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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
Case No. ADJ10335205
Regular
Feb 16, 2017

BARNARD VILLAR vs. STATE OF CALIFORNIA, CDCR, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board found the medical opinion of the panel Qualified Medical Examiner (PQME) to be substantial medical evidence, based on an adequate examination and supported by reasoning. This opinion was relied upon by the workers' compensation administrative law judge. Consequently, the applicant's petition was denied.

Petition for ReconsiderationDeniedWorkers' Compensation Appeals BoardWCJ ReportAdopted and IncorporatedSubstantial Medical EvidenceReasonable Medical ProbabilityPanel Qualified Medical ExaminerPQMEBarry Gwartz M.D.
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. ADJ9319284
Regular
Jun 21, 2016

RYAN COPP vs. SCHIMMICK CONSTRUCTION COMPANY, AMERICAN CONTRACTORS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration and dismissed their petition for removal. The WCAB affirmed the WCJ's decision that the applicant was not temporarily disabled, relying on the panel qualified medical examiner's (PQME) opinion as substantial evidence. The WCAB found the PQME's opinion persuasive regarding the applicant's permanent and stationary status and ability to return to usual work without restrictions, despite conflicting medical reports and the applicant's testimony. The WCAB also ruled that removal was an improper remedy as reconsideration was appropriate for a final order regarding temporary disability.

Petition for ReconsiderationPetition for RemovalTemporary DisabilityPermanent and Stationary DateQualified Medical Examiner (PQME)Panel Qualified Medical Examiner (PQME)Treating Physician (PTP)Res JudicataSubstantial EvidenceIndustrial Injury
References
Case No. ADJ16528931
Regular
Apr 25, 2025

Marisa Kelly vs. Sacramento County Child Protective Services, PSI, County of Sacramento

Defendant sought reconsideration of a Findings of Fact, Awards and Orders (F&O) issued on February 5, 2025, which found that the applicant, Marisa Kelly, sustained a work-related psychiatric injury. The defendant contended that the medical evidence supporting this finding, specifically from the Panel Qualified Medical Examiner (PQME), was not substantial. The Workers' Compensation Appeals Board, after reviewing the petition and the WCJ's report, determined that the PQME's reasoning clearly supported the causation of the applicant's temporary disability and need for medical treatment. The Board concluded that the PQME's use of 'exacerbation' instead of 'aggravation' was immaterial, and therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardSacramento County Child Protective ServicesMarisa KellyPetition for ReconsiderationFindings of Fact Awards and OrdersInjury Arising Out of and Occurring in the Course of EmploymentAOE/COEPsycheMedical EvidencePanel Qualified Medical Examiner
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ10166295 ADJ10166294
Regular
Jun 22, 2016

ANGELICA NAVARRO vs. TAYLOR FRESH FOODS; Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board adopted the WCJ's report, which found the defendant waived their right to request a replacement QME panel by previously agreeing to use a specific physician. The Board also noted the Medical Unit's decision to issue a replacement panel was based on incomplete information and did not comply with regulations. While the WCJ misidentified the physician as an Agreed Medical Examiner instead of a PQME, this error did not affect the outcome.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorPQMEMedical UnitAgreed Medical ExaminerLabor CodeDWC Medical UnitOrthopedic SurgeryPain Medicine
References
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
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