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Case Law Database

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

Case No. ADJ3839297 (GOL 00100930)
Regular
May 31, 2009

Edith Barrett vs. PACIFICA GRADUATE INSTITUTE, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Appeals Board denied defendant's petition for removal, finding it premature. The defendant sought to reinstate an earlier decision denying permanent disability benefits, arguing the WCJ's subsequent rescission of that order would cause irreparable harm through increased litigation costs. However, the WCJ's rescission was a proper procedural step following the applicant's petition for reconsideration, and the case was subsequently resubmitted. Therefore, removal was inappropriate as the defendant's alleged harm was speculative and not yet realized.

Petition for removalRescission of orderFindings and awardPermanent disabilityFurther discoveryIrreparable harmLitigation expensesWCJ report and recommendationTrial briefDue process
References
Case No. ADJ9194237
Regular
Jan 12, 2015

ANDREW CONDRACK vs. BANNING UNIFIED SCHOOL DISTRICT

In this case, the Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of a decision ordering authorization for back surgery. The defendant argued the utilization review was timely, but applicant's response indicated the surgery was subsequently authorized. Therefore, the Board is granting reconsideration to allow the defendant to withdraw their petition or show good cause why the original decision should not be affirmed.

Petition for ReconsiderationUtilization ReviewTimelinessAuthorizationRevision Back SurgeryWCJ DecisionAffirmationGood CauseDefective RequestResubmission
References
Case No. ADJ11423609
Regular
Sep 12, 2022

DANIEL SERVIN vs. CERRITOS LEXUS, ACE AMERICAN INSURANCE

This case concerns a defendant's petition for reconsideration of an order authorizing left shoulder surgery. The defendant argued a prior utilization review denial should prevent subsequent authorizations, citing Labor Code section 4610(k). However, the applicant's physician resubmitted the request with additional supporting documentation, triggering a new utilization review. This subsequent review certified the surgery as medically necessary, resolving the medical dispute. The Board denied reconsideration, holding that the defendant voluntarily submitted the resubmitted request, making the February 2, 2022 certification final and precluding further utilization review.

Utilization ReviewFindings and OrderPetition for ReconsiderationMedical NecessityReverse Total Shoulder ArthroplastyRequest for AuthorizationNon-certificationCertificationLabor Code Section 4610Resubmission
References
Case No. ADJ15516233
Regular
Aug 04, 2025

JULIE GARTZ vs. UNITED CONTINENTAL HOLDINGS, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Applicant Julie Gartz sought reconsideration of a WCJ's May 5, 2025 Findings of Fact, which found her primary treating physician's report lacked substantial evidence for a functional restoration program and deemed Utilization Review unnecessary for a second Request for Authorization. The applicant argued the defendant delayed treatment and that the WCJ erred on UR requirements and WCAB jurisdiction. The Workers' Compensation Appeals Board granted the Petition for Reconsideration, deferring a final decision for further review of the merits and the complete record, while highlighting its continuing jurisdiction and relevant legal principles.

Petition for ReconsiderationFunctional Restoration ProgramUtilization ReviewRequest for AuthorizationMedical NecessityChange of Material FactsTimelinessWCAB JurisdictionDubon IILabor Code Section 4610
References
Case No. ADJ7188251; ADJ7188272
Regular
Mar 08, 2013

Raymond Mark vs. City of Los Angeles

This case involves a petition by applicant Raymond Mark to resubmit or remove two workers' compensation cases, alleging the City of Los Angeles refused to fund an arbitrator. The Appeals Board dismissed the petition for three reasons: no arbitrator decision existed for review, the underlying claims were previously dismissed giving the Board no jurisdiction, and the Board lacks jurisdiction over disputes concerning the administration of the Alternative Dispute Resolution Agreement itself. The Board concluded that the applicant's recourse for funding disputes lies in collective bargaining, arbitration, or petitioning the Administrative Director to decertify the agreement.

Petition for ResubmissionADR CasesL.C. § 3201.7ADR ARB IVCity of Los AngelesFunding ArbitratorOpinion and Order Granting ReconsiderationDecision After ReconsiderationOrder of DismissalJurisdiction
References
Case No. ADJ7188251; ADJ7188272
Regular
Dec 30, 2013

RAYMOND MARK vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's "Petition for Re-Submission of ADR Cases" for being identical to a previously dismissed petition. The WCAB cited the same reasons as the prior dismissal in their Opinion and Order. The Board warned that further attempts to obtain action in violation of Labor Code section 3201.7 may be construed as a bad faith action, potentially leading to sanctions. Therefore, the applicant's petition was dismissed.

Petition for ResubmissionRemovalLC § 3201.7ADR ARB IVBad Faith ActionSanctionsLabor Code Section 5813Workers' Compensation Appeals BoardCity of Los AngelesPermissibly Self-Insured
References
Case No. ADJ7148195
Regular
Jan 03, 2020

KARIN SMITH vs. MARIN GENERAL HOSPITAL, ATHENS ADMINISTRATORS

This case concerns defendant's petition for reconsideration of an award for applicant's back surgery. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirmed the award, and corrected a clerical error in the case number. The WCAB found that while an initial surgery request was denied via Utilization Review (UR) and Independent Medical Review (IMR), the applicant's treating physician later submitted a new request supported by documented changes in material facts, including new neurological symptoms and an MRI showing critical stenosis and potential cauda equina syndrome. Because the second request indicated an imminent and serious threat to the applicant's health and was based on new medical evidence, the 12-month UR decision validity period did not apply.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardUtilization ReviewIndependent Medical ReviewLabor Code Section 4610(k)Documented Change in ConditionLumbar Spine SurgeryNurseCauda Equina Syndrome
References
Case No. ADJ8937162
Regular
Sep 24, 2015

REGINALD HARRIS vs. LETICIA CORPORATION, LIBERTY MUTUAL

The Workers' Compensation Appeals Board dismissed the petition for reconsideration because the underlying order vacating submission was interlocutory and not a final decision on substantive rights or liabilities. The Board also denied the petition for removal, finding that the defendants failed to demonstrate substantial prejudice or irreparable harm that reconsideration would not adequately address later. The WCJ's decision to seek clarification of medical reports before determining admissibility was deemed procedurally sound. Therefore, the defendants' challenges to the admissibility of evidence and request for resubmission were premature.

WCABPetition for ReconsiderationPetition for RemovalOrder Vacating SubmissionAdmissibility of Medical ReportsPanel QMETreating PhysicianPermanent and Stationary ReportApportionmentLabor Code Section 5502(d)(3)
References
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