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. ADJ10975151
Regular
Jan 06, 2020

RUSSELL CAMARA vs. TESLA, INC., AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the Applicant sustained an admitted industrial injury to the lumbar spine. The Applicant's primary treating physician (PTP) designated a secondary physician to evaluate permanent and stationary status and impairment, whose report the PTP adopted. The defense challenged the validity of this secondary physician's report, arguing only the Panel Qualified Medical Examiner's (PQME) report was properly obtained. The Workers' Compensation Appeals Board denied the Petition for Reconsideration, affirming that the PTP, or a physician designated by the PTP, is authorized to render opinions on medical issues, provided proper notice and procedural requirements are met. The Board found the designation and subsequent report were compliant with Labor Code and Administrative Director Regulations.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianQualified Medical ExaminerLabor Code Section 4061.5Permanent and Stationary ReportMedical-Legal EvaluationSecondary PhysicianAdministrative Director Rule 9785Designation of Physician
References
0
Case No. ADJ8505079
Regular
May 11, 2016

MATTHEW LOPEZ vs. CITY AND COUNTY OF SAN FRANCISCO

This case concerns Matthew Lopez's claim for workers' compensation benefits for a back injury. The City and County of San Francisco, the defendant, denied a Request for Authorization (RFA) for disc replacement surgery recommended by Dr. Jones, a consulting physician. The Appeals Board held that Dr. Jones, acting at the primary treating physician's behest and possessing specialized expertise, qualified as a secondary treating physician authorized to submit an RFA. Because the defendant failed to timely perform utilization review (UR) on Dr. Jones' RFA or communicate its decision, the Board affirmed the award of medical treatment, finding jurisdiction to determine its necessity.

Workers' Compensation Appeals BoardUtilization ReviewRequest for AuthorizationSecondary Treating PhysicianPrimary Treating PhysicianMedical NecessityLabor Code section 4610DWC Form RFAAdministrative Director RulesPeer Review
References
6
Case No. 533089
Regular Panel Decision
Oct 07, 2021

Matter of Barden v. General Physicians PC

Claimant, a patient services representative, sought to amend her workers' compensation claim to include left shoulder aggravation after a work-related injury to her right shoulder. The Workers' Compensation Board disallowed this request, finding that claimant failed to provide sufficient credible medical evidence to establish a causal relationship between her employment and the left shoulder condition. The Appellate Division, Third Department, affirmed the Board's decision. The court noted that the claimant's treating physician opined the left shoulder pathology was largely preexisting and unrelated to the work injury, and other medical opinions either lacked sufficient weight or were based on inaccurate information, providing no basis to disturb the Board's finding.

Workers' CompensationShoulder InjuryCausationMedical EvidencePreexisting ConditionAppellate ReviewBoard DecisionClaim AmendmentPatient Services Representative
References
10
Case No. ADJ7160976
Regular
Sep 25, 2012

ANTONETTA WILLIAMS vs. CLAIRE'S STORES, INC., TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded the prior award and returned the case for further proceedings because the administrative law judge improperly relied on a secondary treating physician's report. The judge failed to establish that the requested attendant care was authorized or constituted substantial medical evidence. The Board emphasized that the primary treating physician must issue opinions on medical issues and the record needs further development to determine entitlement to attendant care.

Attendant carePrimary treating physicianSecondary treating physicianMedical treatment authorizationUtilization reviewSubstantial medical evidenceWorkers' Compensation Appeals BoardFindings and AwardReconsiderationAgreed Medical Examiner
References
0
Case No. ADJ8323717
Regular
Mar 24, 2014

