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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ7212946
Regular
Dec 13, 2012

JOSE QUINTERO vs. CORPORATE PERSONNEL NETWORK, NEW HAMPSHIRE INSURANCE CO., administered by CHARTIS

The Appeals Board granted reconsideration to address the admissibility of Dr. Konstat's psychiatric evaluation. The Board found Dr. Konstat's report inadmissible because it was a medical-legal evaluation obtained in violation of statutory procedures for represented employees, bypassing the requirement for an Agreed Medical Evaluator or Qualified Medical Evaluator. Consequently, the Board amended the prior award to exclude industrial injury to the psyche due to lack of substantial medical evidence. The applicant's award for orthopedic injuries and medical treatment was affirmed.

Workers' Compensation Appeals BoardJose QuinteroCorporate Personnel NetworkNew Hampshire Insurance Co.ChartisAmended Findings and Awardindustrial injuryleft shoulderneckback
References
Case No. ADJ7074256
Regular
May 23, 2014

ALFONSO RODRIGUEZ vs. DANDEE TRANSPORTATION, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over whether the applicant, Alfonso Rodriguez, adequately pursued medical evaluations before a mandatory settlement conference. The applicant sustained an injury in 2009 and has undergone evaluations by an Agreed Medical Evaluator and Qualified Medical Evaluators. However, at the settlement conference, the applicant claimed he still required treating physician reports in psychiatry and internal medicine, leading the trial judge to take the case off calendar. The Appeals Board granted the defendant's petition for removal, finding the applicant waived objections to proceeding by not objecting to the defendant's Declaration of Readiness to Proceed or the QME panels. The Board rescinded the order and returned the case to the trial level for another settlement conference and potential trial, emphasizing the applicant's lack of diligence in discovery.

Petition for RemovalRescind OrderOff CalendarAgreed Medical EvaluatorQualified Medical EvaluatorMandatory Settlement ConferenceDeclaration of Readiness to ProceedLabor Code section 4061(i)Due DiligenceDiscovery
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. ADJ10183065, ADJ10449030
Regular
Mar 21, 2018

DENNIS MOORE (Dec'd), SHIRLEY MOORE (Wife), ERIC MOORE (Son) vs. WAL-MART, ACE AMERICAN INSURANCE COMPANY, YORK RISK SERVICES GROUP, INC.

In this workers' compensation case, the Appeals Board granted defendant's Petition for Removal, rescinded the WCJ's order, and returned the matter to the trial level. The Board found that setting the case for trial and closing discovery over defendant's objection denied due process. Specifically, it determined that applicant's privately obtained medical report lacked the required review by a Qualified Medical Evaluator (QME) or authorized treating physician. Consequently, the Board ordered that the parties proceed with proper medical-legal discovery, likely through an Agreed Medical Evaluator or QME process, to establish compensability.

Petition for RemovalAOE/COEWCJ OrderDue ProcessRebuttal EvidenceDiscovery ClosureSection 4605 EvaluationMedical-Legal ReportsQME PanelAgreed Medical Evaluator
References
Case No. ADJ6736604
Regular
Sep 26, 2013

WHITNEY DITLEVSEN vs. GOLD COUNTRY TRUE VALUE, BERKSHIRE HATHAWAY

In this workers' compensation case, the applicant has been unable to secure a timely QME evaluation after four attempts due to scheduling issues with chosen physicians. The Appeals Board granted the applicant's petition for removal, overturning the WCJ's decision to issue another QME panel. The Board invoked its inherent powers to appoint a physician directly, deeming it necessary to expedite the resolution of permanent disability. A dissenting opinion argued this violated regulations and precedent by prioritizing expediency over established procedures.

Petition for RemovalQualified Medical EvaluatorPanel of QMEsAdministrative DirectorLabor Code Section 4062.2AD Rule 31.5(a)(2)Substantial EvidenceTimely EvaluationAgreed Medical EvaluatorWCJ
References
Case No. SAC 354144
Regular
Apr 25, 2008

CHANDRA BOERSMA vs. RITE AID PHARMACY, ST. PAUL FIRE & MARINE INSURANCE COMPANY

The Appeals Board granted removal, rescinded the order to select a panel QME, and returned the case to the trial level. The Board found that while the WCJ properly identified deficiencies in the prior QME reports, the procedures under Labor Code section 4062.2 were inapplicable due to the pre-2005 injury date. Consequently, the WCJ must now appoint a "regular physician" to further develop the medical record.

Workers' Compensation Appeals BoardRemovalQualified Medical EvaluatorAgreed Medical EvaluatorLabor Code Section 4062.2Date of InjuryCumulative TraumaSubstantial EvidenceMedical-Legal EvaluationComprehensive Medical Evaluation
References
Case No. ANA 394407
Regular
Feb 01, 2008

DEWAYNE TORRENCE vs. CITY OF LOS ANGELES

The Appeals Board denied the applicant's petition for removal, upholding the WCJ's order for a new Qualified Medical Evaluator (QME) panel. The applicant, previously examined by Dr. Flores as a QME while unrepresented and later treated by him, argued he should not undergo another QME evaluation. However, the Board found that since Dr. Flores also provided treatment, he was disqualified from conducting a subsequent QME evaluation under relevant regulations, necessitating a new panel when parties could not agree on an evaluator.

Petition for RemovalQualified Medical EvaluatorAgreed EvaluatorLabor Code Section 4062.2Labor Code Section 4062.3(j)Industrial Medical Council Rule 11(d)Rule 31(d)Primary Treating PhysicianSecondary PhysicianUnrepresented Employee
References
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