CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. ADJ6470549
Regular
Feb 27, 2012

KATHRYN BENSON vs. CITY OF SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, allowing a Qualified Medical Examiner's (QME) report into evidence. The original decision excluded the QME report, finding no ratable permanent disability based on the treating physician's opinion. The Appeals Board found the QME report should have been admitted, as there are no explicit time limits for objecting to a treating physician's report or obtaining a QME evaluation for permanent disability. The case is remanded for further proceedings on permanent disability and attorney's fees with the QME report now part of the record.

Workers Compensation Appeals BoardFindings and AwardPetition for ReconsiderationQualified Medical Examiner (QME)Permanent DisabilityFuture Medical TreatmentTreating PhysicianAgreed Medical Examiner (AME)Labor Code Section 4061Strawn v. Golden Eagle Insurance Co.
References
1
Case No. ADJ3615708 (BAK 0147668) ADJ2881957 (BAK 0147353) ADJ1664277 (BAK 0147354)
Regular
Oct 27, 2015

FRANCISCO JAVIER CASILLAS vs. SAN JOAQUIN VALLEY TRANSPORTATION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision, arguing that a key psychiatric AME report was unreliable and that the WCJ failed to address this in the opinion. The WCAB denied the reconsideration, finding that the WCJ properly relied on the reports of a different psychiatric AME, thus rendering the applicant's argument regarding the disputed report irrelevant. However, the WCAB granted reconsideration on its own motion to correct clerical errors in the original decision identified by the parties. The matter was then remanded to the WCJ to reissue a corrected decision.

California Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Awards and OrdersAgreed Medical Evaluator (AME)Dr. John StalbergDr. Carl Marusaksubstantial medical evidencepsychiatric claimspermanent disabilitylabor code section 132a
References
4
Case No. MISSING
Regular Panel Decision

Pizzo v. Barnhart

Plaintiff Kathleen Pizzo appealed the Commissioner of the Social Security Administration's final determination denying her disability insurance benefits. The District Court reviewed the ALJ's decision, which had assigned no weight to the treating physician's opinion and significant weight to a consulting physician's report. The court found that the ALJ erred by failing to give appropriate weight to the treating physician's opinion, not adequately developing the administrative record to obtain missing medical notes, and giving undue weight to the consulting physician's report which did not explicitly support the capacity for sedentary work. Consequently, the Commissioner's determination was remanded for further administrative proceedings consistent with the District Court's decision, granting the plaintiff's motion for judgment on the pleadings to the extent of the remand and denying the Commissioner's cross-motion.

Social Security ActDisability Insurance BenefitsAdministrative Law JudgeTreating Physician RuleResidual Functional CapacitySedentary WorkMedical EvidenceRemandSubstantial EvidenceRecord Development
References
23
Case No. 9420257 [MF]; 8802141 [2] 8802135 [3]
Regular
Nov 02, 2019

RICHARD GLASSMAN vs. STATE OF CALIFORNIA DEPT OF CORRECTIONS & REHABILITATION

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant permanently and totally disabled. The defendant contended the Administrative Law Judge erred by relying on the applicant's vocational expert, psychiatric AME, and inadmissible reports, and making a determination contrary to *Fitzpatrick*. The Board found the ALJ's reliance on the vocational expert and AME was supported by evidence, and the applicant's credibility was not impeached. While an inadmissible report was considered for jaw injury, it was deemed inconsequential to the permanent disability rating. The Board found the decision was consistent with the facts and medical opinions presented.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanently Totally DisabledVocational ExpertAgreed Medical ExaminerPsychiatric AMETreating PhysicianLabor Code § 5903Admitted InjuryCombined Values
References
3
Case No. ADJ285099 (SFO 0496940) ADJ224856 (SFO 0496941)
Regular
Nov 13, 2008

