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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ12180865
Regular
Dec 01, 2022

FRANCELIA DIAZ vs. MEDTRONIC, INC., ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the WCJ's order for an additional pain management QME panel. The Board found the applicant did not demonstrate good cause for the panel, as the current orthopedic QME's reports sufficiently addressed the applicant's diagnoses, including CRPS. The Board substituted new findings acknowledging the applicant's AOE/COE injuries but denying the request for a pain management QME panel.

Workers' Compensation Appeals BoardMedtronicInc.Ace American Insurance CompanyAdjudication Number ADJ12180865Petition for ReconsiderationAmended Opinion on DecisionFindings of Fact and OrderInjury AOE/COEQuality Control Inspector
References
Case No. ADJ757155
Regular
Mar 21, 2013

FRANK KEY vs. TORRANCE MEMORIAL MEDICAL CENTER, MATRIX ABSENCE MANAGEMENT, INC.

The Workers' Compensation Appeals Board denied the Defendant's Petition for Reconsideration. The Defendant argued that the applicant's condition had improved post-surgery, necessitating reevaluation by medical and vocational experts. However, the Board upheld the WCJ's finding that the applicant's testimony was credible and that his chronic pain and unemployability were well-established. The Board agreed with the WCJ that further evaluations were unnecessary as pain management was ongoing and did not alter the applicant's permanent total disability status.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeCredibilityGarza v. Workers' Comp. Appeals Bd.PhlebotomistLumbar spineCervical spineLeft lower extremityPsyche
References
Case No. ADJ8731635
Regular
Apr 02, 2019

Daissy Contreras vs. CRESTWOOD BEHAVIORAL HEALTH, UNION FIRE INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior award, finding the medical record inadequate to determine applicant's claim of Complex Regional Pain Syndrome (CRPS). While some physicians noted symptoms consistent with CRPS, the Agreed Medical Examiner (AME) found no objective evidence. The Board ordered the matter returned to the trial level for further development of the medical record by appointing a pain management specialist. This new evaluation will aim to diagnose the applicant's right upper extremity condition and determine its industrial causation.

Complex Regional Pain SyndromeCRPSskin injuryrashcumulative traumaAgreed Medical ExaminerAMEskin conditionright upper extremitypain management specialist
References
Case No. ADJ6933293
Regular
Aug 05, 2015

Norma Salazar vs. Fresno County In-Home Support Services, York Insurance Service Group

The Workers' Compensation Appeals Board (WCAB) granted the applicant's request for an additional Qualified Medical Evaluator (QME) in pain management after reconsideration. The WCAB found good cause due to concerns raised by prior medical evaluators regarding the applicant's significant pain issues, extensive narcotic use, and the need for ongoing pain management strategies. Although the initial petition was procedurally flawed, the WCAB elected to address the merits and reversed the WCJ's denial.

Workers' Compensation Appeals BoardNorma SalazarFresno County In-Home Support ServicesYork Insurance Service GroupPetition for ReconsiderationQualified Medical EvaluatorPain ManagementLumbar Spine InjuryPsyche InjurySleep Disturbance
References
Case No. ADJ722399 (SDO 0324979) ADJ1109167 (SDO 0339490)
Regular
Feb 07, 2011

SAMANTHA HOWE vs. SCRIPPS HEALTH, Permissibly Self-Insured

The Appeals Board denied defendant Scripps Health's petition for removal, upholding the WCJ's decision to deny a compel order for a QME examination. Scripps Health sought to compel an examination by Dr. Strauser regarding applicant Samantha Howe's pain management treatment. The Board ruled that Scripps Health's objection to the pain management treatment must be addressed through utilization review, not a QME evaluation, citing the *Sandhagen* Supreme Court decision. Therefore, Scripps Health is barred from using Labor Code section 4062 to dispute treatment recommendations for pain management.

Petition for RemovalQualified Medical EvaluationMedical ExaminationPain Management TreatmentUtilization ReviewLabor Code Section 4610Labor Code Section 4062Industrial InjurySurgical TechnicianDental Treatment
References
Case No. ADJ7422993
Regular
Apr 06, 2015

SHIRLEY LESCALLETT vs. WAL-MART, ACE AMERICAN INSURANCE, YORK RISK SERVICES

In this workers' compensation case, the applicant sought to select a pain management specialist as her primary treating physician. The employer's Medical Provider Network (MPN) did not have any pain management specialists within the 15-mile/30-minute access standard for primary physicians, though it did have specialists within a 30-mile/60-minute radius. The Appeals Board affirmed the WCJ's decision, holding that if an applicant chooses a specialist for their primary care, the MPN must provide at least three physicians of that specialty within a 15-mile/30-minute radius. Since the defendant's MPN failed to meet this standard for pain management specialists, the applicant was permitted to choose one outside the MPN. A dissenting opinion argued that the 30-mile/60-minute standard for specialists should apply, allowing the applicant to select a physician within that broader radius from the MPN.

MPNMedical Provider NetworkPrimary Treating PhysicianSpecialistAccess StandardsAdministrative Director's RulePain Management PhysicianGeographic RadiusLabor CodeWorkers' Compensation Appeals Board
References
Case No. ADJ2755694; ADJ453468; ADJ3409238
Regular
Oct 15, 2025

CASSANDRA WASHINGTON vs. COUNTY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

Applicant Cassandra Washington sought reconsideration of a January 25, 2021 Findings, Award & Order (F&A) from a Workers' Compensation administrative law judge (WCJ) concerning multiple industrial injury claims against the County of Los Angeles. Key contentions included the improper exclusion of Dr. Miller's pain management report and the need for further development of the record regarding psychiatric injury, industrially related hypertension, sleep dysfunction, and temporary total disability. The Workers' Compensation Appeals Board (WCAB) agreed with the WCJ's subsequent Report, finding Dr. Miller's report admissible under Labor Code section 4060 for compensability disputes and that the record required further development for psychiatric injury due to insufficient medical evidence. Consequently, the WCAB rescinded the F&A and returned the matter to the trial level for additional proceedings consistent with this opinion.

Workers' Compensation Appeals BoardReconsiderationLicensed Vocational NurseIndustrial InjuryLumbar SpineBilateral ShouldersPermanent Partial DisabilityPain Management PhysicianLabor Code Section 4060Hypertension
References
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