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Case Law Database

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

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ9625407
Regular
Sep 12, 2018

KEITH FIELD vs. CITY OF PINOLE

This case involves a firefighter who sustained bilateral carpal tunnel syndrome after retirement. The Appeals Board reversed the trial judge, holding that Labor Code section 4458.5 applies, entitling the applicant to permanent disability benefits calculated at the maximum indemnity rate. This applies regardless of the applicant's actual earnings or the fact that carpal tunnel syndrome is not a specifically enumerated presumptive injury. The case is remanded for determination of the precise date of injury to calculate the benefit rate.

Workers' Compensation Appeals BoardKeith FieldCity of PinolePermissibly Self-InsuredMunicipal Pooling AuthorityADJ9625407Opinion and Decision After Reconsiderationindustrial injuryfirefighterbilateral upper extremities
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. 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. ADJ10021120 ADJ8949346
Regular
Apr 14, 2017

ANTHONY BERNARD EDWARDS (Dec'd), CANDACE EDWARDS (Widow), ASHLEY EDWARDS (Daughter), ANTHONY EDWARDS, JR. (Son) vs. CITY OF LOS ANGELES; LOS ANGELES WORLD AIRPORTS, Permissibly Self-Insured

This case involves a workers' compensation death benefit claim for Anthony Bernard Edwards, who died in the course of his employment. The dependents seek death benefits and burial expenses, which were initially awarded by the WCJ. The employer, City of Los Angeles, sought reconsideration, arguing it should receive credit for a third-party settlement the dependents obtained from Kaiser Permanente. The Board agreed to reconsider the issue of credit, specifically whether Civil Code section 3333.1 bars such credit. The Board ultimately deferred the credit issue, affirming the death benefit award and returning the matter for further proceedings to determine the applicability of Civil Code section 3333.1 and potential employer negligence.

Workers' Compensation Appeals BoardADJ10021120ADJ8949346death benefitsLabor Code section 4702burial expensesCivil Code section 3333.1Medical Injury Compensation Reform ActMICRAthird-party settlement
References
Case No. ADJ10029050
Regular
Mar 11, 2016

MARIBEL SANCHEZ vs. GRAPEVINE CATERING, SECURITY NATIONAL INSURANCE COMPANY

The Board dismissed the Defendant's Petition for Reconsideration because it was not taken from a final order, as only final orders are subject to reconsideration under Labor Code section 5900(a). The WCJ's order concerning the invalidity of a QME panel and the issuance of a new one was deemed an interlocutory discovery matter, not a final decision. Even if considered a petition for removal, the Board would have denied it on the merits because the Medical Unit misinterpreted QME Regulation 30(d)(1) by limiting QME panel requests to defendants, which conflicts with Labor Code sections 4060 and 4062.2. The Board expressed no opinion on the appropriateness of the pain management specialty, noting the Defendant could dispute it separately.

QME panelMedical Unitpain managementorthopedicsPetition for Reconsiderationfinal orderLabor Code section 5900Maranian v. Workers' Comp. Appeals Bd.removalLabor Code section 5310
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ12248957
Regular
Oct 06, 2025

QUINTON THORN vs. FORBIX CAPITAL CORP.; EMPLOYERS COMPENSATION INSURANCE FUND; THE HARTFORD

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's finding that applicant Quinton Thorn's psychiatric claim was barred by a post-termination defense. The Board determined the WCJ incorrectly applied Labor Code Section 3600(a)(10) instead of Section 3208.3(e) for psychiatric injuries. Applicant alleged psychiatric injury from sexual harassment and discrimination based on gender identity during his employment with Forbix Capital Corp. The Board rescinded the WCJ's findings and remanded the case to the trial level, directing the WCJ to properly analyze the post-termination defense, the date of injury, and consider the good faith personnel action defense if raised.

Workers' Compensation Appeals BoardReconsiderationFindings of FactLabor Code Section 3600(a)(10)Labor Code Section 3208.2(c)Labor Code Section 3208.3(c)Labor Code Section 3208.3(e)Psychiatric InjuryPost-Termination DefenseGender Identity Discrimination
References
Case No. ADJ6899666 ADJ6899667
Regular
Jan 25, 2016

KIMBERLY CHAMBERS vs. UCLA MEDICAL CENTER, Permissibly SelfInsured, Administered By SEDGWICK CMS

This case concerns an applicant's industrial injury causing cardiovascular and digestive system damage. The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration as moot due to the judge's rescission of a prior award. The Board granted the defendant's petition, limiting the applicant's total temporary disability to 104 weeks per Labor Code section 4656(c)(2). The issue of a 15% permanent disability increase under Labor Code section 4658(d)(2) was deferred for further proceedings.

Petition for ReconsiderationDismissalFindings of FactOrder and AwardWCJPhlebotomistIndustrial InjuryCardiovascular SystemTemporary DisabilityPermanent Disability
References
Case No. ADJ19947925
Regular
May 19, 2025

Andres De Jesus Garcia vs. Slater's 50/50, Security National Insurance Company

Applicant, Andres De Jesus Garcia, sought reconsideration of a March 12, 2025 Findings and Award (F&A) which denied his request for a new primary treating physician (PTP) or a second opinion. The workers' compensation administrative law judge (WCJ) had found that the applicant reached maximum medical improvement (MMI) based on reports from his PTP and a panel qualified medical evaluator (PQME). Applicant contended he is entitled to a change of PTP or a second opinion within the medical provider network (MPN) under various Labor Code sections and WCAB Rules. The Appeals Board granted the Petition for Reconsideration, deferring a final decision after reconsideration to allow for further review of the factual and legal issues.

Petition for ReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Maximum Medical Improvement (MMI)Qualified Medical Evaluator (PQME)Labor Code sections 4616.3 and 4616.4WCAB Rules 9767.6(e) and 9767.7Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Labor Code section 5909Electronic Adjudication Management System (EAMS)
References
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