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Case Law Database

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

Case No. ADJ1139186 (OAK 0308001) ADJ483865 (OAK 0308002) ADJ6524430

Regular

Jan 06, 2011

PATRICK RECORDS vs. WASTE MANAGEMENT OF ALAMEDA COUNTY AND CIGA, CONVERIUM, ACE, ET AL.

The Workers' Compensation Appeals Board granted reconsideration to address CIGA's claim for contribution against Converium for a cumulative trauma injury ending February 15, 2000. CIGA argued that the statute of limitations was tolled by medical treatment and payments made under a Compromise and Release Agreement. However, the Board found the record insufficient, lacking crucial medical evidence regarding the cumulative trauma injury and benefit payment details. Therefore, the case was returned to the trial level to allow the admission of necessary documents, including the Agreed Medical Examiner's reports and a clear benefit payment printout, to determine the validity of CIGA's contribution claim.

CIGAConverium InsuranceContribution claimCumulative traumaStatute of limitationsCompromise and Release AgreementTollingMedical treatmentAgreed Medical ExaminerApplication for Adjudication of Claim

References

Case No. ADJ11053430; ADJ14397522

Regular

Jun 23, 2025

MICHAEL FISHEL vs. RICK'S LUBE AND COMPLETE AUTO, OAK RIVER INSURANCE COMPANY

Applicant Michael Fishel, an auto mechanic, sustained an injury to his back and other body parts on August 18, 2017, while employed by Rick's Lube and Complete Auto, insured by Oak River Insurance Company. The case involved extensive litigation concerning the necessity of lumbar spine surgery and the waiver of the Utilization Review/Independent Medical Review process, leading to the appointment of Dr. Laura Hatch. The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, rescinding and substituting a prior Findings and Award. The Board's decision clarified Dr. Hatch's appointment date and the scope of her evaluation, ultimately upholding the award for the applicant's lumbar spine surgery based on Dr. Hatch's medical opinions.

AOE/COEUR/IMRRegular PhysicianStipulationPetition for ReconsiderationFindings and AwardLabor Code Section 5701Lumbar Spine SurgeryQualified Medical EvaluatorPrimary Treating Physician

References

Case No. ADJ1717969 (VNO 0449705)

Regular

Mar 20, 2013

ERIKA ROLLINS vs. FILM PAYMENT SERVICES, KID BROTHERS PRODUCTION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION, in liquidation, ST. PAUL FIRE & MARINE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded an arbitrator's award because the arbitration proceedings lacked a proper record, violating Labor Code sections requiring findings on all facts and compliance with case record standards. The WCAB returned the matter for further proceedings to ensure a complete record is created, adhering to due process principles and established case law. If a compliant record cannot be created, the case will be remanded for a new arbitrator selection. The parties sought reconsideration of the original award, which found Travelers' insurance to be "other insurance" and held them liable for the applicant's injury, ordering CIGA's dismissal.

California Insurance Guarantee AssociationCIGASt. Paul Fire & Marine Insurance CompanyTravelersWorkers' Compensation Appeals BoardArbitrator's AwardReconsiderationOther InsuranceInsurance Code Section 1063.1(c)(9)Prejudgment Interest

References

Case No. SFO 0485546

Regular

Apr 08, 2008

Carmen Apodace vs. Pinnacle Law Group, Everest National Insurance Company

The Workers' Compensation Appeals Board granted reconsideration and rescinded the trial judge's decision because it relied on medical records not admitted into evidence. The case is returned to the trial level to properly develop the record, including potentially relevant testimony from an Agreed Medical Examiner. The defendant's contentions regarding the date of injury can be addressed again after the record is complete.

Cumulative traumaDate of injuryLabor Code section 5412Rehabilitation Unit jurisdictionQualified Injured WorkerDisabilityDWC-1 Claim FormStatute of limitationsSection 5500.5Insurer liability

References

Case No. ADJ10902577, ADJ10902596

Regular

Jul 08, 2019

EDWARD MCMAHON vs. CITY OF TRACY, AIMS INSURANCE

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding the WCJ's order appointing a physician. The Board found the order was issued without sufficient evidence in the record and lacked due process. This decision was based on the principle that Appeals Board decisions must be supported by admitted evidence and a complete record. The case is returned to the trial level to establish an evidentiary record before any decision is made.