PATRA NESSETH-STEFFES vs. HAYWARD UNIFIED SCHOOL DISTRICT, SCHOOLS INSURANCE GROUP

The Appeals Board affirmed the WCJ's decision, finding that the applicant's right knee injury did not have an indicated permanent disability in 2004 based on treating physician reports, thus requiring the use of the 2005 Permanent Disability Rating Schedule. The majority concluded that Dr. Lim's MRI report, while showing tears, did not explicitly state the existence of permanent disability from the industrial injury, and the treating physician's report at the time showed no physical evidence of permanent impairment. A dissenting opinion argued that Dr. Lim's MRI report, supported by subsequent medical findings and the applicant's ongoing restrictions, indicated permanent disability in 2004, warranting application of the older 1997 rating schedule.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability Rating ScheduleMedical-Legal EvaluationTreating Physician ReportPermanent and StationaryLabor Code Section 4660(d)American Medical Association GuidesZenith Insurance Co. v. Workers' Comp. Appeals Bd. (Cugini)Genlyte Group v. Workers' Comp. Appeals Bd. (Zavala)
References
2
Case No. ADJ10223818
Regular
Sep 14, 2018

Irene Malagon vs. Larsen Supply Company, Inc.; Samsung Fire and Marine Insurance Company, Administered by Broadspire

This case involves a workers' compensation applicant claiming injury to her shoulders, neck, and back. The defendant sought reconsideration of the WCJ's finding of industrial causation, arguing the medical evidence was insufficient. The Board affirmed the WCJ's decision, finding the applicant's treating physician's report to be substantial evidence despite some historical inconsistencies. The Board also found the Qualified Medical Evaluator's reports problematic, particularly regarding causation for wrist and hand injuries due to contradictory opinions and insufficient analysis. A dissenting commissioner believed both medical reports had significant flaws, necessitating further evaluation.

AOE/COEProduction workerCumulative injuryMedical opinionSubstantial evidenceTreating physicianQualified Medical Evaluator (QME)CausationReconsiderationCredibility determination
References
0
Case No. SDO 0309691
Regular
Jan 29, 2008

TERESA ROBLES vs. FAIRFIELD RESIDENTIAL, LLC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's decision that a neuromuscular stimulator provided by Advanced Rehabilitation Technologies (ART) was reasonable and necessary medical treatment. The Board found the medical evidence supporting the WCJ's decision was insufficient, specifically noting unclear reports from Dr. McClung and the absence of opinion from the agreed medical evaluator, Dr. Wieseltier. The case was returned to the trial level for further development of the record, including obtaining supplemental reports from the treating physicians.

ReconsiderationNeuromuscular stimulatorReasonable and necessaryMedical treatmentLien claimantStipulated awardPermanent disabilityAgreed medical evaluator (AME)Record developmentSupplemental reports
References
1
Case No. ADJ9176813
Regular
Jul 24, 2017

MARIA ABIGAIL SANCHEZ vs. OLGA CABRAL dba CABRAL FAMILY DAY CARE, Uninsured, UNINSURED EMPLOYERS BENEFITS TRUST FUND

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, reversing a prior decision that denied industrial injury. Although initial medical reports were insufficient, the Board found an unrebutted physician opinion that the applicant's pain arose from working activities. The Board ordered further development of the medical record, including a report from an agreed or qualified medical evaluator, to ensure substantial justice. This action aims to allow a decision based on a fully developed record regarding the claimed cumulative injury.

Workers' Compensation Appeals BoardUninsured Employers Benefits Trust FundPetition for ReconsiderationCumulative InjuryIndustrial CausationMedical Record DevelopmentPrimary Treating PhysicianAgreed Medical EvaluatorPanel Qualified Medical EvaluationLabor Code Section 5906
References
5
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
4
Case No. ADJ7207861
Regular
May 06, 2011

STEVE TORDINI vs. JAMES DIEDRICH, PREFERRED EMPLOYERS INS. CO.

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contention that the WCJ erred in relying on the treating physician's opinion over the PQME's regarding permanent disability and apportionment. The Board found the treating physician's opinion unsubstantiated, as it included unqualified legal conclusions and improperly utilized AMA Guides criteria for apportionment. Consequently, the WCAB rescinded the prior award and returned the case for a new decision, directing the WCJ to base findings on the PQME's report. A dissenting opinion argued that both medical opinions were flawed and recommended further medical development.

PQMEWCJWPIapportionmentLabor Code sections 46634664Almaraz IIAMA GuidesDRE Lumbar Category IVdisc protrusion
References
4
Showing 1-10 of 30,128 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational