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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ10789448
Regular
Mar 07, 2023

MARCELO CHAN HAU vs. BARRETT BUSINESS SERVICES, INC., ACE AMERICAN INSURANCE COMPANY, CORVEL CORPORATION

The Workers' Compensation Appeals Board affirmed a prior decision denying liens for medical treatment provided by claimants Ira Reinherz Chiropractic Inc. and Sachet Pream. The Board found that the applicant received treatment within the employer's Medical Provider Network (MPN) and that there was no evidence the defendant denied medical treatment or failed to comply with MPN regulations. Therefore, the defendant was not liable for the self-procured treatment provided by the lien claimants outside the MPN. The claimants' argument regarding procedural time requirements was also rejected.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNLien ClaimantsFindings of Fact and OrderAdministrative Director RulesAOE/COEQualified Medical ExaminerQMEMaximum Medical Improvement
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. ADJ7433042, ADJ7433045, ADJ7433048
Regular
Aug 06, 2013

MARIA GOMEZ vs. HARRIS RANCH BEEF CO., AIMS INSURANCE CO.

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of a prior decision. The WCJ disallowed the lien claimant's lien for medical treatment, finding that the lien claimant failed to prove the treatment was reasonable and necessary, and its charges were reasonable. The Board affirmed the WCJ's decision, holding that the lien claimant did not meet its evidentiary burden, and denied the petition.

Lien claimantPetition for ReconsiderationJoint Findings of Fact and Ordersubstantial evidencedisallowance of liensCompromise and Releaseuntimely serviceex parte communicationsubstantial medical evidencereasonable and necessary treatment
References
Case No. ADJ8947837
Regular
Jun 09, 2015

JOSE JIMENEZ vs. BARRETT BUSINESS SERVICES, INC.; CORVEL

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and issued a new finding that applicant Jose Jimenez sustained industrial injury to his back, as stipulated by the parties. The Board deferred issues regarding injury to lower extremities, psyche, and internal systems, as well as maximum medical improvement (MMI) and temporary total disability indemnity. The Board noted defendant's failure to properly serve the petition for reconsideration but declined to dismiss it, issuing a strong admonishment for future compliance.

Petition for ReconsiderationFindings and AwardMaximum Medical Improvement (MMI)Temporary Total Disability (TTD) indemnityStipulationMedical Provider Network (MPN)Qualified Medical Evaluator (QME)Substantial EvidenceMedical OpinionPermanent and Stationary Date
References
Case No. ADJ6808453
Regular
Dec 14, 2012

JOSEFINA PARRA vs. CHULA VISTA ELEMENTARY SCHOOL DISTRICT, TRISTAR RISK MANAGEMENT

The Appeals Board dismissed the defendant's petition for reconsideration and denied their petition for removal. The Board found the WCJ's order to develop the medical record was not a final order, making reconsideration improper. Furthermore, the Board agreed that the defendant failed to demonstrate sufficient grounds for removal and found the PQME's opinions lacking substantial evidence due to insufficient rationale. The Board affirmed the need to further develop the medical record, specifically by re-evaluating the applicant with her treating physician.

WCABPetition for ReconsiderationPetition for RemovalFindings and OrdersPanel Qualified Medical EvaluatorPQMEsubstantial evidencedevelop the medical recordtreating physicianorthopedic surgeon
References
Case No. ADJ7056858
Regular
Mar 26, 2012

JISIFRIDO CHAVEZ vs. MENASHA CORPORATION, SENTRY INSURANCE COMPANY

This case involves an applicant who sustained a shoulder injury and underwent two surgeries. The defendant sought reconsideration of an award of temporary disability, arguing the applicant had reached maximum medical improvement and was subject to the 104-week statutory cap. The Workers' Compensation Appeals Board denied reconsideration, adopting the WCJ's report. The WCJ found the applicant had not reached maximum medical improvement, supported by medical evidence indicating continued pain and failed surgical repair, and the defendant's arguments regarding the cap were already addressed.

Workers' Compensation Appeals BoardReconsideration DeniedLabor Code Section 4656Temporary DisabilityPermanent and StationaryAgreed Medical ExaminerRotator Cuff RepairMaximum Medical ImprovementModified DutyShoulder Injury
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
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