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. ADJ9101616
Regular
Feb 20, 2018

MARIA MENCITAR vs. JESUS EDGARDO PACHECO, STAR INSURANCE CO., Administered by MEADOWBROOK INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted removal and rescinded a WCJ's order that dismissed a medical-legal provider's petition for determination of non-IBR medical-legal dispute for lack of jurisdiction. The WCAB found the WCJ erred by not holding a hearing, as no procedural rule required the provider to file a lien first. This decision allows the provider to pursue its claim for medical-legal expenses at the trial level.

WCABPetition for RemovalPetition for ReconsiderationPetition for Determination of Non-IBR Medical-Legal DisputeWCJMinute OrderFinal OrderInterlocutory OrderMedical-Legal ExpensesLien Claimant
References
12
Case No. ADJ11364300
Regular
May 24, 2019

JOHN MANNING vs. ORANGE COUNTY FIRE AUTHORITY

This case involves a dispute over an applicant's entitlement to an Independent Medical Examiner (IME) under an Alternative Dispute Resolution (ADR) agreement governing workers' compensation claims. The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration, finding the original order was not a final decision. However, the WCAB granted the petition for removal, rescinded the administrative law judge's finding that no IME was warranted, and returned the case for further proceedings. The WCAB determined it was unclear whether it had jurisdiction to rule on the medical-legal discovery dispute, as parties cannot confer jurisdiction by stipulation, and ordered the trial judge to determine if the ADR program or the WCAB has jurisdiction.

ADR agreementCalifornia Labor Code §3201.7Independent Medical Examiner (IME)removalreconsiderationWorkers' Compensation Appeals Board (WCAB)specific injurycumulative traumafire captainskin cancer
References
1
Case No. ADJ11329981
Regular
Jan 14, 2019

JEFFERY DANHAUSER vs. HOWROYD WRIGHT EMPLOYMENT AGENCY, INC., ACE AMERICAN INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC., UNITEDHEALTH GROUP, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case involved a petition for reconsideration and removal by a lien claimant disputing medical bill payments. The Appeals Board denied reconsideration and dismissed the removal petition, affirming the WCJ's findings. The Board reiterated that disputes over medical bill amounts after review must proceed to Independent Bill Review (IBR), not through the Appeals Board. A decision directing a party to IBR is a threshold determination, making reconsideration the appropriate remedy, not removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAdministrative Law Judge (WCJ)Independent Bill Review (IBR)Substantive RightLiabilityQuasijurisdictionalThresholdLien Claimant
References
2
Case No. ADJ4418771 (FRE 0242974)
Regular
Oct 08, 2019

FIDELA GARCIA vs. GCA PRODUCTION SERVICES, EMPLOYERS INSURANCE OF WAUSAU

The Workers' Compensation Appeals Board (WCAB) rescinded the trial judge's order denying a Petition for Determination of Non-IBR Medical-Legal Dispute. The WCAB found the trial judge's decision lacked supporting evidence regarding the fee schedule's applicability to petitioner's copy services performed in 2016. Additionally, the WCAB noted that WCAB Rule 10451.1(c)(3)(D) does not require medical-legal providers to file a lien in conjunction with such a petition. The case is returned to the trial level for further proceedings and development of the record.

Petition for Non-IBR DisputeWCAB Rule 10451.1(c)(3)(D)medical-legal providercopy servicesfee scheduleLabor Code section 5313Report and Recommendation on Petition for ReconsiderationrescindedAD Rules 9980-9983petition for removal
References
3
Case No. ADJ8677592
Regular
Aug 27, 2018

LINDA DAVIES vs. SECURITAS SECURITY SERVICES USA, INC.

This case involves a dispute over reimbursement for medical-legal expenses incurred by a lien claimant, Dr. Kauss, who was designated as the applicant's primary treating physician. The Workers' Compensation Appeals Board (WCAB) rescinded the initial award, finding that the WCJ erred in determining the compensability of Dr. Kauss's reports. The WCAB remanded the case for further proceedings to evaluate compliance with specific statutory requirements regarding objections to medical-legal bills and the distinction between IBR and non-IBR disputes. A dissenting opinion argued Dr. Kauss did not fulfill the duties of a primary treating physician and should not be reimbursed.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ExpensesPrimary Treating PhysicianLabor Code Section 4060Labor Code Section 4061Lien ClaimantIndependent Bill ReviewExplanation of ReviewDefense Attorney
References
3
Case No. ADJ7038469
Regular
Sep 17, 2014

AZIZA SAYED vs. GIORGIO ARMANI, FEDERAL INSURANCE COMPANY

The defendant's petition to appeal an Administrative Director's Independent Bill Review (IBR) determination was dismissed. The Board found the petition premature as it was not first heard by a trial level Workers' Compensation Judge (WCJ). Additionally, the petition failed to comply with numerous procedural requirements, including proper captioning, verification, service, and stating specific grounds for appeal. Consequently, both the petition for reconsideration and the petition appealing the IBR determination were dismissed.

