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. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ982471 (LAO 0859620)
Regular
Apr 28, 2014

JUVENCIO TORRES-RAMOS vs. FELIX MARQUEZ, REDWOOD FREE INSURANCE COMPANY, BERKSHIRE HATHAWAY

The Workers' Compensation Appeals Board denied the defendant's petition for removal and dismissed the applicant's petition for reconsideration. The Board adopted the WCJ's report, finding that the defendant failed to show significant prejudice or irreparable harm to warrant removal. The applicant voluntarily withdrew their reconsideration petition after understanding that their pain management treatment request lacked the required authorization form. The case was referred to the Independent Medical Review (IMR) process for a decision on the applicant's need for pain management treatment.

WCABPetition for RemovalPetition for ReconsiderationIndependent Medical ReviewIMRsubstantial evidenceutilization reviewtimelyprimary treating physicianDWC Form PR-2
References
Case No. ADJ9677618
Regular
Mar 04, 2018

ROBERT PRATER vs. CAST & CREW ENTERTAINMENT SERVICES, INC., ZURICH AMERICAN INSURANCE COMPANY

This case concerns a workers' compensation applicant seeking reconsideration of an award based on disputed earnings. The applicant contends their 2012 earnings were higher than determined by the WCJ, as evidenced by a W-2 from a prior employer, SMG, in addition to the defendant's W-2. The Board rescinded the original Findings and Award, finding the WCJ's report inadequately addressed the applicant's testimony and documentary evidence regarding potential earnings from SMG. The case is remanded to the trial level for further proceedings to develop the record on the applicant's total earnings at the time of injury.

WCABReconsiderationFindings and AwardPermanent Partial DisabilityEarnings CalculationOccupational Group NumberFurther Medical TreatmentAttorney's FeesW-2 FormTax Form
References
Case No. ADJ1208276 (VEN 0109627)
Regular
Sep 02, 2016

DANIEL GARCIA vs. PEPSI COLA CO.; SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board rescinded a prior decision and remanded the case for further proceedings concerning chiropractic treatment for an admitted neck and upper back injury. The original decision allowed 16 visits for 2007, deeming them reasonable and necessary, and found the applicant not subject to the 24-visit cap. However, the Board found the Qualified Medical Evaluator's report, used to support the decision, was stale, having been issued ten years prior to the treatment. The Board directed parties to obtain an updated report from the QME, and noted that the defendant failed to conduct utilization review, a proper avenue for disputing treatment reasonableness.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law JudgeLien ClaimantChiropractic ServicesLabor Code Section 4603.2(b)(2)PenaltiesSanctionsReasonable and Necessary Treatment
References
Case No. ADJ13109382
Regular
Nov 23, 2020

TERESA CERASIA vs. CIGNA, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of the original award. The Board rescinded the prior decision and returned the case to the trial judge for further proceedings due to insufficient substantial evidence. Specifically, the Board found the record needed development regarding the applicant's claim of temporary total disability, the admissibility of a physician's report, and the applicant's resignation circumstances. The issue of ongoing temporary disability benefits also requires further development of the record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact & AwardTemporary Total DisabilityPrimary Treating PhysicianMedical ReportsAdmissibility of EvidenceForm 5021PR-2 formAD Rule 9785
References
Case No. ADJ8061890
Regular
Sep 24, 2012

MARIA TIBURCIO VALERIANO vs. BEU INDUSTRIES, STAR INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original finding of industrial injury. The Board found the applicant failed to provide substantial medical evidence establishing industrial causation for her cumulative trauma injury. Furthermore, the Board determined the claim was barred by Labor Code section 3600(a)(10) due to the applicant filing after notice of termination without demonstrating applicable exceptions. Consequently, the applicant was ordered to take nothing by her claim.

Labor Code section 3600(a)(10)post-termination defenseindustrial causationsubstantial evidencePR-2 formprimary treating physiciancumulative traumamedical evidenceEDD claim formnotice of injury
References
Case No. ADJ361855 (GOL 0100706) ADJ987728 (GOL 0100705)
Regular
Jun 06, 2011

CYNTHIA SIEGERT vs. COTTAGE HEALTH SYSTEM; Permissibly Self-Insured, Administered by KEENAN & ASSOCIATES

The Appeals Board granted the applicant's petition for reconsideration and denied the defendant's. It affirmed the original award of 45% permanent disability, finding the Agreed Medical Evaluator's (AME) deposition testimony admissible and substantial evidence. The Board amended the temporary disability period to extend to March 27, 2008, finding applicant reached Maximal Medical Improvement on that date. Finally, the Board deferred the issue of further medical treatment, including acupuncture, for evaluation by the AME.

Workers Compensation Appeals BoardCynthia SiegertCottage Health SystemKeenan & AssociatesADJ361855ADJ987728Petition for ReconsiderationFindings and AwardRegistered NurseLumbar Spine
References
Case No. ADJ9066748
Regular
May 23, 2014

RAMATU KABBA vs. DAMERON HOSPITAL ASSOCIATION

Applicant Ramatu Kabba sought reconsideration of a finding that her psychiatric injury claim was not presumed compensable. The applicant argued the 90-day presumption period under Labor Code § 5402(b) began when the employer allegedly failed to provide a claim form promptly after receiving notice of injury. However, the Board denied reconsideration, adhering to the holding in *Honeywell v. Workers' Comp. Appeals Bd.* that the 90-day period runs from the filing of the claim form, not the employer's breach. Absent evidence of the employer misleading the applicant into not filing, the presumption did not arise.

Labor Code section 5402(b)presumption of compensabilitypetition for reconsiderationclaim formdenial of liabilityHoneywell v. Workers' Comp. Appeals Bd. (Wagner)estoppelDWC Form 1industrial injurypsyche
References
Case No. ADJ10079944
Regular
Feb 26, 2019

Robert Fndkyan vs. Opus One Labs, Employers Compensation Insurance Company

This case concerns an applicant's entitlement to a Supplemental Job Displacement Voucher (SJDV). The original decision denied the SJDV due to the absence of a specific Physician's Return-to-Work form. However, the Appeals Board granted reconsideration, finding that the employer was sufficiently informed of the applicant's permanent disability status and work restrictions through a Qualified Medical Evaluator's report. Therefore, the Board determined that the applicant substantially complied with the requirements and is entitled to the SJDV, prioritizing substance over strict adherence to a particular form.

Supplemental Job Displacement VoucherPhysician's Return-To-Work and Voucher formQualified Medical Evaluation ReportLabor Code section 4658.7(b)permanent and stationary statuspermanent partial disabilityvocational statuswork capacitysubstantial complianceform over substance
References
Case No. ADJ4442660
Regular
Jan 18, 2011

JAIME ANDRES vs. PRIORITY BUSINESS SERVICES, AMERICAN HOME ASSURANCE

This case involves competing petitions for reconsideration regarding a workers' compensation award. The Appeals Board granted reconsideration, rescinded the original decision, and returned the case to the trial level for further proceedings. Key issues include the applicability of a 15% increase in permanent disability payments under Labor Code section 4658(d)(2) and whether temporary disability benefits exceeded the statutory 104-week limit. The Board found insufficient evidence to address the 4658(d)(2) issue and noted potential deficiencies in the applicant's arguments regarding a sudden and extraordinary event and rebuttal of diminished future earning capacity.

WCABReconsiderationLabor Code 4658(d)(2)BontempoPermanent DisabilityTemporary DisabilityDFECSudden and Extraordinary EventLabor Code 4656(c)(1)Modified Work
References
Showing 1-10 of 1,200 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