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Case Law Database

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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
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. 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. ADJ15763825
Regular
Sep 16, 2025

CLAUDIO CARDOZO vs. ROCK AND ROLL CAR WASH, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by Redwood Fire and Casualty Insurance Company dba Berkshire Hathaway Homestate Companies. The petition challenged a lien trial decision concerning a medical-legal evaluation performed by Dr. Michaels of Premier Psychological Services. The WCJ found that a medical dispute regarding psyche existed at the time of the evaluation, Dr. Michaels was validly designated as the Primary Treating Physician, and the evaluation was not barred by the 60-day rule for new claims as it was an amendment to an already accepted claim. The Appeals Board adopted the WCJ's reasoning and denied the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Adjudication NumberOpinion and Order Denying PetitionWCJ ReportEAMS TransmissionNotice of TransmissionProof of ServiceFindings and Order
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. LAO 0879648
Regular
Jun 09, 2008

ANTO'NIO GONZALEZ vs. ASH, AMIR LANKARANI dba ANAHEIM CAR WASH

The Workers' Compensation Appeals Board denied reconsideration of a decision finding Antonio Gonzalez was an employee of Anaheim Car Wash when he was injured. The Board adopted the administrative law judge's report, which found the applicant credible and the employer not credible. The judge determined that Gonzalez was hired to provide services for a daily wage, fulfilling the definition of an employee.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportLabor Code section 5313credibility findingGarza v. Workmen's Comp. Appeals Bd.employment disputeAnaheim Car WashAntonio GonzalezAmir Lankarani
References
Case No. ADJ473373 (ANA 0406381)
Regular
Feb 10, 2012

FERNANDO GUTIERREZ vs. SOCAL FRAMING aka BMHC; ACE AMERICAN INSURANCE, administered by ESIS, INC.

This case concerns applicant's claim for extended temporary disability (TD) benefits beyond 104 weeks due to a left eye injury. The Appeals Board affirmed the WCJ's denial of the "amputation" exception, ruling that the surgical removal of an eye does not fit the statutory definition. However, the Board remanded the case for further development of the record on the "high-velocity eye injury" exception, as the velocity and force of the object that struck the applicant's eye were unclear. The applicant's Petition for Removal was dismissed as reconsideration was the appropriate remedy.

Workers' Compensation Appeals BoardFernando GutierrezSoCal FramingBMHCACE American InsuranceESISInc.ADJ473373ANA 0406381Opinion and Decision
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
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
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