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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. 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. ADJ2270309 (VNO 0113668) ADJ4503834 (VNO 0113665) ADJ3103605 (VNO 0113666) ADJ2309113 (VNO 0113667)
Regular
Aug 17, 2009

MARIA GARCIA vs. CITY OF LOS ANGELES

This case involves a dispute over whether Dr. Nagelberg is the applicant's primary treating physician (PTP). The Appeals Board granted reconsideration, reversing the trial judge's finding that Dr. Nagelberg was not the PTP. The Board found substantial evidence that Dr. Nagelberg is indeed the PTP, and that the trial judge erred in relying on an unadmitted nurse case manager's report. The matter is returned to the trial level for further proceedings to determine the applicant's entitlement to medical treatment.

Workers' Compensation Appeals BoardMaria GarciaCity of Los AngelesPetition for RemovalPetition for DisqualificationPetition for ReconsiderationFindings and OrderWorkers' Compensation Judge (WCJ)Primary Treating Physician (PTP)Qualified Medical Evaluator (QME)
References
2
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
Case No. ADJ6439173
Regular
Jan 19, 2017

JULIETA CEBALLOS vs. SUNVIEW VINEYARDS of CALIFORNIA, WAUSAU INSURANCE COMPANIES

The Workers' Compensation Appeals Board (WCAB) rescinded the original award, finding the primary treating physician's (PTP) report insufficient to establish injury to all claimed body parts. The WCAB also raised concerns about the admissibility of a supplemental PTP report obtained after the Mandatory Settlement Conference without a showing of due diligence. The case is returned to the trial level for further proceedings to adequately address the admitted body parts and develop the record. A dissenting opinion argued the PTP's reports constituted substantial evidence and no further development was needed.

WCABReconsiderationPrimary Treating PhysicianQualified Medical Evaluatorsubstantial evidencePetition for ReconsiderationFindings Orders and AwardMandatory Settlement ConferenceLabor Code Section 5502due diligence
References
16
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
12
Case No. ADJ11995067
Regular
Jul 25, 2025

ADELINA PEREZ vs. KYONG AE YUN, CHONG MYON YUN, ZENITH INSURANCE COMPANY

Applicant Adelina Perez sought removal of a May 9, 2022, Findings & Order (F&O) by a workers’ compensation administrative law judge (WCJ), which found Dr. Marcel Ponton's medical-legal report inadmissible and ordered his replacement, arguing Dr. Ponton was a treating physician to whom Labor Code section 4062.3 did not apply. The Workers' Compensation Appeals Board (WCAB) treated the petition as one for reconsideration and found that Dr. Ponton was indeed a treating physician, not a panel-selected medical-legal evaluator, rendering section 4062.3 inapplicable. Consequently, the WCAB rescinded the WCJ's F&O, substituted new findings affirming Dr. Ponton's role as a treating physician, and ordered his continuation as the medical-legal neuropsychological evaluator.

RemovalReconsiderationLabor Code section 4062.3Ex parte communicationMedical-legal evaluatorTreating physicianMPNNeuropsychological assessmentTraumatic brain injuryAdmissibility of evidence
References
17
Case No. ANA 0400833
Regular
Aug 18, 2008

WILLIAM GEORGE THOMAS JULIE THOMAS as GUARDIAN AD LITEM and TRUSTEE vs. H&A AUTO, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of an award finding industrial injury and permanent total disability. The employer challenged the reliance on the applicant's treating physician's medical reports. The Board affirmed the findings, holding that treating physician reports are admissible under Labor Code sections 4060(b) and 4061.5. The employer failed to rebut the treating physician's opinions by properly invoking independent medical evaluation procedures.

Workers Compensation Appeals BoardGuardian Ad LitemTrusteeIndustrial InjuryAuto MechanicNeck InjuryQuadriplegiaTemporary DisabilityPermanent Total DisabilityTreating Physician
References
1
Case No. ADJ9343248
Regular
Dec 07, 2017

LONNY BUBAK vs. SOLANO COUNTY SHERIFFS DEPARTMENT

This case, concerning a workers' compensation claim by Lonny Bubak against Solano County Sheriff's Department, involves the application of Labor Code section 4062.9, which presumes the correctness of a treating physician's opinion. The Appeals Board denied the defendant's petition for reconsideration, affirming the administrative law judge's finding that the defendant failed to rebut this presumption. This means the defendant did not provide sufficient evidence to disprove the industrial nature of the injury as determined by the treating physician. Therefore, the Appeals Board was bound to accept the treating physician's opinion as correct.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgePresumptionLabor Code Section 4062.9Treating PhysicianBurden of ProofRebuttalIndustrial RelationshipSolano County Sheriffs Department
References
2
Case No. ADJ6948621 ADJ7946738
Regular
Apr 22, 2013

STEFANO MUSETTI vs. GOLDEN GATE DISPOSAL & RECYCLING dba RECOLOGY, permissibly self-insured, administered by CORVEL CORP.

In this workers' compensation case, the employer sought reconsideration of an award ordering a total knee replacement. The applicant's treating physician recommended the surgery, but the employer argued the award was premature as a panel qualified medical evaluator's report was pending and the treating physician's report lacked proper authorization markings. The Appeals Board denied reconsideration, finding the employer had sufficient time to obtain the PQME report and that the treating physician's report constituted substantial medical evidence supporting the surgery. The Board also noted that the employer failed to initiate utilization review despite being aware of the treatment request.

Workers' Compensation Appeals Boardindustrial injuryright kneegarbage collectortotal knee replacementsupplemental reportpanel qualified medical evaluator (PQME)treating physiciansubstantial medical evidencePetition for Reconsideration
References
7
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