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

Case No. ADJ8010240
Regular
Nov 14, 2013

TIMETHY KINTZ vs. KDC CONSTRUCTION, SEABRIGHT INSURANCE COMPANY

Here's a summary of the case in four sentences: The Workers' Compensation Appeals Board denied the defendant's petition for removal, which sought to rescind an order closing discovery and continuing the case to trial. The defendant argued the claim was barred by intoxication and that a toxicology QME report was necessary. The Board found that other dispositive issues, like statute of limitations or fraud, could be decided without a QME report. Therefore, the Board found no substantial prejudice to the defendant from the discovery closure.

Petition for RemovalLabor Code section 3600(a)(4)intoxicationqualified medical evaluators (QME)toxicologyAOE/COElachesstatute of limitationsfraudpresumption of compensability
References
Case No. FRE 0217800; FRE 0218000; FRE 0222219; FRE 0222220; FRE 0222221
Regular
Jun 23, 2008

JULIO ALVAREZ vs. CLOVIS UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured, Adjusted By TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted applicant's petition for reconsideration to correct a clerical error, increasing the permanent disability rating from 10% to 11% after apportionment, as stipulated by the parties. The Board affirmed the WCJ's findings that the applicant did not sustain industrial injury due to mold exposure or psychological injury, as the applicant failed to meet the burden of proof for these claims. The Board found the WCJ's reliance on the toxicology expert's opinion was supported by substantial evidence, thus affirming the denial of mold-related injury.

Workers' Compensation Appeals BoardPermanent DisabilityApportionmentMold ExposureIndustrial InjuryAOE/COEClaim FormPresumption of CompensabilitySubstantial EvidenceClerical Error
References
Case No. ADJ9533148
Regular
Apr 17, 2019

ANTHONY TAYLOR (deceased) vs. MERCED COUNTY SHERIFF’S DEPARTMENT

The Workers' Compensation Appeals Board granted reconsideration to reverse a prior finding of bad faith against the defendant, Merced County Sheriff's Department. The Board determined that the defendant acted within its legal rights to dispute the medical specialty for a Qualified Medical Evaluator (QME) and sought a replacement panel. Because the defendant's actions were permissible under regulations, they were not considered bad faith, thus rescinding the attorney's fees award. The Board otherwise affirmed the original decision regarding the appropriateness of an internal medicine specialist.

Workers' Compensation Appeals BoardMerced County Sheriff’s DepartmentAnthony Taylordeath benefitspancreatic cancercorrectional sergeantsepticemiabiliary tract obstructionQME panelinternal medicine
References
Case No. ADJ2738004
Regular
Nov 24, 2014

RONALD PAYTON vs. KLEINFELDER GROUP, AIG CLAIMS

The Workers' Compensation Appeals Board denied Ronald Payton's petition for reconsideration of a prior decision. The Board adopted the administrative law judge's report, which found that Payton's claims of injury were not supported by substantial evidence. The judge detailed how Payton, proceeding pro se, failed to present new or relevant evidence and misrepresented existing medical opinions. Therefore, the Board affirmed the original denial of the claim.

Petition for ReconsiderationSubstantial EvidenceAgreed Medical EvaluatorPro PerDWC-1MMIAgreed Medical EvaluatorPro SeNon-industrial PneumoniaToxicology
References
Case No. ADJ7324566
Regular
Apr 09, 2013

BRANDON CLARK DECEASED, JOVELYN CLARK (WIDOW), GUARDIAN AD LITEM FOR JOANNA CLARK (MINOR CHILD), BRITTANY CLARK (MINOR CHILD), BENJAMIN CLARK (MINOR CHILD) vs. SOUTH COAST FRAMING, INC., REDWOOD FIRE AND CASUALTY COMPANY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board denied reconsideration of a death claim where the decedent, Brandon Clark, died from combined toxic effects of sedating drugs. The defense argued that industrially prescribed medications did not significantly contribute to the death, but the Board upheld the finding that the industrially prescribed amitriptyline was a contributing factor. The Board found ample evidence supported industrial causation, rejecting the defense's attempt to limit causation solely to non-industrial medications and their untimely raised claim of intentional overdose.

