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. ADJ4577451 (WCK 0063127) ADJ336675 (WCK 0063128)
Regular
Sep 10, 2013

EDUARDO GUERRA vs. POMEROY CORPORATION, TRAVELERS INSURANCE COMPANY

The Appeals Board granted reconsideration to review the WCJ's award of total temporary disability and future medical treatment, including spinal surgery. The Board rescinded the WCJ's decision because the record regarding the necessity of spinal surgery was not fully developed. Specifically, Dr. Harf's second opinion report was incomplete due to unobtained diagnostic tests, preventing a definitive recommendation on surgery. The case is returned to the trial level to further develop the medical evidence on the surgery issue and other deferred matters.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary Disability IndemnitySpinal SurgerySecond Opinion PhysicianUtilization ReviewPenaltiesDiscoveryDeclaration of Readiness to Proceed
References
6
Case No. ADJ1124701 (OAK 0304697)
Regular
Jan 25, 2010

GENE THOMAS vs. SLEEP TRAIN MATTRESS CENTER, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision favoring the applicant's spinal surgery, finding that proper procedural steps were not followed. The employer's utilization review (UR) had denied the surgery, but neither party followed the required second-opinion process under Labor Code section 4062(b). The WCAB returned the case to the trial level, allowing the employer ten days from receipt of the decision to object to the surgery and initiate the second-opinion process. This decision aligns with the WCAB's en banc ruling in *Cervantes*, which clarified the procedures for handling spinal surgery disputes after UR denials.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code section 4062(b)Spinal SurgerySecond OpinionCervantes v. El Aguila Food ProductsACOEM GuidelinesExperimental TreatmentEn Banc DecisionAdministrative Director Rules
References
4
Case No. ADJ7117844
Regular
Dec 05, 2011

Tommy Robison vs. CITY OF MARICOPA

The Workers' Compensation Appeals Board denied reconsideration of an award of spinal surgery for Tommy Robison. The employer argued the award was improper because the Spinal Surgery Second Opinion (SSSO) report was untimely and they had implicitly agreed to an Agreed Medical Evaluator's (AME) opinion. The Board found the employer failed to prove a timely objection to the treating physician's recommendation or timely Utilization Review at the hearing. Therefore, the treating physician's recommendation for surgery was controlling, despite the tardiness of the SSSO report, and an AME's opinion did not waive the SSSO process.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeny ReconsiderationSpinal SurgeryAgreed Medical EvaluatorSecond Opinion EvaluatorTimelinessLabor CodeUtilization ReviewTreating Physician
References
5
Case No. ADJ1505960 (RDG 0127227)
Regular
Jan 05, 2010

JOSEPH RHOADS vs. WESTERN READY MIX, INC., TRAVELERS PROPERTY \& CASUALTY

The Workers' Compensation Appeals Board rescinded a prior award of spinal surgery, remanding the case for further proceedings. The Board found that the defendant's objection to the treating physician's spinal surgery recommendation failed to follow proper utilization review procedures as outlined in *Cervantes v. El Aguila Food Products, Inc.* The defendant must now adhere to the prescribed utilization review and objection timelines, starting with a new report from the treating physician. The Board expressed no final opinion on the applicant's entitlement to surgery or the attorney's fee pending the WCJ's new decision.

Workers' Compensation Appeals BoardRemovalReconsiderationFindings and AwardWorkers' Compensation JudgeIndustrial InjurySpinal SurgeryTreating PhysicianSecond Opinion PhysicianAmerican College of Occupational and Environmental Medicine Guidelines
References
3
Case No. ADJ3308341
Regular
Jan 27, 2009

MICHAEL COLEMAN vs. RAITO, INC., TIG SPECIALTY INSURANCE CO., RISK ENTERPRISE MANAGEMENT, LTD.

The Workers' Compensation Appeals Board reconsidered a decision regarding Michael Coleman's entitlement to spinal surgery. The Board found that the defendant, TIG Specialty Insurance, failed to meet the strict procedural timelines required for objecting to a treating physician's surgical recommendation, specifically citing AD Rule 9792.6(o) and Labor Code section 4610(g)(1). Consequently, the Board rescinded the prior award and remanded the case, giving the defendant ten days to properly initiate the objection process for the spinal surgery. The Board also clarified that the Agreed Medical Evaluator was not qualified to perform the required second opinion surgery evaluation.