Petition for RemovalLabor Code Section 5701Regular Physician AppointmentWCJ AuthorityDue ProcessEvidentiary RecordSubstantial EvidenceMandatory Settlement ConferenceDeclaration of ReadinessStipulations

References

Case No. ADJ4478194 (ANA 0379216)

Regular

Nov 25, 2008

MILTON T. WYNN vs. BALTIMORE RAVENS, ATLANTA FALCONS, HOUSTON TEXANS, TAMPA BAY BUCCANEERS, ST. LOUIS RAMS, GULF INSURANCE COMPANY; WARD NORTH AMERICA, INC., Permissibly SelfInsured;, TRAVELERS INSURANCE COMPANY Successor in interest by merger GULF INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to allow an Independent Medical Examiner (IME) to review newly obtained medical records related to the applicant's pre-existing hip condition. The defendant argued these records were crucial for proper apportionment of permanent disability and that the IME lacked a complete history. The Board rescinded the prior award to develop the medical record further, allowing the IME to provide a supplemental report.

Workers' Compensation Appeals BoardIndependent Medical Examinersubstantial medical evidencebilateral slipped capital femoral epiphysisapportionmentpermanent disabilitycumulative traumaagreed medical examinersupplemental reportnewly discovered evidence

References

Case No. ADJ8733591

Regular

Mar 13, 2017

ANELLA MILES vs. RALPHS GROCERY COMPANY, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for removal, rescinding the original order. The WCAB found the original order, which replaced a Qualified Medical Examiner (QME) for alleged unavailability for deposition, was improperly issued due to a lack of a proper record. The WCAB emphasized that a complete record, including stipulations and admitted evidence, is essential for decisions. Therefore, the case was returned to the WCJ for further proceedings with a proper evidentiary record.

Petition for RemovalReplacement QME PanelWCJDepositionCal. Code Regs. §35.5PrejudiceIrreparable HarmMSC Minutes of HearingRule 35.5(f)Mandatory Settlement Conference

References

Case No. ADJ2128084 (VNO 0428792) ADJ1712801 (VNO 0428794) ADJ346332 (VNO 0428790) ADJ6882145

Regular

Feb 07, 2017

NAYER GARAS vs. RXI PLASTICS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded the WCJ's order for continuing home health care, finding the record insufficient to support the decision. Although the parties stipulated to timely utilization review denials, the specific RFAs forming the basis for these denials were not adequately documented in the record. The Board determined it could not ascertain whether the defendant's reliance on UR was inappropriate or if the applicant's care was improperly terminated without a change in circumstances. The case is returned to the WCJ for further proceedings to develop a complete record.

Workers' Compensation Appeals BoardReconsiderationPetition for ReconsiderationHome Health CareUtilization ReviewRequest for AuthorizationTreating PhysicianAdministrative Law JudgeLiver TransplantMedical Necessity

References

Case No. ADJ9652696

Regular

Jul 11, 2016

JAVIER GARCIA vs. YIRAE FASHION, INC., EMPLOYERS' COMPENSATION INSURANCE COMPANY

The Appeals Board granted the applicant's petition for removal due to a May 24, 2016 Minute Order from the WCJ. The order's ambiguity regarding trial issues of "reopening the record" or "clarification" would cause the applicant irreparable harm. The Board found the WCJ's order lacked clarity on issues, stipulations, and admitted evidence, violating the duty to create a complete and comprehensible record. Consequently, the Minute Order was rescinded, and the case was returned to the trial level to properly clarify issues and establish the record.

Petition for RemovalWorkers' Compensation Appeals BoardWCJMinute OrderReopen RecordClarification of RecordSignificant PrejudiceIrreparable HarmQualified Medical ExaminationPQME

References

Case No. ADJ8479818

Regular

Feb 17, 2015

JORGE LIEVANOS vs. CITY OF SANTA MARIA

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration due to an inadequate record. The WCAB rescinded the prior award and remanded the case to the trial level because the original decision lacked clarity on issues like permanent disability apportionment and the admission of key evidence. The WCAB emphasized the need for a complete record, including stipulated evidence and clear findings, to ensure meaningful review. This action aims to allow the WCJ to create a proper record and issue a compliant decision.

