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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7685567
Regular
Feb 12, 2015

KATHLEEN O'NEAL vs. HALE ALOHA/MARK ONE CORPORATION, CALIFORNIA SELF-INSURERS' SECURITY FUND

This case involves a dispute over authorization for cervical surgery for applicant Kathleen O'Neal. The defendant argued that Dr. McCormack, who recommended the surgery, was a one-time consultant, not a treating physician, and thus his request for authorization was not subject to utilization review (UR). The Workers' Compensation Appeals Board (WCAB) affirmed the judge's order, finding Dr. McCormack acted as a treating physician by undertaking to obtain authorization and proceed with the surgery. Therefore, the defendant's failure to submit Dr. McCormack's request for authorization to UR in a timely manner meant the UR denial was invalid. The WCAB concluded the defendant was obligated to provide the surgery as it was supported by substantial medical evidence and reasonably necessary.

Utilization ReviewAuthorization RequestTreating PhysicianConsulting PhysicianPrimary Treating PhysicianSecondary Treating PhysicianWorkers' Compensation Appeals BoardAdministrative Director's RuleTimelinessJurisdiction
References
Case No. ADJ3918602 (SAC 0330507) ADJ2722371 (SAC 0354775)
Regular
May 04, 2009

THOMAS MELTON vs. COUNTY OF SACRAMENTO, SHERIFF'S DEPARTMENT

The applicant, a deputy sheriff, sustained admitted low back injuries in 2003 and 2006. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an award for spinal surgery, finding the WCJ erred by relying on an unsigned physician's assistant report. The WCAB determined this report lacked substantial evidence and did not reflect proper physician supervision as required by statute. The matter was returned to the trial level for further proceedings to develop the medical record and a new decision.

Workers Compensation Appeals BoardThomas MeltonCounty of Sacramento Sheriff's DepartmentAmended Findings of Fact and Awardspinal surgeryprimary treating physicianPasquale Montesano M.D.industrial injurylow backLabor Code section 4062(b)
References
Case No. ADJ10975151
Regular
Jan 06, 2020

RUSSELL CAMARA vs. TESLA, INC., AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the Applicant sustained an admitted industrial injury to the lumbar spine. The Applicant's primary treating physician (PTP) designated a secondary physician to evaluate permanent and stationary status and impairment, whose report the PTP adopted. The defense challenged the validity of this secondary physician's report, arguing only the Panel Qualified Medical Examiner's (PQME) report was properly obtained. The Workers' Compensation Appeals Board denied the Petition for Reconsideration, affirming that the PTP, or a physician designated by the PTP, is authorized to render opinions on medical issues, provided proper notice and procedural requirements are met. The Board found the designation and subsequent report were compliant with Labor Code and Administrative Director Regulations.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianQualified Medical ExaminerLabor Code Section 4061.5Permanent and Stationary ReportMedical-Legal EvaluationSecondary PhysicianAdministrative Director Rule 9785Designation of Physician
References
Case No. ADJ2745839 (AHM 0136320)
Regular
Dec 15, 2008

Linda Kiehlmeier vs. CALIFORNIA EMERGENCY PHYSICIAN, TRAVELERS ORANGE

This case involves a physician's assistant claiming cumulative industrial injuries from 2000-2006. The WCAB granted reconsideration to clarify temporary disability indemnity, affirming the finding of injury but amending the benefit period and rates for temporary total disability. The applicant will receive benefits starting January 1, 2008, with adjusted weekly amounts for different periods, crediting the defendant for benefits already paid.

Petition for ReconsiderationCumulative Industrial InjuryPhysician's AssistantTemporary DisabilityMaximum RatePanel QMEAquatic TherapyTempurpedic MattressRetroactive BenefitsReport and Recommendation
References
Case No. ADJ18027061
Regular
Sep 10, 2025

HEATHER TILLER KELLEY vs. SACRAMENTO CITY UNIFIED SCHOOL DISTRICT

Defendant Sacramento City Unified School District sought reconsideration of a WCAB decision that found applicant Heather Tiller Kelley sustained industrial injuries and that reports from her treating physicians (Mark Zuber, D.C., Adrienne Pasek, Psy.D., and Kasra Maasumi, M.D.) were admissible. Defendant argued these physicians lacked a proper treatment relationship and that the reports were improperly obtained. The Workers' Compensation Appeals Board denied the petition for reconsideration, affirming that defendant relinquished medical control by denying liability, allowing applicant to self-procure treatment, and thus the treating physician reports were admissible in proceedings.