MARIA GONZALEZ vs. AMERICAN APPAREL, INC.; NEW HAMPSHIRE INSURANCE COMPANY, administered by ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior "take nothing" order. The Board found that the administrative law judge improperly excluded four medical reports from secondary treating physicians, ruling they were admissible evidence even if not reviewed by the primary treating physician. The case is returned to the trial level for further proceedings and decision, with the admitted medical reports to be considered. The Board emphasized that this does not reopen discovery, but allows the WCJ to weigh all evidence to determine industrial causation.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderIndustrial CausationMedical ReportsAdmissible EvidencePrimary Treating PhysicianSecondary Treating PhysicianValdez v. Workers' Comp. Appeals Bd.Labor Code Section 4061.5
References
2
Case No. ADJ3543065 (AHM 0145064)
Regular
Jan 18, 2011

RAMON MARTINEZ vs. JUICE HARVEST CORP., PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the disallowance of Dr. Vazquez's lien. The Board agreed with the administrative law judge that there was insufficient evidence Dr. Vazquez provided medically necessary treatment to the applicant. Furthermore, as a secondary treating physician, Dr. Vazquez lacked the authority to provide treatment beyond the initial course recommended by the primary treating physician, Dr. Aun. The Board found that treatment provided outside Dr. Aun's authorization was not compensable.

Workers Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderCompromise and ReleaseMachine OperatorIndustrial InjuryRight ShoulderRight ElbowRight Hand
References
0
Case No. ADJ1581964 (MON 0344940) ADJ3113707 (MON 0344944) ADJ1018953 (MON 0344941)
Regular
May 10, 2018

JORGE ALVARADO vs. WARNER BROS. STUDIOS, AIG CLAIMS

The Workers' Compensation Appeals Board (WCAB) dismissed Warner Bros. Studios' Petition for Reconsideration and denied their Petition for Removal. The WCAB found that the challenged order, requiring authorization of secondary treating physicians, was procedural and not a final order subject to reconsideration. Furthermore, the WCAB found no basis for the defendant's claims of irreparable harm or prejudice, upholding the applicant's right to select his treating physicians under Labor Code Section 4600. The defendant's arguments regarding bypassing Utilization Review and duplicative treatment were also rejected.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalSecondary Treating PhysicianPrimary Treating PhysicianCumulative Trauma InjuryLabor Code Section 4600Utilization ReviewRequest for AuthorizationMedical Provider Network
References
0
Case No. ADJ71 43769
Regular
May 11, 2016

CURTIS KLEIN vs. WARNER BROS. STUDIO

This case involves a dispute over reimbursement for medical treatment provided by Dr. Marina Russman and other lien claimants. The defendant, Warner Bros. Studio, argued that Dr. Russman's treatment requests should not have been authorized because they were not submitted by the applicant's primary treating physician and therefore did not trigger the utilization review (UR) process. The Appeals Board affirmed the original award, holding that requests for authorization from secondary treating physicians do trigger the UR process. The Board also found substantial evidence supported the reasonableness and necessity of Dr. Russman's treatment, rejecting the defendant's argument that the applicant's condition was due to a pre-existing injury. Finally, a clerical error in the original order regarding a lien claimant was corrected.

Workers' Compensation Appeals BoardCurtis KleinWarner Bros. StudioPermissibly Self-InsuredOpinion and Decision After ReconsiderationPetition for ReconsiderationFindings of Fact Orders and AwardAdministrative Law Judge (WCJ)Lien ClaimantsDr. Marina Russman
References
9
Case No. ADJ7484505, ADJ7484506
Regular
Dec 18, 2019

FRANCISCO VILCHIS MONDRAGON vs. PACIFIC FLOOR COVERING, ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to award a lien claimant reimbursement for psychological treatment services. The Board found that the primary treating physician did refer the applicant to the lien claimant, received and reviewed the lien claimant's reports, and thus complied with reporting requirements. This reversed the trial judge's denial of the lien based on the primary physician's alleged failure to incorporate the secondary physician's reports. The matter was returned for determination of the amount owed.

Workers' Compensation Appeals BoardLien ClaimantPsychological Assessment ServicesPrimary Treating PhysicianSecondary Treating PhysicianRule 9785(e)(4)Reporting RequirementsMedical Treatment ExpensesIndustrial InjuryPsyche
References
3
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
2
Showing 1-10 of 2,315 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