Petition for ReconsiderationFindings of Fact and AwardPermanent DisabilityApportionmentAgreed Medical Examiner (AME)Disability Evaluation Unit (DEU)Report and RecommendationElectronic Adjudication Management System (EAMS)Labor Code Section 4664Labor Code Section 4663

References

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Updated Daily

Case Law Database

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

Case No. ADJ1139186 (OAK 0308001) ADJ483865 (OAK 0308002) ADJ6524430

Regular

Jan 06, 2011

PATRICK RECORDS vs. WASTE MANAGEMENT OF ALAMEDA COUNTY AND CIGA, CONVERIUM, ACE, ET AL.

CIGAConverium InsuranceContribution claimCumulative traumaStatute of limitationsCompromise and Release AgreementTollingMedical treatmentAgreed Medical ExaminerApplication for Adjudication of Claim

References

Case No. ADJ11053430; ADJ14397522

Regular

Jun 23, 2025

MICHAEL FISHEL vs. RICK'S LUBE AND COMPLETE AUTO, OAK RIVER INSURANCE COMPANY

AOE/COEUR/IMRRegular PhysicianStipulationPetition for ReconsiderationFindings and AwardLabor Code Section 5701Lumbar Spine SurgeryQualified Medical EvaluatorPrimary Treating Physician

References

Case No. ADJ1717969 (VNO 0449705)

Regular

Mar 20, 2013

ERIKA ROLLINS vs. FILM PAYMENT SERVICES, KID BROTHERS PRODUCTION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION, in liquidation, ST. PAUL FIRE & MARINE INSURANCE COMPANY

References

Case No. SFO 0485546

Regular

Apr 08, 2008

Carmen Apodace vs. Pinnacle Law Group, Everest National Insurance Company

Cumulative traumaDate of injuryLabor Code section 5412Rehabilitation Unit jurisdictionQualified Injured WorkerDisabilityDWC-1 Claim FormStatute of limitationsSection 5500.5Insurer liability

References

Case No. ADJ10902577, ADJ10902596

Regular

Jul 08, 2019

EDWARD MCMAHON vs. CITY OF TRACY, AIMS INSURANCE

References

Case No. ADJ4478194 (ANA 0379216)

Regular

Nov 25, 2008

MILTON T. WYNN vs. BALTIMORE RAVENS, ATLANTA FALCONS, HOUSTON TEXANS, TAMPA BAY BUCCANEERS, ST. LOUIS RAMS, GULF INSURANCE COMPANY; WARD NORTH AMERICA, INC., Permissibly SelfInsured;, TRAVELERS INSURANCE COMPANY Successor in interest by merger GULF INSURANCE COMPANY

References

Case No. ADJ8733591

Regular

Mar 13, 2017

ANELLA MILES vs. RALPHS GROCERY COMPANY, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Petition for RemovalReplacement QME PanelWCJDepositionCal. Code Regs. §35.5PrejudiceIrreparable HarmMSC Minutes of HearingRule 35.5(f)Mandatory Settlement Conference

References

Case No. ADJ2128084 (VNO 0428792) ADJ1712801 (VNO 0428794) ADJ346332 (VNO 0428790) ADJ6882145

Regular

Feb 07, 2017

NAYER GARAS vs. RXI PLASTICS, INC., STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ9652696

Regular

Jul 11, 2016

JAVIER GARCIA vs. YIRAE FASHION, INC., EMPLOYERS' COMPENSATION INSURANCE COMPANY

Petition for RemovalWorkers' Compensation Appeals BoardWCJMinute OrderReopen RecordClarification of RecordSignificant PrejudiceIrreparable HarmQualified Medical ExaminationPQME

References

Case No. ADJ8479818

Regular

Feb 17, 2015

JORGE LIEVANOS vs. CITY OF SANTA MARIA

References

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