WCABPetition for ReconsiderationOpinion and Order Granting PetitionAdmissible EvidenceTreating PhysiciansMedical-Legal ReportsLabor Code Section 4062.2Self-Procured TreatmentRemoval StandardPermanent and Stationary Status
References
Case No. SBR 0338656
Regular
May 27, 2008

BRYAN YOUNG vs. CITY OF BEAUMONT, Permissibly Self-Insured c/o S.C.R.M.A.

The Workers' Compensation Appeals Board vacated its prior order granting reconsideration, dismissed the applicant's petition, and granted removal. The Board rescinded the administrative law judge's order requiring the applicant to choose a physician from the employer's network. This decision clarifies that an employee has the right under Labor Code section 4605 to select and pay for their own physician, independent of employer-provided medical care.

Workers' Compensation Appeals BoardBryan YoungCity of BeaumontPetition for ReconsiderationPetition for RemovalLabor Code Section 5902Labor Code Section 4605Medical Provider NetworkPrimary Treating PhysicianConsulting Physician
References
Case No. ADJ11314069
Regular
Nov 20, 2018

LUIS TOLENTINO vs. LUKE'S ROOFING, REDWOOD FIRE INSURANCE COMPANY

This case concerns the proper designation of a primary treating physician within a Medical Provider Network (MPN). The applicant selected Dr. Huang, who was employed by Casa Colina. The defendant argued this was improper because Casa Colina was only listed for ancillary services and Dr. Huang was not individually listed in the MPN. The Board affirmed the WCJ's decision, holding that Dr. Huang's designation was proper as long as he acted through Casa Colina, which was included in the MPN without restriction. Regulations permit an entity in the MPN to have its employee physicians considered part of the network, unless specifically excluded.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianMedical Provider Network (MPN)Ancillary ServicesEmployee PhysicianNon-natural personApplicable RegulationsEntityEmployee
References
Case No. ADJ9924983
Regular
Sep 25, 2015

Jesus Rodriguez Garcia vs. BARRETT BUSINESS SERVICES, INC.

The Workers' Compensation Appeals Board denied Jesus Rodriguez Garcia's petition for removal. The Board found that the applicant failed to demonstrate substantial prejudice or irreparable harm, which are required for removal. Applicant's arguments regarding physician choice and MPN access standards were not sufficiently established as remedies are available within the defendant's Medical Provider Network. Therefore, the Board affirmed the Administrative Law Judge's Finding of Fact.

Medical Provider NetworkMPNPetition for RemovalFinding of FactLabor Code section 4616.3primary treating physicianselection of physicianphysician of choiceCalifornia Code of Regulationstitle 8
References
Case No. ADJ2123966 (SFO 0510193)
Regular
Jul 20, 2015

TOMMY GUTIERREZ vs. BIGGE CRANE & RIGGING COMPANY, ZURICH AMERICAN INSURANCE COMPANY

This case concerns a dispute over the necessity of prescription pain medications for Tommy Gutierrez. The defendant, Bigge Crane & Rigging Company, sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded the medications. The core issue was the defendant's failure to prove timely communication of their utilization review (UR) decision to the applicant's treating physician, Dr. Abeles, within 24 hours. As a result, the UR decision was deemed untimely and invalid, allowing the WCAB to determine medical necessity. The Board affirmed the original award, finding substantial medical evidence supported the applicant's continued need for the medications to manage chronic pain.

Workers' Compensation Appeals BoardUtilization ReviewRequest For AuthorizationUntimely CommunicationFindings & AwardPermanent DisabilityFuture Medical TreatmentAdministrative Director RuleBodamDubon
References
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