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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. ADJ1934243 (FRE 0221043)
Regular
Apr 25, 2011

MARIA RAYOS vs. WALGREENS, ZURICH INSURANCE COMPANY

This case concerns a dispute over a second Qualified Medical Examiner (QME) for an applicant with a work-related knee, back, and hip injury. The defendant sought removal, arguing that allowing a second QME without striking the first QME's reports violated due process and would taint the new evaluation. The Appeals Board granted removal, amended the prior order, and clarified that a new QME is allowed. However, the admissibility of the first QME's reports is deferred to the trial judge, and those reports, unlike diagnostic study results, are not to be provided to the new evaluator.

Petition for RemovalQualified Medical Evaluator (QME)Admissibility of ReportsDue ProcessWorkers' Compensation Appeals Board (WCAB)Administrative Law Judge (WCJ)Industrial InjuryMedical EvaluationsDiscoveryMandatory Settlement Conference (MSC)
References
Case No. ADJ7212946
Regular
Dec 13, 2012

JOSE QUINTERO vs. CORPORATE PERSONNEL NETWORK, NEW HAMPSHIRE INSURANCE CO., administered by CHARTIS

The Appeals Board granted reconsideration to address the admissibility of Dr. Konstat's psychiatric evaluation. The Board found Dr. Konstat's report inadmissible because it was a medical-legal evaluation obtained in violation of statutory procedures for represented employees, bypassing the requirement for an Agreed Medical Evaluator or Qualified Medical Evaluator. Consequently, the Board amended the prior award to exclude industrial injury to the psyche due to lack of substantial medical evidence. The applicant's award for orthopedic injuries and medical treatment was affirmed.

Workers' Compensation Appeals BoardJose QuinteroCorporate Personnel NetworkNew Hampshire Insurance Co.ChartisAmended Findings and Awardindustrial injuryleft shoulderneckback
References
Case No. ADJ8939533
Regular
Dec 23, 2019

MAURICIO FLORES vs. MERCY HOUSING, INC., FEDERAL INSURANCE COMPANY

This case concerns an employer's petition for reconsideration regarding the denial of a new Qualified Medical Evaluator (QME) panel. The applicant amended his claim to include a cumulative trauma injury and additional body parts, but he did not file a new claim form. The Board denied the petition, holding that because the applicant amended an existing application and did not file a new claim form, the employer was not entitled to a new QME panel. The ruling relies on the principle that the filing date of the claim form determines which evaluator considers the injury claim.

Cumulative traumaQualified Medical EvaluatorQME panelAmendment of ApplicationDWC-1 Claim FormNavarro v. City of MontebelloThreshold issueInterlocutory decisionRemovalReconsideration
References
Case No. ADJ9845740
Regular
Dec 18, 2019

RICHARD OKUNIEWICZ vs. CHRISTOFFERSON TRANSPORTATION, QBE-PRAETORIAN INSURANCE COMPANY

This case concerns an employer's petition for removal challenging a judge's order denying a motion to compel an in-person vocational evaluation. The Appeals Board denied the petition, treating it as a reconsideration request because the underlying order resolved threshold issues. Although the decision was final regarding threshold matters, the Board reviewed the discovery dispute under the extraordinary removal standard. The majority found no significant prejudice or irreparable harm from denying the in-person evaluation, as a remote evaluation was deemed sufficient.

Petition for ReconsiderationPetition for RemovalFindings and OrderMedical-Legal EvaluationCompelSignificant PrejudiceIrreparable HarmThreshold IssueInterlocutory IssueVocational Evaluation
References
Case No. STK 0157805
Regular
Jan 14, 2008

Barbara Wright vs. BROWN & WILLIAMSON TOBACCO COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the lower judge's decision, finding that the applicant *did* show good cause to reopen her claim for new and further disability. The Board held that the initial petition's lack of specificity was waived by the defendant and that the applicant was not precluded from claiming new body parts or increased disability due to prior stipulations. The case was returned to the trial level for further proceedings on the merits of the new and further disability claim.

Petition to ReopenNew and Further DisabilityStipulated AwardMedical EvaluationCarpal Tunnel SyndromeThoracic SpineGood CauseInformality of PleadingsIn Camera ReviewPanel Qualified Medical Evaluator
References
Case No. ADJ2182506 (SFO 0470932)
Regular
Jun 08, 2010

LARRY CHIAPPELLONE vs. NORCAL/GOLDEN GATE DISPOSAL and RECYCLING COMPANY, JT2 INTEGRATED SERVICES

This case involved a defendant's petition for removal seeking a new Qualified Medical Evaluator (QME) due to alleged delays. The Appeals Board denied the petition, adopting the WCJ's reasoning that Labor Code section 4062.5 and related regulations do not mandate a new QME for untimely supplemental reports. Specifically, regulations address timeframes for initial evaluations, not supplemental ones, and the failure to meet supplemental report deadlines does not necessitate a new QME. Therefore, the WCJ's denial of the defendant's motion was not an abuse of discretion.

Petition for RemovalQualified Medical EvaluatorSupplemental ReportRegulatory TimeframesLabor Code Section 4062.5Administrative Director Rule 38(h)WCJ DiscretionNew Panel QMEMedical Evaluation ProcessReappointment Grounds
References
Case No. ADJ9011624
Regular
Dec 13, 2019

ELISHA HARDEN vs. COUNTY OF SACRAMENTO

This case concerns whether specific medical reports obtained for a disability retirement claim are admissible in a workers' compensation proceeding. The Appeals Board rescinded the prior ruling, holding these reports are relevant and may be provided to the orthopedic Agreed Medical Evaluator (AME) and psychiatric Qualified Medical Evaluator (QME). The Board found the reports relevant to the medical issues, even though they were not obtained through the standard workers' compensation medical-legal evaluation process. Consequently, the applicant's objection to providing these reports to the evaluators was overruled.

RemovalReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Medical-legal evaluatorsMedical recordsLabor CodeFindings and Orders (F&O)Disability retirementPermanent impairment
References
Case No. ADJ1813115
Regular
Sep 17, 2012

JOSE GALARRETA vs. H.R. STAFFING, STATE COMPENSATION INSURANCE FUND

This case involves a worker seeking to reopen his workers' compensation claim based on alleged new and further disability. The applicant argued that a Qualified Medical Evaluator's report used by the judge was improperly admitted. However, the Board denied reconsideration, finding the applicant waived his objection by not raising it until trial, effectively permitting "doctor shopping." The Board also affirmed the administrative law judge's reliance on the evaluator's report over the treating physician's, finding no compelling reason to overturn the determination of no new and further disability.

new and further disabilitypetition to reopenqualified medical evaluatorLabor Code section 4062.3(j)waiver of objectioninvited errorTelles TransportFajardoCounty of Sonomamedical evaluator timeliness
References
Case No. ADJ7511305
Regular
Nov 29, 2010

BENNETT IORNS vs. R & L BROSAMER, INC., SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision regarding a reopened claim for deep vein thrombosis (DVT). The Board found the original record inadequate and the Arbitrator's decision lacked proper explanation and proper procedure. The matter was returned for further development of the medical record, including a new Independent Medical Evaluator evaluation, and for a new decision after proper submission. This ensures due process and a clear evidentiary basis for future rulings.

Petition for ReconsiderationNew and Further DisabilityDeep Vein Thrombosis (DVT)Waiver of IssueDue ProcessIndependent Medical Evaluator (IME)Summary of EvidenceSubstantial EvidenceHamilton v. LockheedAlternative Dispute Resolution (ADR)
References
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