CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ9074552; ADJ9074553
Regular
Jul 01, 2014

VINCENT HERNANDEZ vs. COUNTY OF MONTEREY, INTERCARE HOLDINGS INSURANCE SERVICES, INC.

The Workers' Compensation Appeals Board dismissed the applicant's Petition for Removal regarding the selection of an Occupational Medicine QME panel. The Board adopted the WCJ's report, which found that the defendant's request for an Occupational Medicine QME panel complied with Labor Code Section 4062.2. The report reasoned that Title 8 California Code of Regulations Section 31.1(b)'s requirement for supporting documentation for specialty changes does not invalidate a request if not provided. Additionally, the Board found the applicant's arguments regarding an unfair advantage and the WCJ's interpretation of Section 31.1 to be misplaced.

Workers' Compensation Appeals BoardPetition for RemovalWCJQME panelOccupational MedicineTitle 8 California Code of Regulations Section 31.1Labor Code Section 4062.2Treating PhysicianPhysical Medicine and RehabilitationMedical Unit
References
Case No. ADJ12728611
Regular
Apr 09, 2020

MARTIN JACOBO vs. COKE FARM, RISICO CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal because the WCJ exceeded their authority by invalidating a Qualified Medical Examiner (QME) solely based on the specialty of occupational medicine for a post-surgical knee evaluation. The Board determined that an occupational medicine physician is appropriately qualified to assess such injuries according to DWC guidelines. Therefore, the WCJ's decision was rescinded, and the case was returned for further proceedings, suspending action on the Compromise and Release agreement pending further development.

Petition for RemovalPanel Qualified Medical ExaminerPQMEOccupational MedicineToxicologyPost-surgical kneeLabor Code section 4062.2(b)Administrative Director Rule 35.5Scope of practiceClinical competence
References
Case No. ADJ9348004
Regular
May 26, 2015

DOLORES NATIVIDAD vs. SHERBOURNE PROPERTIES, INC., EMPLOYERS COMPENSATION INSURANCE COMPANY

The defendant petitioned for removal, challenging the WCJ's decision to validate a chiropractic QME panel. The applicant failed to follow the rule requiring justification for requesting a specialty other than the treating physician's. However, the defendant's objection to the QME panel was deemed untimely as it was not raised with the Medical Unit promptly. The Appeals Board denied the petition for removal, finding the defendant failed to demonstrate prejudice or irreparable harm.

Petition for RemovalAmended Findings of Fact and OrderQualified Medical Evaluator (QME) panelAdministrative Director Rule 31.1(b)Labor Code section 4060occupational medicinechiropractic medicineorthopedic medicineMedical UnitDeclaration of Readiness to Proceed
References
Case No. ADJ9687796
Regular
Mar 23, 2015

MOHAMMAD RAFIQ vs. VILLAGE NURSERIES, APPLIED RISK

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought treatment outside the defendant's Medical Provider Network (MPN), arguing the MPN lacked toxicologists. The judge found the applicant was not entitled to out-of-MPN treatment as they were not treating with a toxicologist and the MPN had sufficient internal medicine physicians. The applicant also failed to prove medical necessity for a toxicologist through treating physician reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedMPNLabor Code §4616(a)Cal. Code of Reg. §9767.5Medical TreatmentSelf-Procured Medical TreatmentToxicologistInternal Medicine
References
Case No. ADJ10591990
Regular
Aug 07, 2018

Sammy Mendoza vs. City of Tracy

This case concerns a dispute over the appropriate specialty for a Qualified Medical Evaluator (QME) in a workers' compensation claim. The WCJ found the defendant failed to prove Physical Medicine and Rehabilitation was medically inappropriate for the applicant's knee injury. However, the Appeals Board granted removal, finding the WCJ's decision lacked substantial evidence. The Board rescinded the WCJ's order, returning the case for further proceedings to properly develop the evidentiary record regarding the specialty dispute.

RemovalPetition for RemovalFindings of Fact and OrdersQualified Medical EvaluatorQME panelPhysical Medicine and RehabilitationOccupational MedicineMedical UnitSpecialty disputeMedical Director
References
Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
Case No. LBO 0369190
Regular
Apr 21, 2008

MARTIN PEREZ vs. ROYAL CABINETS, EMPLOYERS DIRECT INSURANCE CO.

This case concerns a lien claim by a chiropractor for $13,474.90 for 45 visits. The Workers' Compensation Appeals Board (WCAB) reconsidered the decision, determining that Labor Code Section 4604.5(d)(1) limits chiropractic visits to 24 per industrial injury for injuries after January 1, 2004. The WCAB found the lien claimant failed to prove the existence of a second cumulative trauma injury, therefore limiting the lien to 24 visits.

Workers' Compensation Appeals BoardPetition for ReconsiderationCompromise and ReleaseLien ClaimantChiropractic TreatmentLabor Code Section 4604.5(d)(1)Medical Treatment Utilization ScheduleAmerican College of Occupational and Environmental MedicineOccupational Medicine Practice GuidelinesCumulative Trauma Injury
References
Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Showing 1-10 of 445 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational