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. ADJ1457992 (AHM 0084718)
Regular
Dec 26, 2014

DARLENE HELLER vs. COWELL BAKER'S STRIPPING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS, FREMONT INSURANCE COMPANY

This case concerns a dispute over the correct procedure for obtaining medical reevaluations for a worker's injury with a date prior to January 1, 2005. The Appeals Board denied the applicant's petition for reconsideration, reversing an earlier decision that had directed the parties to use the panel QME process. The Board clarified that for pre-2005 injuries, the pre-Senate Bill 899 AME/QME procedures apply, not the current section 4062.2 QME process. One Commissioner dissented, arguing the prior award should be reinstated.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order DenyingFindings and AwardLabor Code section 4062.2panel qualified medical examinationQMEdisputed body partsadmitted liabilitydate of injury
References
Case No. ADJ6974763
Regular
Nov 04, 2011

TradeY PRUITT vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

This case involves an inmate firefighter claiming industrial injury to her knees from a fall while on duty. The original award found temporary and permanent disability, but the defendant sought reconsideration. The appeals board granted reconsideration, rescinded the award, and returned the matter for further proceedings. This was due to the medical expert's report on apportionment not adhering to the current legal standards for causation as established by Senate Bill 899. The board emphasized that new apportionment requires physicians to determine the percentage of disability caused by the industrial injury versus other factors, which the prior report failed to do.

Labor Code Section 4658(d)Inmate FirefighterOccupational Code 492Occupational Group 460Permanent Disability IndemnityReconsiderationApportionmentCausationSenate Bill 899AMA Guides
References
Case No. ADJ5829433
Regular
Nov 08, 2017

JESSICA SENQUIZ vs. CITY OF FREMONT, YORK INSURANCE

In this workers' compensation case, the Workers' Compensation Appeals Board (WCAB) reconsidered a prior decision regarding payment for medical services. The defendant reduced payments for epidural steroid injections based on National Correct Coding Initiative (NCCI) edits, arguing this was a fee schedule dispute subject to Independent Bill Review (IBR). The WCAB ultimately rescinded the prior decision, finding that disputes over procedure coding, even if not explicitly adopted in the fee schedule, are considered disputes over the amount payable under the Official Medical Fee Schedule. Therefore, the WCAB concluded that such billing disputes are subject to IBR and not within the WCAB's jurisdiction.

WCABJessica SenquizCity of FremontYork InsuranceADJ5829433Opinion and Decision After Reconsiderationtransforaminal epidural steroid injectionsFremont Surgery CenterIndependent Bill Review (IBR)National Correct Coding Initiative (NCCI)
References
Case No. ADJ2005173 (AHM 0132388)
Regular
Jan 25, 2010

RUFUS TANKSLEY vs. CITY OF SANTA ANA

The Workers' Compensation Appeals Board granted reconsideration to both applicant and defendant. The Board rescinded the prior decision, finding that the medical reports of Drs. Jay and Stewart were admissible under pre-SB 899 procedures applicable to the claimed date of injury. The case was returned to the trial level for admission of these reports, further medical development if necessary, and a new decision addressing all issues, including the statute of limitations defense.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersPanel Qualified Medical ExaminersQMEMedical Report AdmissibilityLabor Code §4060(d)Statute of LimitationsLabor Code §5405Cumulative Period
References
Case No. ADJ1003604 (VNO 0473994)
Regular
May 10, 2016

MARIO CARRASCO vs. CITY OF LOS ANGELES

Lien claimant Western Medical Center (Western) sought reconsideration of an Independent Bill Review (IBR) determination that found no reimbursement warranted for medical services. Western argued the IBR determination was plainly erroneous because the defendant failed to provide a contract justifying payment below the official medical fee schedule. However, the Board dismissed Western's petition, finding it premature and improperly filed. Western failed to exhaust the required statutory appeal process to the Workers' Compensation Appeals Board trial level before filing for reconsideration.

