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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. 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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. ADJ9 636706; ADJ9636707 ADJ9447837
Regular
Aug 09, 2016

RICK PARKER vs. DSC LOGISTICS, ZURICH NORTH AMERICA

This case concerns whether a Qualified Medical Evaluator (QME) must address all claimed industrial injuries filed prior to their initial evaluation. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order that denied the defendant's petition to vacate new QME panels. The WCAB held that Labor Code section 4062.3(j) requires a QME to evaluate all contested medical issues arising from injuries reported on one or more claim forms prior to the employee's initial appointment. Therefore, the applicant must return to the original QME, Dr. Steinmann, to evaluate the disputed medical issues in all relevant case numbers.

Workers' Compensation Appeals BoardReconsiderationPetition to Vacate QME PanelsLabor Code section 4062.3Qualified Medical EvaluatorPanel QMEDuplicative Medical EvaluationsDoctor ShoppingNavarro v. City of MontebelloContested Medical Issues
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
Case No. ADJ9163494, ADJ9163491
Regular
Dec 28, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN AND COUNTRY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original decision due to an inadequate medical report from the panel qualified medical evaluator (PQME). The PQME's opinion was based on incomplete medical records, including a failure to review records related to the applicant's cancer treatment, and did not adequately address the applicant's claimed injuries or permanent disability according to AMA Guides. The case is returned to the trial level for further development of the medical record, including the potential appointment of a regular physician and consideration of a videotape of the injury.

Workers' Compensation Appeals BoardReconsiderationPanel Qualified Medical EvaluatorSubstantial Medical EvidenceCumulative Trauma InjuryIndustrial InjuryPermanent DisabilityFuture Medical TreatmentMedical Record DevelopmentAgreed Medical Evaluator
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ10166295 ADJ10166294
Regular
Jun 22, 2016

ANGELICA NAVARRO vs. TAYLOR FRESH FOODS; Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board adopted the WCJ's report, which found the defendant waived their right to request a replacement QME panel by previously agreeing to use a specific physician. The Board also noted the Medical Unit's decision to issue a replacement panel was based on incomplete information and did not comply with regulations. While the WCJ misidentified the physician as an Agreed Medical Examiner instead of a PQME, this error did not affect the outcome.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorPQMEMedical UnitAgreed Medical ExaminerLabor CodeDWC Medical UnitOrthopedic SurgeryPain Medicine
References
Case No. ADJ6754074
Regular
Dec 14, 2010

BARBARA JACOME vs. DURHAM SCHOOL SERVICES, OLD REPUBLIC, SEDGWICK CMS

This case involves an applicant's petition for removal challenging a WCJ's order granting the defendant's request for a replacement Qualified Medical Evaluator (QME). The applicant argued the defendant's objection to the QME's report timeliness was conditional and not properly served, thereby waiving their right to a replacement. The Appeals Board granted removal, finding the defendant's objection, made after receiving the report, was insufficient and void. Therefore, the defendant was not entitled to a replacement panel, and the QME's report was deemed admissible.

Petition for RemovalQualified Medical EvaluatorReplacement PanelTimeliness ObjectionConditional ObjectionLabor Code SectionsCalifornia Code of RegulationsMedical DirectorAdministrative DirectorComprehensive Medical-Legal Evaluation
References
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