Workers' Compensation Appeals BoardIndependent Bill ReviewPetition for ReconsiderationAdministrative DirectorLabor Code section 4603.6MAXIMUS Federal ServicesInc.Lien claimantOfficial Medical Fee ScheduleWCAB Rules of Practice and Procedure
References
0
Case No. ADJ9421326, ADJ9358335
Regular
May 06, 2016

IVY CHEN vs. COUNTY OF ALAMEDA

This case involves a dispute over whether the parties mutually consented to cancel their agreement to use an Agreed Medical Evaluator (AME) for applicant Ivy Chen. The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's Petition for Reconsideration, finding the initial order non-final. The WCAB then granted the defendant's Petition for Removal, rescinded the prior order, and returned the matter for further proceedings. The Board determined that while no explicit written cancellation existed, the parties' actions in jointly pursuing a Qualified Medical Examiner (QME) constituted mutual consent to abandon the AME agreement.

Agreed Medical EvaluatorPetition for ReconsiderationPetition for RemovalLabor Code section 4062.2(f)mutual written consentQualified Medical Examinerinterim orderfinal ordersignificant prejudiceirreparable harm
References
0
Case No. ADJ11328275
Regular
Dec 10, 2018

DENISE DOYLE vs. TECH MAHINDRA (AMERICAS) INC., ALLMERICA FINANCIAL BENEFIT INSURANCE COMPANY, HANOVER INSURANCE GROUP

The defendant sought reconsideration of an order allowing the applicant to consult a second physician within the employer's Medical Provider Network (MPN). The defendant argued that the MPN physician's release from care was not a dispute over diagnosis or treatment, and Labor Code sections 4061 and 4062, requiring medical-legal evaluations, applied instead. The Appeals Board dismissed the petition, finding it was not taken from a final order as it did not determine substantive rights or liabilities. The Board also noted that even if considered on its merits, the petition would be denied because Labor Code Section 4616.3 and Administrative Director Rule 9785(b)(3) allow an employee to seek a second opinion within the MPN when disputing a release from care.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical Provider NetworkMPNLabor Code Section 4616.3Second Physician ConsultMedical-Legal EvaluationFinal OrderSubstantive Right or LiabilityThreshold Issue
References
4
Case No. ADJ9336762
Regular
Mar 17, 2025

Ramiro Hernandez vs. Riverside Landscape & Irrigation Inc., California Insurance Guarantee Association

The Appeals Board considered petitions for reconsideration from lien claimants RMS Medical Group and Basso Pharmacy regarding a WCJ's Findings and Order from December 11, 2024, which denied their lien claims related to applicant Ramiro Hernandez's industrial injury. The Board denied Basso Pharmacy's petition, upholding the finding that Basso Pharmacy was not properly licensed. Conversely, the Board granted RMS Medical Group's petition, ruling that their medical-legal services, performed by the primary treating physician Dr. Gottschalk, are compensable as a medical-legal expense, even with an AME in the case. Consequently, the matter was returned to the trial level for the WCJ to determine the reasonable value of RMS Medical Group's services.

Workers Compensation Appeals BoardRamiro HernandezRiverside Landscape & Irrigation Inc.California Insurance Guarantee AssociationIntercareCastlepoint InsuranceRMS Medical GroupBasso PharmacyPrimary Treating PhysicianMedical-Legal Reports
References
1
Case No. ADJ1787355 (SAC 0336410) ADJ1318220 (SAC 0338049)
Regular
Aug 06, 2012

MARY JANE EIDMAN vs. LAW OFFICES OF THOMAS PLUMB, PARADISE CHEVROLET, STATE COMPENSATION INSURANCE FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board denied the Subsequent Injuries Benefits Trust Fund's (SIF) petition for reconsideration, affirming the finding of total permanent disability due to a prior condition combined with a later industrial injury. The Board granted the applicant's petition, reversing the original decision to make the applicant personally liable for a medical-legal report. SIF is now liable for the reasonable cost of Dr. Abeliuk's report, which is deemed a necessary medical-legal expense for the applicant's claim. The case was returned for further proceedings to determine the cost of Dr. Abeliuk's report.

Workers' Compensation Appeals BoardSubsequent Injuries Benefits Trust Fundpermanent disabilitymedical-legal expensereconsiderationadministrative law judgesubstantial medical evidencequalified injured workermedical reportingliability
References
5
Showing 1-10 of 26,519 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