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Case Law Database

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

Case No. ADJ519728
Regular
Aug 08, 2011

LOWELL BAPTISTE vs. METROPOLITAN TRANSIT AUTHORITY

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding industrial injury and temporary total disability dating back to 2000. The Board found that the medical opinion relied upon by the workers' compensation judge was not substantial evidence due to staleness, lack of complete records, and insufficient specialization. To ensure a fair resolution, the Board ordered new evaluations by independent orthopedic and psychiatric physicians, who will report on all outstanding medical issues.

Workers' Compensation Appeals BoardReconsiderationCompelling Medical EvaluationsTemporary Total DisabilityIndustrial InjuryOrthopedicsPsychiatrySubstantial EvidenceMedical OpinionWCJ
References
2
Case No. ADJ8836050
Regular
Jan 26, 2016

EDUARDO CASTILLO vs. GENERAL MOTORS; permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Appeals Board granted the defendant's petition for removal, rescinding the WCJ's orders appointing new orthopedic and psychiatric evaluators. The Board found the WCJ erred by directly appointing new physicians without first attempting to supplement existing medical reports or deposing prior evaluators, as per the *McDuffie* precedent. The Board determined the existing medical reports were not "fatally flawed" and directed the parties to pursue supplemental opinions or depositions before appointing new evaluators.

WCABPetition for RemovalOrdersMedical Record DevelopmentPanel Qualified Medical EvaluatorAgreed Medical EvaluatorSupplemental ReportsDepositionsPrejudiceDelay
References
3
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
0
Case No. ADJ13010543
Regular
Oct 26, 2020

THONG TO vs. BENCHMARK ELECTRONICS, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, TRAVELERS SACRAMENTO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a Workers' Compensation Judge's (WCJ) order appointing a regular physician. The WCAB found that the WCJ's order to develop the record by appointing a physician was premature and not supported by a clear dispute. The Board clarified that if a dispute arises requiring medical evaluation, parties can utilize the Qualified Medical Evaluator (QME) process. Alternatively, if treatment is disputed, the applicant can seek intervention through a Declaration of Readiness to Proceed.

WCABPetition for ReconsiderationFindings and OrderStipulated AwardInadequate AwardMaximum Medical ImprovementLabor Code Section 5701Develop the RecordRegular Treating PhysicianAOE/COE
References
8
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
7
Case No. ADJ10356570
Regular
Oct 20, 2017

SYRUS YARBROUGH vs. SOUTHERN GLAZER'S WINE AND SPIRITS, TRUMBALL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Syrus Yarbrough's Petition for Removal, rescinding a previous order compelling him to attend an Agreed Medical Evaluator (AME) appointment. The WCAB found that Labor Code section 4067, relied upon by the judge, did not apply as applicant had not yet attended a formal AME evaluation. Furthermore, the WCAB clarified that Labor Code section 4062.2(f) only applies after an AME evaluation has occurred and does not preclude withdrawal from an AME agreement before such an evaluation. The WCAB noted that the applicant could still be ordered to see his regular physician or a Qualified Medical Evaluator.

Petition for RemovalAgreed Medical EvaluatorPetition to CompelMedical ExaminationSignificant PrejudiceIrreparable HarmLabor Code Section 4067Labor Code Section 4062.2(f)Withdraw from AMEWCAB
References
1
Case No. ADJ345248 (RDG 0128229)
Regular
Oct 26, 2011

JEREMY CHISSIE vs. REIBES AUTO PARTS, LLC, PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted removal and rescinded the WCJ's order to appoint an Independent Medical Examiner (IME). The Board found the WCJ improperly bypassed the established procedure for selecting a Qualified Medical Evaluator (QME) when the original QME became unavailable. Instead, the matter must return to the trial level to follow the Administrative Director's rules for appointing a replacement QME. This ensures the defendant's right to participate in the physician selection process.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical Examiner (IME)Qualified Medical Evaluator (QME)Labor Code section 4062.2Administrative Director's Rule 31.5Rule 32.6Medical UnitPanel QME
References
3
Case No. MISSING
Regular Panel Decision

Union Appointed Trustees of the Tapers Industry Insurance & Annuity Funds v. Employer-Appointed Trustees of the Tapers Industry Insurance & Annuity Funds

A dispute arose between the Employer-Appointed Trustees and Union-Appointed Trustees of the Tapers Industry Insurance and Annuity Funds concerning delinquent employer contributions. An arbitrator issued an award, which the Employer-Appointed Trustees sought to confirm and the Union-Appointed Trustees cross-moved to vacate. Judge Walker of the District Court reviewed the arbitration award, noting the arbitrator based his findings on prior judicial decisions rather than independently interpreting the collective bargaining agreement. The Court determined that the arbitrator failed to apply the contract as bargained for by the parties, thus exceeding his authority. Consequently, the Court vacated the arbitration award and remanded the dispute for proceedings consistent with its order.

Arbitration AwardVacate Arbitration AwardConfirm Arbitration AwardCollective Bargaining AgreementTrust FundsDelinquent ContributionsRes JudicataManifest Disregard of LawScope of Judicial ReviewLabor Dispute
References
12
Case No. ADJ9328371
Regular
Oct 31, 2016

LEYLA FATHI vs. MISSION HOSPITAL REGIONAL MEDICAL CENTER, HARTFORD ACCIDENT & INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration because the WCJ's order for additional Qualified Medical Evaluator (QME) panels was an interlocutory procedural order, not a final determination of substantive rights or liabilities. The defendant's petition for removal was also denied, as they failed to demonstrate substantial prejudice or irreparable harm. While good cause for additional evaluations may have existed, the record was insufficient to make a definitive ruling on the merits of the removal. Therefore, the WCAB affirmed the WCJ's order for further medical development of the record.

Petition for ReconsiderationPetition for RemovalAdditional Panel QMEQualified Medical EvaluatorInternal MedicinePsychiatryNeurologyMedical Record DevelopmentFinal OrderInterlocutory Order
References
8
Case No. ADJ7521436
Regular
Jun 24, 2013

ABEL RAMIREZ vs. CROWN WIRE COMMUNICATIONS, INC., TOWER SELECT INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because it was filed against a non-final discovery order. The Board then removed the case to itself and amended the original order. The amended order allows the parties 15 days to agree on an Agreed Medical Evaluator (AME) for the issue of diabetes aggravation, and if they cannot agree, they must request a Qualified Medical Evaluator (QME) panel. The Board found the WCJ's original appointment of a "regular physician" was premature.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code Section 5701Labor Code Section 4062.2Industrial InjuryAggravation of DiabetesInternal Medicine
References
8
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