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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ8264840
Regular
May 30, 2018

GABRIELA ARROYO vs. STANFORD UNIVERSITY, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board granted applicant's Petition for Removal, rescinding the prior decision that denied a psychiatric Qualified Medical Evaluator (QME). The WCAB found that the administrative law judge improperly decided the issue of good cause to reopen, rather than the sole issue presented for trial: entitlement to a PQME in psychiatry. Granting removal was necessary due to potential prejudice and due process concerns. The Board substituted its own order, granting the applicant's request for a PQME in psychiatry.

PQMEPetition for RemovalWCABCompensable Consequence InjuryNew and Further InjuryDue ProcessGood Cause to ReopenStipulations with Request for AwardPermanent DisabilityFuture Medical Treatment
References
5
Case No. ADJ14784661
Regular
Aug 01, 2025

Jeremy Vietmeier vs. Northrop Grumman Systems Corporation, American Home Assurance Company

Applicant Jeremy Vietmeier sought reconsideration of a WCJ's May 8, 2025 Findings of Fact and Orders (F&O) which found good cause for an additional neurology QME panel but denied one in psychiatry. The Appeals Board dismissed the petition for reconsideration but granted it as a petition for removal. They rescinded the original F&O and substituted new findings, determining that good cause exists for additional QME panels in both neurology and psychiatry. The Board also provided guidance regarding the admissibility of a psychiatric report from David Kauss, Ph.D., disagreeing with a dissenting commissioner on its immediate inadmissibility, noting the issue was not yet ripe for a ruling.

WCABPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorDivision of Workers' Compensation (DWC)AdmissibilityPsychiatric ReportGood CauseFinal Order
References
17
Case No. ADJ10310553, ADJ10310557
Regular
Nov 20, 2018

JOSE ESPINOSA vs. SECCOMBE HOMES, INC., dba NORTH STAR CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Appeals Board dismissed the applicant's petition for reconsideration of the WCJ's denial of a psychiatry QME panel, finding the order interlocutory. However, the Board granted the petition for removal, recognizing that denying a psychiatric QME panel irreparably harmed the applicant's ability to conduct necessary medical-legal discovery regarding his psyche claim. The Board amended the Joint Findings and Award to find good cause for an additional QME panel in psychiatry and granted the applicant's request. This decision allows for proper evaluation of the applicant's psychiatric complaints and potential permanent impairment rating, especially given Labor Code §4660.1's nuances for post-2013 injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings and AwardQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)good causepsychiatric injurypermanent impairment ratingLabor Code §4660.1
References
0
Case No. ADJ6905551
Regular
May 24, 2010

Donald Laytham vs. SUTTER CENTER FOR PSYCHIATRY

This case concerns whether an industrial injury claim was barred as post-termination under Labor Code § 3600(a)(10). The applicant faxed a claim form on April 10, 2009, before receiving his termination notice on April 14, 2009, which was dated April 10, 2009, and mailed April 13, 2009. The Board affirmed the finding that the employer had sufficient notice of the injury prior to termination via the faxed claim form. Therefore, the claim was not barred as post-termination.

Workers' Compensation Appeals BoardReconsiderationFindings of FactIndustrial InjuryFacilities and Project CoordinatorClaim FormPost Termination ClaimLabor Code Section 3600(a)(10)Labor Code Section 5401(c)Labor Code Section 5402(a)
References
1
Case No. ADJ8668832
Regular

BACILIO ANGEL SALAZAR vs. SAN DIEGO PERSONNEL AND EMPLOYMENT AGENCY, INC., AMTRUST NORTH AMERICA for CASTLEPOINT NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding a prior order that deemed a QME report timely. The Board found Dr. Tahami's psychiatric evaluation report was untimely served on the defendant. As the defendant objected prior to receiving the report, they are entitled to a replacement QME panel in psychiatry.