Workers' Compensation Appeals BoardReconsiderationFindings of Fact and AwardPetition for ReconsiderationAdjusting AgentUtilization ReviewSpinal SurgeryTreating PhysicianAdministrative Director RuleLabor Code Section
References
1
Case No. MISSING
Regular Panel Decision

United Spinal Ass'n v. Board of Elections in the City of New York

Plaintiffs United Spinal Association and Disabled in Action brought an action against the Board of Elections in the City of New York (BOE) under Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act, alleging pervasive access barriers at poll sites. The Court previously denied a preliminary injunction. Both parties subsequently moved for summary judgment. The Court found no genuine dispute of material fact regarding the existence of pervasive and recurring accessibility barriers and deemed the BOE's accommodation methods insufficient. Consequently, the Court granted the plaintiffs' motion for summary judgment on liability and denied the defendants' cross-motion. The case is now referred to a Magistrate Judge for the determination of the appropriate remedy.

AccessibilityVoting RightsAmericans with Disabilities ActRehabilitation ActPoll SitesSummary JudgmentDisability DiscriminationBoard of ElectionsMeaningful AccessReasonable Accommodation
References
26
Case No. ADJ4480206 (POM 0274117)
Regular
Sep 23, 2008

JESUS MORALES vs. EXCEL CABINETS, INC., STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration to clarify that the industrial injury includes the applicant's psyche, as stipulated, and requires related medical treatment. Defendant waived its right to object to the recommended spinal surgery due to failure to timely object per Labor Code Section 4062(b). The Board awarded updated diagnostic workup and the recommended spinal surgery, while affirming the need for further development on temporary disability and average weekly earnings.

WCABReconsiderationFindings and AwardSpinal SurgeryLabor Code Section 4062(b)Second Opinion ReportTreating PhysicianIndustrial InjuryPsycheTemporary Disability
References
4
Case No. ADJ288083 (RDG 0128539)
Regular
Jun 01, 2010

JACOB VERVALIN vs. MISSION UNIFORM & LINEN, TRAVELERS INSURANCE

The Appeals Board rescinded the original decision, finding that the WCJ erred in admitting a supplemental AME report and authorizing spinal surgery based on it. The Board determined that the proper procedure under Labor Code sections 4610 and 4062 for disputing spinal surgery recommendations was not followed. Specifically, the medical opinions from Dr. Jones and Dr. Pappas were found to be based on inadequate reviews of the applicant's medical records, necessitating further development of the record. Consequently, the case was returned to the trial level for additional proceedings and a new decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjurySpinal SurgeryAgreed Medical Examination (AME)Utilization Review (UR)Labor Code Section 4610Labor Code Section 4062Second Opinion Report
References
5
Case No. ADJ8033181
Regular
Jun 04, 2013

MARCIA MATTHEWS vs. NEIMAN MARCUS, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board granted the applicant's Petition for Removal, overturning a prior order to select an Agreed Medical Evaluator. The Board found that the applicant's physician, Dr. Chambi, provided substantial evidence supporting the need for spinal surgery. Conversely, the defense's second opinion physician, Dr. Ma, failed to adequately explain his non-surgical recommendation and his initial report was untimely due to the defense's failure to provide complete medical records. Therefore, the Board ordered the defendant to provide the requested spinal surgery.

Petition for RemovalAgreed Medical EvaluatorRegular PhysicianLabor Code Section 5701Spinal SurgeryNeurosurgical ConsultationUtilization Review DenialSecond Opinion EvaluatorFormer Labor Code Section 4062(b)Expedited Hearing
References
1
Case No. ADJ900432 (SAC 0323091)
Regular
Dec 30, 2011

MARLENE COPUS vs. NORTH SACRAMENTO ELEMENTARY SCHOOL DISTRICT

This case involves a dispute over the necessity of spinal surgery for an applicant who sustained a cumulative trauma injury to her neck and back. While the applicant's treating physician recommended surgery, a second opinion physician disagreed, citing a lack of nerve root compression. The Appeals Board found that the medical evidence was insufficient to determine the necessity of surgery, particularly in light of ACOEM Practice Guidelines which generally recommend against surgery without nerve root compression. Therefore, the Board rescinded the prior award and remanded the case to appoint an independent physician to evaluate the applicant and determine the reasonableness and necessity of the proposed surgery.

Workers' Compensation Appeals BoardMarlene CopusNorth Sacramento Elementary School Districtcumulative traumaspinal surgerynerve root impingementcervical stenosisDr. OrisekDr. GregoriusACOEM Practice Guidelines
References
4
Showing 1-10 of 863 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