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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. 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
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. ADJ4629950
Regular
Dec 21, 2012

JOHNNY BETTENCOURT vs. DONALD WILLIAMS, SAFECO INSURANCE COMPANY, UNINSURED EMPLOYERS' BENEFIT TRUST FUND DEPARTMENT OF INDUSTRIAL RELATIONS

The Uninsured Employers' Benefit Trust Fund (UEBTF) sought reconsideration, arguing Safeco's policy covered the applicant's injury. The Arbitrator previously ruled Safeco had no liability as its policy with Donald Williams did not include "comprehensive personal liability" insurance as required by Insurance Code section 11590. The Appeals Board affirmed this decision, finding the Safeco policy explicitly limited coverage to premises liability and lacked the necessary language for comprehensive personal liability coverage. Therefore, Safeco was correctly found not liable for the applicant's injury.

Uninsured Employers' Benefit Trust Fundcomprehensive personal liability insuranceLabor Code section 3351(d)Labor Code section 3352(h)Insurance Code section 11590premises liability insuranceSafeco Insurance CompanyDonald WilliamsJohnny Bettencourtworker's compensation coverage
References
Case No. ADJ3437654 (AHM 0142431)
Regular
Jun 11, 2015

DORA LATKOCZY vs. ENVIRONMENTAL & OCCUPATIONAL RISK MANAGEMENT, AMERICAN AUTOMOBILE INSURANCE COMPANY, FIREMAN'S FUND INSURANCE COMPANY

Defendant sought reconsideration of a WCJ's order that required payment of out-of-state medical treatment at higher rates and utilization of a California primary treating physician. The WCAB dismissed the petition because the WCJ's order was not final, as it provided a 90-day trial period. The Appeals Board held that reconsideration is only available for final orders that determine substantive rights or liabilities. Therefore, the defendant's petition was dismissed as premature.

Workers' Compensation Appeals BoardJoint Compromise and Release AgreementPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeMedical TreatmentMedicare RateOfficial Medical Fee Schedule (OMFS)Primary Treating PhysicianSecondary Treating PhysicianUtilization Review
References
Case No. ADJ2497883 (SFO 0450940) ADJ3261393 (SFO 0504693)
Regular
Apr 30, 2010

JANETTE HARDIN vs. COUNTY OF ALAMEDA, SEDGWICK CLAIMS MANAGEMENT SERVICES, CHARTIS INSURANCE, TRISTAR RISK MANAGEMENT

This case involves Chartis Insurance seeking reconsideration of an arbitrator's decision setting the date of cumulative trauma injury for Janette Hardin's breast cancer as May 28, 1997, not the previously stipulated date of May 16, 2001. Chartis argued the stipulated date was res judicata and could not be altered, especially in a contribution proceeding. The Workers' Compensation Appeals Board denied the petition, affirming that contribution proceedings allow for a relitigation of liability and the determination of the true date of injury based on facts, not prior stipulations between the applicant and one defendant. The Board reasoned that findings of liability in the primary case are not binding in supplemental contribution proceedings.

Cumulative traumaDate of injuryContribution proceedingsRes judicataStipulated awardLabor Code section 5500.5Apportionment of liabilityCase-in-chiefSupplemental proceedingsGreenwald v. Carey Distribution Company
References
Case No. ADJ2708349 (SBR 0339433)
Regular
Oct 06, 2008

MELVIN LANE vs. BIG LOTS STORES, INC., ZURICH INSURANCE, SEDGWICK CLAIMS MANAGEMENT SERVICES

The applicant sought reconsideration after being ordered to treat within the employer's Medical Provider Network (MPN). The Appeals Board granted reconsideration, finding that while the employer provided adequate notice of its MPN, the applicant has the right under Labor Code section 4605 to self-procure medical treatment at his own expense. Therefore, the applicant cannot be forced to treat within the MPN and the employer is not liable for self-procured treatment.

MPNself-procureLabor Code section 4605Labor Code section 4600Medical Provider Networkworkers' compensationWCJreconsiderationfindings and orderstatutory obligation
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
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