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. ADJ8010276; ADJ8010319
Regular
May 18, 2012

JOSE MEZA vs. GATEWAY CONCRETE INC., INSURANCE CO. OF THE WEST GROUP INSURANCE COMPANIES

The applicant sought reconsideration of a decision that found the employer had a valid Medical Provider Network (MPN) and was not liable for treatment outside it. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration. This dismissal was based on the petition being unsigned, unverified, and lacking proof of service on all parties. Failure to meet these procedural requirements, as mandated by Labor Code section 5902 and related regulations, is grounds for dismissal. The WCAB emphasized that proper service is a substantive right, not a mere irregularity.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalUnverified PetitionUnsigned PetitionProof of ServiceLabor Code Section 5902Medical Provider NetworkEmployer LiabilityMedical Treatment Control
References
Case No. ADJ3274521 (POM 0289674)
Regular
Mar 06, 2012

ANTONIO ORTIZ (ANTONIO ORTIZ CUEVAS) vs. NEW REAL INC.; AMERICAN ALL RISK LOSS

The Workers' Compensation Appeals Board dismissed applicant Antonio Ortiz's petition for reconsideration. The petition was untimely as it was filed significantly after the deadline for reconsideration. Furthermore, the petition lacked proof of service on the opposing parties, and it was deemed "skeletal" for failing to cite any facts, evidence, or legal principles from the record. The Board strongly advised the applicant to consult with the Information and Assistance Officer for future filings.

Workers' Compensation Appeals BoardPetition for ReconsiderationProof of ServiceUntimely FilingSkeletal PetitionLabor Code § 5900(a)California Code of Regulations § 10507Jurisdictional Time LimitService OmissionDismissal
References
Case No. ADJ9466570
Regular
Dec 24, 2014

ELVIRA HERNANDEZ vs. NEWCO FOODS, INC., Operating As JACK IN THE BOX, SECURITY NATIONAL, Administered By AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration to clarify an earlier decision regarding a Medical Provider Network (MPN). The Board affirmed the finding that the defendant failed to prove the existence of a valid MPN. Consequently, findings related to MPN access standards and transfer of care were rescinded, with the applicant permitted to continue treatment outside the invalid MPN with her chosen physician. This decision primarily hinges on the defendant's failure to establish a legally compliant MPN.

Medical Provider NetworkMPNFindings of Fact and AwardPetition for Reconsiderationprimary treating physiciantransfer of careself-procured medical treatmentTitle 8section 9767.5(b)Title 8
References
Case No. ADJ9762825
Regular
Feb 29, 2016

MARIA OLGA BARAJAS vs. BARRETT BUSINESS SERVICES, CORVEL

This case involves Maria Olga Barajas's workers' compensation claim against Barrett Business Services and Corvel. The applicant was injured on July 20, 2014, and her attempts to change her treating physician within the employer's Medical Provider Network (MPN) were unsuccessful. The Workers' Compensation Appeals Board denied the defendants' Petition for Reconsideration, upholding the original award. This award allowed the applicant to seek treatment outside the MPN at the defendants' expense due to the failure to facilitate a timely change of physician.

Medical Provider NetworkMPNPetition for ReconsiderationFindings and Awardremovalchange of treating physicianinterim orderLabor Code § 4616.3(b)Title 8Regulations
References
Case No. ADJ8890109 ADJ8890125
Regular
Jan 09, 2017

ELIZABETH BURGOS vs. IMAGEFIRST HEALTHCARE LAUNDRY SPECIALIST; TRAVELERS

The applicant sought removal from a Workers' Compensation Appeals Board decision finding no denial of care. The applicant argued a 43-day delay in authorizing a change to a new treating physician within the defendant's MPN constituted denial of care. The Board denied removal, finding the applicant did not prove denial of care, as there was no evidence of inability to obtain treatment or refusal by the defendant. Furthermore, the applicant's requested change of physician occurred after the initial 30-day window, thus not falling under Labor Code section 4601(a).

Workers' Compensation Appeals BoardPetition for RemovalJoint Findings and AwardStipulations with Request for AwardPrimary Treating Physician (PTP)Medical Provider Network (MPN)Denial of CareLabor Code section 4601(a)Labor Code section 4600Cal. Code Regs.
References
Case No. ADJ7849757
Regular
Jul 19, 2012

CRESCENCIO REYNOSO vs. V. TERRAZAS CONTRACTING, YORK CLAIMS SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The Board affirmed the finding that the applicant, injured on January 7, 2011, must seek treatment within the employer's established and properly noticed Medical Provider Network (MPN). The applicant's arguments regarding MPN notification defects and the exclusion of evidence were found unmeritorious. The Board concluded the employer did not neglect or refuse to provide reasonably necessary medical treatment.

WCABADJ7849757Medical Provider NetworkMPNLabor Code 3550Labor Code 3551Labor Code 4600Labor Code 4616Self-Procured TreatmentAdministrative Director's Rules
References
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
Case No. ADJ9767744
Regular
Jun 10, 2016

ROSA AGUIRRE vs. DAVID MARLEY, ORLY MARLEY, MID CENTURY INSURANCE COMPANY

This case concerns an applicant's challenge to the replacement of a chiropractic QME panel with an orthopedic one. The applicant argued that the regulation allowing this replacement conflicted with the Labor Code. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration because the challenged order was not a final one. Furthermore, the WCAB denied the petition for removal on the merits, finding no conflict between the regulation and the Labor Code.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorQME Regulation 31.1(b)QME Regulation 31.5(a)(10)Labor Code section 4062.2Final OrderInterim Order
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ7332228
Regular
May 04, 2016

Luis Zapanta vs. Pacific Gas & Electric Company

The Workers' Compensation Appeals Board denied Luis Zapanta's petition for reconsideration, upholding the prior ruling that his Independent Medical Review (IMR) was timely. The Board found that the IMR process, including Maximus Federal Services' review, complied with Labor Code section 4610.6(d) and relevant regulations. Applicant's arguments regarding the timeliness of the IMR determination and whether sufficient medical records were reviewed were rejected. The Board affirmed the administrative law judge's decision based on the WCJ's report and additional supporting regulations.

Workers' Compensation Appeals BoardIndependent Medical ReviewMaximus Federal ServicesPetition for ReconsiderationFindings of Fact and OrderLabor CodeCalifornia Code of RegulationsPrimary Treating PhysicianTimelinessSupporting Documentation
References
Showing 1-10 of 919 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