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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. ADJ7253987
Regular
Jun 29, 2012

Anna Medel vs. Employment Development Department, State Compensation Insurance Fund

The defendant sought reconsideration of an order granting the applicant a new Qualified Medical Evaluator (PQME). The defendant argued their communication with the PQME was not an ex parte violation and that the objection was untimely. The Board dismissed the reconsideration petition, finding the order was procedural, not final. The Board denied the removal petition, agreeing that the defendant's communication violated Labor Code Section 4062.3 by failing to serve the applicant 20 days prior to the PQME evaluation. Therefore, the applicant was correctly awarded a new PQME panel.

Workers' Compensation Appeals BoardPanel Qualified Medical EvaluatorPQMESection 4062.3Ex Parte CommunicationReconsiderationRemovalCumulative Trauma InjuryCervical SpineBilateral Upper Extremities
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. ADJ7626422
Regular
Dec 03, 2014

JOSE AHUMADA vs. BUILDING MATERIALS HOLDING, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration because it sought review of an interlocutory order, not a final decision. However, the WCAB granted removal on its own motion to address the WCJ's order. This order, which directed the parties to obtain a new Qualified Medical Evaluator (PQME), was rescinded because the issue was moot after the defendant canceled the deposition and the PQME became available within the statutory timeframe. The WCAB cautioned the defendant for seeking reconsideration of a non-final procedural order.

PQMEPetition for ReconsiderationWCJ Orderdepositionreplacement PQMEinterlocutory orderremovalrescindedmoot issuevocational expert
References
Case No. ADJ7674144
Regular
Oct 21, 2015

CHERYL FRANK vs. NOVATO UNIFIED SCHOOL DISTRICT, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision finding that most alleged industrial stressors leading to the applicant's psyche injury claim were not barred by Labor Code section 3208.3(d). The WCAB upheld the administrative law judge's (WCJ) determination that the panel Qualified Medical Evaluator's (PQME) reports lacked substantial evidence and removed the PQME. The WCAB dismissed the defendant's petition for removal, finding reconsideration to be the appropriate remedy and giving significant weight to the WCJ's credibility determinations.

Workers' Compensation Appeals Boardpsychiatric injuryindustrial stressorLabor Code section 3208.3(d)removalQualified Medical EvaluatorPQMEsubstantial evidencecredibility determinationsPetition for Reconsideration
References
Case No. ADJ3829948 (OAK 0323674)
Regular
Nov 03, 2009

PHYLLIS PAYNE vs. A.C. TRANSIT, CAMBRIDGE INTEGRATED SERVICES

Defendant sought removal from WCJ's determination that applicant is entitled to psychiatric PQME evaluation. The Appeals Board denied the petition, finding the applicant entitled to such evaluation.

AD Rule 31.7Petition for RemovalQualified Medical EvaluatorPanel Qualified Medical EvaluatorPQMEIndustrial InjuryRespiratory SystemPsycheBus DriverAdministrative Director Rules
References
Case No. ADJ7558401
Regular
May 28, 2013

ROBERT RICE vs. PROCUT, LLC, ZENITH INSURANCE COMPANY

The WCAB granted reconsideration to address the defendant's challenge to the 45% permanent disability award. The defendant argued the Qualified Medical Evaluator's (PQME) opinion was unsubstantiated, particularly regarding the lumbar spine rating and the inclusion of pain impairment. The WCAB found the PQME's reports lacked sufficient rationale and explanation, failing to adequately justify the Almaraz-Guzman rating. Consequently, the WCAB rescinded the award and returned the case for further medical record development.

Workers' Compensation Appeals BoardProCut LLCZenith Insurance CompanyRobert Ricepermanent disabilityqualified medical evaluatorPQMEDr. Sanjay Chauhanwhole person impairmentAMA Guides
References
Case No. ADJ10955805; ADJ10963100
Regular
Oct 20, 2025

DAVID SCHUPP vs. MAGIC MOUNTAIN LLC, PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORD

David Schupp, the applicant, filed workers' compensation claims for injuries to his right ankle, bilateral wrists, and knees while employed by Magic Mountain LLC. The defendant, Magic Mountain LLC, petitioned for removal challenging a Workers' Compensation Judge's (WCJ) findings regarding the Qualified Medical Evaluator (QME) process in pain management. The Appeals Board treated the petition as one for reconsideration, granted it under the removal standard, affirmed the WCJ's findings on employment, injury, and parts of the body, but deferred other interlocutory issues. The case is returned to the WCJ for further proceedings to address the validity of the QME panels, the timeliness and nature of the applicant's objection to a medical report, and potential prejudice to the defendant.

Workers Compensation Appeals BoardPetition for ReconsiderationRemovalJoint Findings and OrderQualified Medical EvaluatorPQMEPain ManagementLabor Code Section 4062.2Agreed Medical EvaluatorMedical Evaluation
References
Case No. ADJ8233060, ADJ8237202
Regular
Aug 23, 2013

SYLVIA TORRES vs. TODD MACKEY dba CAREFREE PLANTS & DESIGN, PREFERRED EMPLOYER'S INSURANCE CO.

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration because the WCJ's order regarding a replacement panel was not a final decision. The Board denied the petition for removal, finding no substantial prejudice or irreparable harm, despite the PQME's late supplemental report. Applicant failed to formally request a replacement panel from the Medical Director as required by regulation. Therefore, the Board affirmed the WCJ's decision not to order a replacement panel and to schedule a supplemental evaluation with the original PQME.

WCABPetition for ReconsiderationPetition for RemovalPanel Qualified Medical EvaluatorPQMESupplemental ReportFindings of Fact and OrderWCJDeclaration of ReadinessReplacement Panel
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
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