Petition for RemovalQualified Medical EvaluatorQME paneluntimely reportreplacement QMEAdministrative Director RuleLabor Codepsychiatric injurymedical-legal evaluationsubstantial prejudice
References
5
Case No. ADJ7873470, ADJ9373759
Regular
Oct 23, 2015

JUAN JOSE RAMIREZ vs. LYNAM INDUSTRIES INC., COMPWEST INSURANCE COMPANY

The Appeals Board granted the defendant's petition for removal, rescinding the WCJ's order to take the case off calendar for a QME evaluation in psychiatry. The Board found the WCJ erred by ordering further discovery after the close of discovery, as the defendant disputed the psychiatric injury and thus Labor Code section 4061(i) did not apply. The matter was ordered to be set for trial immediately on previously delineated issues.

Petition for RemovalLabor Code section 4061(i)Panel Qualified Medical EvaluatorPsychiatryPre-Trial Conference StatementDeclaration of Readiness to Proceedcumulative trauma injuryspecific injuryoff calendarsubstantial prejudice
References
5
Case No. ADJ7348065; ADJ7341118
Regular
Feb 18, 2015

JOSE PRUDENCIO vs. SCC SERVICE SOLUTIONS, HARTFORD INSURANCE COMPANY OF THE MIDWEST

The Appeals Board denied the applicant's Petition for Removal, which sought to overturn an order vacating submission and developing the record. The Board agreed with the judge that further development of the medical record was needed for the internal medicine and psychiatry AMEs. However, the Board disagreed that the orthopedic AME failed to address apportionment, finding his report substantially complied with the law by noting the intertwined nature of the injuries and the difficulty in precise apportionment. The applicant's petition was denied.

Petition for RemovalOrder Vacating SubmissionOrder to Develop the RecordAgreed Medical Evaluator (AME)apportionmentcausationsubstantial evidenceReport and RecommendationLabor Code section 4663(c)Benson v. Workers' Comp. Appeals Bd.
References
1
Case No. ADJ7775067
Regular
Nov 01, 2012

SENEL ACOSTA vs. CREATIVE WATERWAYS, INC., YORK INSURANCE SERVICES GROUP, INC.

The Appeals Board granted the defendant's Petition for Removal to rescind an order directing a panel Qualified Medical Evaluator (QME) in psychiatry. The Board found that the workers' compensation judge erred by ordering further medical record development before the case was tried or submitted. It is premature to mandate a psychiatric QME before establishing deficiencies in existing medical opinions and without trial evidence. The case is returned to the trial level for further proceedings, including a status conference and potential expedited hearing.

Petition for RemovalOrder Off CalendarPanel QMEMedical Record DevelopmentAgreed Medical EvaluatorMandatory Settlement ConferenceDeclaration of Readiness to ProceedExpedited HearingUtilization ReviewWorkers' Compensation Appeals Board
References
1
Case No. ADJ6627019
Regular
May 06, 2013

SANDRA BERKENSTOCK vs. AGILENT TECHNOLOGIES

The defendant sought reconsideration of an order denying their request for a replacement Qualified Medical Evaluator (QME) panel in psychiatry/psychology. The applicant sustained industrial injuries including to her psyche. The administrative law judge denied the replacement panel because the QME's report was eventually received. However, the Workers' Compensation Appeals Board dismissed the defendant's petition. The Board ruled that the denial of a replacement QME panel is an interim, procedural order not subject to reconsideration under Labor Code section 5900(a).

WCABAgilent TechnologiesADJ6627019Petition for ReconsiderationQualified Medical EvaluatorQME panelpsychiatrypsychologyFlorence Thomas-RiddleLabor Code section 139.2(j)(1)(A)
References
7
Case No. ADJ6820122
Regular
Jan 05, 2011

NOEL WILLIAMS vs. FEDEX OFFICE AND PRINT SERVICES

This case concerns an applicant claiming industrial injury to his back and psyche, which the defendant initially denied. While an orthopedic QME found the back injury industrial, the defendant sought psychiatric QMEs. The WCJ denied this, foreclosing the defendant due to a timing issue regarding treating physician reports. The Appeals Board granted removal, finding that because the defendant never accepted the injury as compensable, Labor Code section 4060 still applied, permitting them to seek QME evaluations in psychiatry.

Petition for RemovalQualified Medical EvaluatorQME panelLabor Code section 4062.2Rubanenkoorthopedic injurypsychiatric injurycompensabilitytreating physiciansection 4060
References
0
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