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Case Law Database

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

Case No. ADJ2270309 (VNO 0113668) ADJ4503834 (VNO 0113665) ADJ3103605 (VNO 0113666) ADJ2309113 (VNO 0113667)
Regular
Aug 17, 2009

MARIA GARCIA vs. CITY OF LOS ANGELES

This case involves a dispute over whether Dr. Nagelberg is the applicant's primary treating physician (PTP). The Appeals Board granted reconsideration, reversing the trial judge's finding that Dr. Nagelberg was not the PTP. The Board found substantial evidence that Dr. Nagelberg is indeed the PTP, and that the trial judge erred in relying on an unadmitted nurse case manager's report. The matter is returned to the trial level for further proceedings to determine the applicant's entitlement to medical treatment.

Workers' Compensation Appeals BoardMaria GarciaCity of Los AngelesPetition for RemovalPetition for DisqualificationPetition for ReconsiderationFindings and OrderWorkers' Compensation Judge (WCJ)Primary Treating Physician (PTP)Qualified Medical Evaluator (QME)
References
Case No. ADJ19947925
Regular
May 19, 2025

Andres De Jesus Garcia vs. Slater's 50/50, Security National Insurance Company

Applicant, Andres De Jesus Garcia, sought reconsideration of a March 12, 2025 Findings and Award (F&A) which denied his request for a new primary treating physician (PTP) or a second opinion. The workers' compensation administrative law judge (WCJ) had found that the applicant reached maximum medical improvement (MMI) based on reports from his PTP and a panel qualified medical evaluator (PQME). Applicant contended he is entitled to a change of PTP or a second opinion within the medical provider network (MPN) under various Labor Code sections and WCAB Rules. The Appeals Board granted the Petition for Reconsideration, deferring a final decision after reconsideration to allow for further review of the factual and legal issues.

Petition for ReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Maximum Medical Improvement (MMI)Qualified Medical Evaluator (PQME)Labor Code sections 4616.3 and 4616.4WCAB Rules 9767.6(e) and 9767.7Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Labor Code section 5909Electronic Adjudication Management System (EAMS)
References
Case No. ADJ6638615 ADJ6638655
Regular
Dec 31, 2010

JESUS MEZA GOMEZ vs. ADAMS POOL SOLUTIONS, SEABRIGHT INSURANCE COMPANY

The Appeals Board granted the applicant's petition for removal, finding that the WCJ erred in denying the request to depose the primary treating physician (PTP). The applicant argued that the PTP's recent change in impairment rating and opinion on future treatment necessitated this deposition. The Board concluded that denying the deposition would cause irreparable harm and that the applicant acted prudently by deposing the panel QME first. Consequently, the WCJ's order closing discovery was rescinded, the trial was taken off calendar, and the matter was returned for further proceedings.

Petition for RemovalPrimary Treating Physician (PTP)DepositionDue DiligenceGood CauseIrreparable HarmPanel Qualified Medical Evaluator (Panel QME)Mandatory Settlement Conference (MSC)Labor Code section 5310Sub-rosa surveillance
References
Case No. ADJ12059744
Regular
Feb 17, 2023

JASON WUEST vs. KERN COUNTY SUPERINTENDENT OF SCHOOLS, SELF-INSURED SCHOOLS OF CALIFORNIA

The defendant sought reconsideration of an award finding the applicant sustained injury to his cervical spine, left shoulder, and elbow, resulting in 28% permanent disability. The defendant argued the Qualified Medical Examiner's (QME) reports lacked substantial evidence, while the primary treating physician's (PTP) reports should have been determinative. The Appeals Board denied reconsideration, finding the QME's detailed reports provided substantial evidence supporting the findings. The Board affirmed the WCJ's reliance on the QME's opinions regarding impairment calculations and the compensable consequence neck injury.

ADJ12059744PERMISSIBLY SELF-INSUREDKERN COUNTY SUPERINTENDENT OF SCHOOLSJASON WUESTOPINION AND ORDER DENYING PETITION FOR RECONSIDERATIONFINDINGS ORDER AND AWARDCERVICAL SPINELEFT SHOULDERELBOWPERMANENT DISABILITY
References
Case No. ADJ8159623; ADJ8159625
Regular
Dec 30, 2013

GENEROSA GERVACIO vs. KOOSHAREM dba SELECT STAFFING, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Generosa Gervacio's petition for reconsideration. The Board adopted the Workers' Compensation Judge's findings, which denied her claims for an industrial injury on May 1, 2011, and for a cumulative trauma injury. The judge found that Gervacio's testimony was not credible, noting inconsistencies with a supervisor's testimony and the implausibility of her reported pain levels given her continued work. Furthermore, crucial medical evidence was excluded due to late submission, leaving no substantial medical evidence to support her claim.

