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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. 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. ADJ3786424; (BAK 150831) ADJ3979764; (BAK 152134)
Regular
Sep 12, 2008

PAUL COONE vs. PEPSI BOTTLING CENTER, OLD REPUBLIC INSURANCE COMPANY

The Appeals Board rescinded the WCJ's decision that the applicant validly selected an out-of-network physician. The Board found the defendant did not neglect to provide reasonable medical treatment.

Workers' Compensation Appeals BoardMPNMedical Provider NetworkPrimary Treating PhysicianIndustrial InjuryReconsiderationWCJExhibit AdmissibilitySelf-Procured TreatmentPhysician Selection
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. ADJ7422993
Regular
Apr 06, 2015

SHIRLEY LESCALLETT vs. WAL-MART, ACE AMERICAN INSURANCE, YORK RISK SERVICES

In this workers' compensation case, the applicant sought to select a pain management specialist as her primary treating physician. The employer's Medical Provider Network (MPN) did not have any pain management specialists within the 15-mile/30-minute access standard for primary physicians, though it did have specialists within a 30-mile/60-minute radius. The Appeals Board affirmed the WCJ's decision, holding that if an applicant chooses a specialist for their primary care, the MPN must provide at least three physicians of that specialty within a 15-mile/30-minute radius. Since the defendant's MPN failed to meet this standard for pain management specialists, the applicant was permitted to choose one outside the MPN. A dissenting opinion argued that the 30-mile/60-minute standard for specialists should apply, allowing the applicant to select a physician within that broader radius from the MPN.

MPNMedical Provider NetworkPrimary Treating PhysicianSpecialistAccess StandardsAdministrative Director's RulePain Management PhysicianGeographic RadiusLabor CodeWorkers' Compensation Appeals Board
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. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
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