Death ClaimIndustrial InjuryReconsiderationWidows BenefitsMinor DependentsToxicologyDrug InteractionCausationExpert OpinionMedical Examiner
References
Case No. ADJ1394617 (SDO 0360761) ADJ3352842 (SDO 0360836)
Regular
Aug 23, 2012

GAETANO DELISA vs. DEL MAR THOROUGHBRED CLUB, ZENITH INSURANCE CO.

This case involves applicant Gaetano Delisa's claim for workers' compensation benefits, alleging injury to his respiratory system and other areas due to exposure to a synthetic racetrack surface. The Workers' Compensation Appeals Board affirmed the judge's prior order finding no injury arising out of and in the course of employment. This decision was based on substantial medical evidence from qualified medical evaluators who opined that applicant's conditions were not industrially caused, and the applicant failed to meet his burden of proof. Applicant presented no medical evidence contradicting these expert opinions, thus the claim was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and OrderInjury AOE/COEPolytrackSecurity OfficerRespiratory SystemPqmeToxicologyOccupational Medicine
References
Case No. ADJ12906916
Regular
Feb 25, 2025

Celia Clara Bautista vs. Cal Central Harvesting, Inc.

Defendant sought reconsideration of a WCJ's decision finding industrial injury to the applicant in the form of uterine cancer and to the right foot. Defendant contended the WCJ erred by relying on Dr. Lonky's opinions, arguing his specialty was not relevant and he did not adequately consider exposure and latency periods. The Appeals Board granted reconsideration, finding that the medical record needed further development from additional specialists (oncology, gastroenterology, orthopedics) and supplemental reporting or testimony from Dr. Lonky, thus deferring the issues of industrial injury.

Workers' Compensation Appeals BoardCumulative InjuryUterine CancerRight Foot InjuryPulmonologyToxicologyLatency PeriodPanel Qualified Medical EvaluatorSubstantial Medical EvidencePetition for Reconsideration
References
Case No. ADJ12728611
Regular
Apr 09, 2020

MARTIN JACOBO vs. COKE FARM, RISICO CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal because the WCJ exceeded their authority by invalidating a Qualified Medical Examiner (QME) solely based on the specialty of occupational medicine for a post-surgical knee evaluation. The Board determined that an occupational medicine physician is appropriately qualified to assess such injuries according to DWC guidelines. Therefore, the WCJ's decision was rescinded, and the case was returned for further proceedings, suspending action on the Compromise and Release agreement pending further development.

Petition for RemovalPanel Qualified Medical ExaminerPQMEOccupational MedicineToxicologyPost-surgical kneeLabor Code section 4062.2(b)Administrative Director Rule 35.5Scope of practiceClinical competence
References
Case No. ADJ10435480
Regular
May 17, 2017

BRUCE MOORE vs. JEMICO, LLC, LIBERTY MUTUAL FIRE INSURANCE CO.

The Appeals Board granted reconsideration of a WCJ's award finding applicant sustained industrial injuries, not to decide the merits, but to issue a Notice of Intention to Impose Sanctions. Defendants' Petition for Reconsideration was found to be skeletal, lacking specific record references and relying on unsubstantiated claims, including a Wikipedia search. The Board also noted the defendants' failure to exercise due diligence in developing the record regarding applicant's alleged methamphetamine use. Sanctions are contemplated against defendants and their attorney for bad-faith actions and tactics.

Workers' Compensation Appeals BoardPetition for ReconsiderationSanctionsReasonable ExpensesLabor Code § 5813WCAB Rule 10561Findings and AwardAdministrative Law JudgeTemporary Total DisabilitySelf-Procured Medical Expenses
References
Case No. ADJ6543064
Regular
Jul 23, 2010

PEDRO McKAY vs. CITY OF RIVERSIDE, Permissibly Self-Insured

The applicant sought reconsideration or removal of a WCJ's decision to admit QME reports and bifurcate issues. The Board dismissed the Petition for Reconsideration, finding no final order was issued and the applicant was not aggrieved. The Petition for Removal was denied as applicant failed to demonstrate substantial prejudice or irreparable harm, especially since he introduced the QME reports and issues regarding additional panels were preserved.

WCABPedro McKayCity of RiversidePermissibly Self-InsuredADJ6543064Petition for ReconsiderationPetition for RemovalQualified Medical EvaluatorQME paneltoxicology
References
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