WCABPetition for ReconsiderationAOE/COEJoint Findings and Orderevidentiary rulingsPTPPR-2 reportNCS/EMGsecondary treating physicianpretrial conference statement
References
Case No. ADJ7166756
Regular
Dec 27, 2010

JAVIER BANUELOS vs. BAKU CORPORATION, ENDURANCE INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's Petition for Reconsideration because the challenged order was not a final decision. The Board also denied the applicant's Petition for Removal, finding no significant prejudice or irreparable harm. The core dispute involved whether the defendant must pay for an interpreter during medical examinations. The Board explicitly did not rule on the substantive issue of interpreter service costs.

Workers Compensation Appeals BoardJavier BanuelosBaku CorporationEndurance Insurance CompanyPetition for ReconsiderationPetition for RemovalOrder Clarifying Findings and OrdersWCJInterpreter ServicesMedical Examination
References
Case No. ADJ7048296
Significant
Sep 27, 2011

Elayne Valdez, Applicant vs. Warehouse Demo Services, Zurich North America, Adjusted By ESIS

The Appeals Board affirmed its prior en banc decision, holding that where unauthorized medical treatment is obtained outside a validly established and properly noticed medical provider network (MPN), the resulting non-MPN treatment reports are inadmissible and may not be relied upon to award benefits.

MPNinadmissibilitynon-MPN treatmentLabor Code section 4616.6appeals boardreconsiderationen banc decisionPTPmedical provider networkutilization review
References
Case No. ADJ11059073
Regular
Jan 17, 2023

SHERRILL CLAYTOR vs. ALEXANDER R. LATTERI, M.D., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision allowing the applicant to treat with Dr. Spencer outside the defendant's Medical Provider Network (MPN). The WCAB found insufficient evidence that Dr. Spencer, or the applicant's previously selected physician Dr. Small, were definitively part of the defendant's MPN at the time of the request. Therefore, without proper MPN notification and an established denial of care, the applicant retained the right to resume treatment with her non-MPN physician, Dr. Spencer. The defendant may still attempt to transfer the applicant's care into the MPN by following proper statutory procedures.

MPNPTPmedical provider networkprimary treating physicianreconsiderationfindings and ordertransfer of caredenial of caresubstantial evidenceadministrative director rules
References
Case No. ADJ9840613
Regular
Aug 28, 2025

MINERVA TOMKA vs. PACIFIC GAS ELECTRIC, PACIFIC GAS ELECTRIC - SAN FRANCISCO

Applicant Minerva Tomka sought reconsideration of an order denying her petition to set aside a prior award. She alleged fraud, bad faith, misrepresentation of her occupational group, and clerical errors in the prior Stipulations with Request for Award approved by the WCJ. The Appeals Board reviewed the petition, the defendant's answer, and the WCJ's report. The Board found no evidence of fraud or other grounds to set aside the stipulations but acknowledged clerical errors and the incorrect occupational group number. Consequently, the Board granted reconsideration, rescinded the original order, and issued a new order correcting the applicant's occupational group number to 214 and rectifying various clerical errors.

Petition for ReconsiderationPetition to Set Aside StipulationsStipulations with Request for AwardOccupational Group NumberDEU Consultative RatingPQMEPTPPermanent Disability RatingArising Out of and In the Course of EmploymentAOE/COE
References
Case No. ADJ10594852; ADJ10882589; ADJ10882630
Regular
Apr 14, 2025

AURELIO RAMIREZ vs. PARKHOUSE TIRES, INC.; TRAVELERS PROPERTY CASUALTY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration in the case of Aurelio Ramirez vs. Parkhouse Tires, Inc. and Travelers Property Casualty of America. The WCAB rescinded the original Findings, Order and Award (F&A) from January 14, 2021, and substituted new findings regarding applicant's permanent disabilities for multiple injuries. Specifically, it found a 38% permanent disability for a right index finger injury (ADJ10594852) and a 15% permanent disability for a back injury (ADJ10882630). The Board also determined that the defendant was not entitled to a credit for temporary disability overpayment and deferred the issue of attorney's fees. The matter was returned to the trial level for further proceedings consistent with this decision.

Workers Compensation Appeals BoardReconsiderationFindings Order AwardTire TechnicianRight Index Finger InjuryBack InjuryHernia InjuryTemporary DisabilityPermanent DisabilityMedical Treatment
References
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