Workers' Compensation Appeals BoardIndependent Bill ReviewAdministrative DirectorMaximus Federal ServicesOfficial Medical Fee ScheduleStipulations and AwardCumulative Trauma InjuryLumbar Spinal SurgerySecond Bill ReviewExplanation of Benefits
References
Case No. ADJ4045682
Regular
Sep 07, 2010

BILL DUNEHEW vs. DON KEITH TRANSPORTATION, CENTRAL CARTAGE COMPANY, AARLA, STATE COMPENSATION INSURANCE FUND

This case involves applicant Bill Dunehew seeking reconsideration of a decision allowing defendants to offset permanent disability advances from one claim (ADJ2806318) against a separate claim (ADJ6769921). The Board granted reconsideration, overturning the administrative law judge's decision. They found that allowing such an offset would be inequitable, given that the applicant's permanent disability was apportioned across multiple dates of injury due to legislative changes. Furthermore, the Board determined that applying the credit would negate any new permanent disability benefits for the applicant's 2007 injury, contrary to the purpose of the award.

Petition for ReconsiderationPermanent Disability IndemnityCredit for AdvancesSeparate ClaimsEquitable PrinciplesApportionment of InjurySenate Bill 899Benson v. WCABMaples v. WCABLabor Code Section 4909
References
Case No. ADJ7868976
Regular
May 02, 2018

JAMES BARRIOS vs. BUENA VISTA FOOD PRODUCTS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted reconsideration of a judge's order requiring defendants to pay the balance of a lien claimant's bill. The primary dispute concerns the reasonable value of medical services under the Official Medical Fee Schedule (OMFS). Neither the lien claimant's testimony nor the defendant's bill review expert provided substantial evidence to establish the OMFS amount due. Therefore, the case is remanded for further proceedings to develop the record, potentially through an agreed bill reviewer or an appointed independent reviewer.

Petition for ReconsiderationFindings and OrderCompromise and Releaselien claimantDr. Paynebill reviewofficial medical fee scheduleOMFSsubstantial evidenceindependent bill review
References
Case No. SAC 316687
Regular
Feb 28, 2008

STEVE OLSON vs. DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

This case involves a correctional lieutenant claiming cumulative industrial injury to his heart, hypertension, diabetes, and GERD. The original decision apportioned 80% of his permanent disability to non-industrial causes, but the Appeals Board rescinded this. The Board determined that Labor Code section 4663(e) exempts safety officers like the applicant from apportionment for presumed injuries, and the calculation of permanent disability indemnity must now follow the *Brodie/Welcher* standard.

Workers' Compensation Appeals BoardSAC 316687Steve OlsonDepartment of CorrectionsState Compensation Insurance FundOpinion and Decision After Reconsiderationcorrectional lieutenantcumulative industrial injuryhearthypertension
References
Case No. ADJ4146224 (SBR 0296668) ADJ1272169 (SBR 0296667)
Regular
Oct 28, 2013

KATHLEEN ZAMANJAHROMI vs. KAISER FOUNDATION HOSPITAL

This case involves Kathleen Zamanjahromi seeking increased permanent disability benefits for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied Kaiser Foundation Hospital's petition for reconsideration. The WCAB affirmed the finding of good cause to reopen a prior stipulated award for new and further disability, resulting in a 96% permanent disability rating. The defendant's argument that SB 899's apportionment provisions applied to the original award was rejected. The WCAB clarified that SB 899's apportionment applies to new and further disability but cannot retroactively alter prior findings.

Petition for ReconsiderationNew and Further DisabilityLabor Code Section 5410Senate Bill 899ApportionmentStipulated AwardReopeningFinal OrderWorkers' Compensation Appeals BoardAgreed Medical Examiner
References
Case No. OAK 294681
Regular
Nov 14, 2007

SCOTT SIMPSON vs. GEO OPTIONS, INC., EARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision regarding permanent disability apportionment, finding substantial medical evidence supported a 50% apportionment to pre-existing conditions. The Board also upheld the WCJ's finding of unreasonable delay in medical treatment, justifying a penalty against the defendant. A minor clerical error in the award regarding penalty references was corrected.

Workers' Compensation Appeals BoardScott SimpsonGeo Options Inc.Hartford Insurance CompanyOAK 294681Opinion and Decision After Reconsiderationpermanent disabilityapportionmentspondylolisthesisqualified medical examiner
References
Showing 1-10 of 617 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