK CLAIMS SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Reconsideration. Although the WCJ initially recommended dismissal as untimely, the WCAB found the petition timely because the amended award, correcting a date for permanent disability indemnity, constituted a material change extending the reconsideration period. Despite finding the petition timely, the WCAB adopted the WCJ's reasoning for denying reconsideration on the merits. The WCAB found that the amendment regarding the start date of permanent disability indemnity was a substantial change, and the issue was sufficiently interwoven with the overall award to extend the reconsideration deadline.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeJoint Findings and AwardAmended Joint Findings and AwardPermanent Disability IndemnityClerical ErrorMaterial ChangeJudicial FunctionInterwoven Award
References
Case No. ADJ11509125, ADJ11509591, ADJ13194436
Regular
Dec 15, 2020

ALEX MEJIA vs. LINEAGE LOGISTICS, CORVEL

The Appeals Board granted Lineage Logistics' petition for removal, rescinding an order that changed venue for claim ADJ13194436 to Long Beach. The Board found the record procedurally confused, noting conflicting actions by different district offices and an order that incorrectly stated parties jointly agreed to the venue change despite an objection. The matter is returned to the trial level to address consolidation and proper venue for all three applicant claims.

Petition for RemovalChange of VenueConsolidation of ClaimsProcedural ConfusionAdjudication NumbersDistrict OfficeWorkers' Compensation Appeals BoardCumulative TraumaPetition to ConsolidateNotice of Intention to Change Venue
References
Case No. ADJ10149777
Regular
Dec 31, 2015

TIMOTHY PRATT vs. SOUTHERN MARIN FIRE PROTECTION DISTRICT, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied the applicant's petition for removal, upholding a prior order changing the venue from Oakland to Redding. The change was granted because the applicant resides in Grass Valley, and the Redding District Office is the closest Appeals Board office to that location. The applicant failed to demonstrate factual prejudice stemming from the venue change. Therefore, the original venue change order is affirmed.

Petition for RemovalVenue ChangeLabor Code Section 5501.5Workers' Compensation Appeals BoardAdministrative Law JudgeOakland District OfficeRedding District OfficeApplicant ResidenceAttorney Principal Place of BusinessCumulative Trauma
References
Case No. ADJ9585461
Regular
Feb 02, 2017

TONY DE LA GARZA vs. ROLL GLOBAL/DEL REY JUICE PLANT dba POM WONDERFUL, Permissibly Self-Insured, Administered by BROADSPIRE

The WCAB dismissed the defendant's Petition for Removal, treating it as a Petition for Reconsideration, and denied it. The Board affirmed the WCJ's order requiring the defendant to authorize surgical treatment. The defendant's initial challenge was based on a prior IMR denial, but the Board found a material change in facts occurred when the treating physician clarified the surgery's non-cosmetic, functional purpose. The Board concluded the subsequent UR certification was valid and the defendant must authorize the treatment.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderUtilization ReviewIndependent Medical ReviewMedical TreatmentSurgical ProcedureScar DeformityPainful Scar
References
Case No. ADJ10034122
Regular
Dec 22, 2017

CRYSTAL WYANT vs. AMERICAN MEDICAL RESPONSE, ACE AMERICAN INSURANCE COMPANY

This case concerns an applicant's industrial back injury requiring lumbar spinal fusion. Defendants sought to overturn a prior award granting ongoing medical treatment, arguing a subsequent Utilization Review (UR) certification was invalid. The Appeals Board denied reconsideration, finding the UR process was correctly followed. A second Request for Authorization (RFA) submitted by the applicant's physician included "Change in Material Facts," triggering a new review. This second UR decision, dated September 11, 2017, authorized the surgery as medically necessary, superseding the earlier denial.

Utilization ReviewIndependent Medical ReviewReconsiderationFindings and AwardAdministrative Law JudgeLabor Code Section 4610Request for AuthorizationLumbar Spinal FusionMedical TreatmentChange in Material Facts
References
Case No. ADJ3867943 [SFO 0511706] ADJ 1789690 [SFO 0511707]
Regular
Sep 03, 2008

DOUGLAS MUNYER vs. STATE OF CALIFORNIA, CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES (Adjusting Agent)

The WCAB granted the defendants' petition for removal, rescinding a prior order that denied a change of venue. The Board found the judge's subsequent order changing venue was void due to exceeding jurisdictional time limits. However, the Board then exercised its removal power to grant the venue change to Sacramento.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationPetition for RemovalOrder Denying Change of VenuePresiding Workers' Compensation Administrative Law JudgeLabor Code Section 5310WCAB Rule 10843WCAB Rule 10859Interlocutory orderFinal order
References
Case No. ADJ10962162
Regular
May 17, 2018

ANNA MONTANARO vs. KEY CODE MEDIA, INC., HANOVER INSURANCE GROUP

The Workers' Compensation Appeals Board (WCAB) dismissed a petition for reconsideration because the order changing venue was not a final decision. The WCAB granted a petition for removal and rescinded the order changing venue to investigate whether the defendant received proper notice and an opportunity to object to the venue change. This due process concern arose because there was no proof of service for the notice of intent to change venue. The matter was returned to the Presiding WCJ for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Changing VenueNotice of Intent to Change VenueDue ProcessProof of ServiceInterlocutory OrderFinal OrderSubstantive Right
References
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