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Case Law Database

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

Case No. ADJ736188 (GOL 0099658)
Regular
Sep 22, 2017

Deanna Power vs. St. John's Regional Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns Deanna Power's claim for continued medical treatment, specifically prescription medications Xyrem and Lunesta, for a previous industrial injury. The employer denied authorization for these medications through Utilization Review (UR), and the applicant's subsequent Independent Medical Review (IMR) application was deemed untimely. The trial judge initially ordered continued treatment and directed the Administrative Director to process the IMR appeal, finding it timely. However, the Appeals Board granted reconsideration, finding the trial judge lacked jurisdiction to order treatment when a timely UR decision was issued and the applicant's sole recourse was the IMR process. The matter was returned to the trial level for a determination solely on the timeliness of the IMR appeal, not the medical necessity of the medications.

WCABPetition for ReconsiderationFindings of Fact and AwardXyremLunestaIndependent Medical ReviewIMRUtilization ReviewURprescription medications
References
3
Case No. ADJ8531754
Regular
Mar 11, 2019

ARTURO TRUJILLO vs. TIC THE INDUSTRIAL COMPANY, THE HARTFORD INSURANCE

The Workers' Compensation Appeals Board (WCAB) vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration. The WCAB granted the defendant's petition for removal, rescinded the WCJ's findings and orders, and returned the case to the trial level for further proceedings. This decision stemmed from a dispute over whether an Agreed Medical Evaluator's (AME) interview with the applicant's wife and the applicant's provision of medical records at the AME's deposition constituted impermissible ex parte communication. The WCAB found that the interview with the wife was permissible as a collateral source to supplement the applicant's potentially impaired memory due to a brain injury, and that the provision of records at the deposition was not ex parte as the defendant was present. However, the WCAB remanded the case for the WCJ to determine if the applicant improperly provided information to the AME, as parties must agree on what information is provided to an AME.

Agreed Medical EvaluatorEx Parte CommunicationPetition for RemovalMedical-Legal ReportingCollateral InterviewApplicant's WifeDepositionsMedical RecordsSubstantial EvidenceLabor Code Section 4062.3
References
20
Case No. ADJ8580399
Regular
Aug 14, 2018

LAUREANO LEON vs. COAST SPORTWEAR, INC.; Administered by CHUBB GROUP OF INSURANCE COMPANIES

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal and vacated a prior order authorizing disclosure of medical information to a lien claimant. This decision was based on the fact that the defendant had resolved the lien claimant's lien prior to the issuance of the disclosure order. The Board also found that the lien claimant no longer had standing to pursue its claim as its lien was resolved. Furthermore, the Board determined the defendant's petition was timely filed due to defective service of the disclosure order.

Petition for RemovalOrder Granting Medical Disclosuremootlien claimantstandingdefective serviceEAMSWCJvacatedSeam Operator
References
3
Case No. MISSING
Regular Panel Decision

Goldberg v. Edson

The plaintiffs appealed two orders from the Supreme Court, Rockland County. The first order, dated January 5, 2006, granted summary judgment to defendants Page Edson and the County of Rockland, dismissing the complaint against them regarding claims of legal and medical malpractice. The second order, dated January 23, 2006, granted summary judgment to defendant Elizabeth O’Connor, dismissing the complaint against her for legal malpractice. The appellate court affirmed both orders, finding that Edson and the County were immune from liability under Social Services Law § 419 for reporting suspected child abuse and removing a child, and that O’Connor was not negligent in her legal services.

Legal MalpracticeMedical MalpracticeSummary JudgmentChild Abuse ReportingSocial Services LawImmunityMandated ReportersAppellate ReviewGood FaithNegligence
References
6
Case No. SBR 0338656
Regular
May 27, 2008

BRYAN YOUNG vs. CITY OF BEAUMONT, Permissibly Self-Insured c/o S.C.R.M.A.

The Workers' Compensation Appeals Board vacated its prior order granting reconsideration, dismissed the applicant's petition, and granted removal. The Board rescinded the administrative law judge's order requiring the applicant to choose a physician from the employer's network. This decision clarifies that an employee has the right under Labor Code section 4605 to select and pay for their own physician, independent of employer-provided medical care.

Workers' Compensation Appeals BoardBryan YoungCity of BeaumontPetition for ReconsiderationPetition for RemovalLabor Code Section 5902Labor Code Section 4605Medical Provider NetworkPrimary Treating PhysicianConsulting Physician
References
4
Case No. ADJ12349952
Regular
Oct 13, 2025

Dinh Tran vs. UL, LLC; Federal Insurance Company

The Workers' Compensation Appeals Board granted in part a petition for removal filed by Dinh Tran, who sought to prevent the discovery of raw testing data from a Qualified Medical Evaluator (QME) due to privacy concerns. While affirming the underlying Findings and Orders on its merits, the Board intervened to correct a clerical error and amend the orders regarding the confidentiality of medical records. The amended order strictly limits the reproduction and disclosure of raw testing materials and data, requiring their destruction after litigation and mandating defense counsel to ensure confidentiality and report any violations, thereby safeguarding the applicant's privacy rights.

Petition for RemovalQualified Medical EvaluatorRaw Testing DataRight to PrivacyClerical ErrorsSubstantial PrejudiceIrreparable HarmWaiver of PrivilegeNarrowly Circumscribed DisclosureConfidentiality
References
9
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. ADJ8272688
Regular
Feb 04, 2013

CATARINO VERDUZCO vs. ABLE BUILDING MAINTENANCE, ZURICH NORTH AMERICA INSURANCE CO.

This case involves a dispute over a proposed Compromise and Release (C&R) settlement. The defendant sought removal, arguing the WCJ improperly ordered a medical evaluation before approving the C&R when the applicant had not provided medical evidence or conducted discovery. Applicant initially denied injury in the C&R but later presented medical reports, creating a contradiction. The Appeals Board granted removal, ordering the applicant to file an answer addressing the defendant's statute of limitations and post-termination defenses.

Petition for RemovalCompromise and ReleaseWorkers' Compensation JudgeQualified Medical EvaluationAdequacy of SettlementStatute of LimitationsPost-termination DefenseAOE/COEIndustrial InjuryPR-2 Reports
References
0
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. ADJ8204664
Regular
Dec 16, 2013

MARIA MUNOZ vs. FLOREZ FAMILY, INC. dba McDONALD'S RESTAURANT

This case involves a defendant's petition for reconsideration of an interlocutory order by a WCJ regarding the proper selection of a medical panel. The Appeals Board vacated its prior order granting reconsideration, finding that interlocutory orders are not subject to reconsideration. Additionally, the Board granted removal on its own motion due to the defense attorney's failure to respond to a notice of intent to impose sanctions. Consequently, the defense attorney was ordered to pay a $100 sanction to the Workers' Compensation Appeals Board.

Workers' Compensation Appeals BoardReconsiderationSanctionsDefense AttorneyFindings and AwardFindings and OrderLabor Code section 4062.2Labor Code section 5900Interlocutory OrderRemoval
References
8
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