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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Billy Overstreet v. TRW Commercial Steering Division

This concurring opinion by Judge William C. Koch, Jr. addresses the legal basis for prohibiting ex parte communications between an employer's counsel and an employee's treating physician in a Workers' Compensation Act claim. While the Court's main conclusion relies on an implied-in-law contract theory, Judge Koch advocates for a fiduciary duty stemming from the physician-patient relationship. He clarifies that physicians have a duty of non-disclosure, subject to statutory exceptions for workers' compensation reports, but these exceptions do not permit ex parte communications. The opinion asserts that employees retain their medical privacy unless explicitly altered by law.

Physician-patient privilegeConfidentialityEx parte communicationWorkers' CompensationFiduciary dutyImplied contractMedical records disclosureHIPAALegal ethicsPatient rights
References
34
Case No. 2015-01-0281
Regular Panel Decision
Mar 19, 2018

Tucker, David E. v. Star Transportation

David Tucker, an employee of Star Transportation, sought to change his treating physician for a shoulder injury sustained on July 1, 2015. He expressed a loss of confidence in Dr. Mejia due to perceived ineffectual treatment, improper impairment assessment methodology, and the physician's refusal to complete a Physician Certification Form. The Court, citing precedents like Scott v. Integrity Staffing Solutions and Baker v. Electrolux, found no legal basis to compel the employer to provide a new panel of physicians. The Court ruled that Mr. Tucker's subjective dissatisfaction and the alleged inadequacies of Dr. Mejia did not warrant a change in treating physician.

Workers' CompensationShoulder InjuryTreating PhysicianMedical TreatmentImpairment RatingAMA GuidesTennessee LawRight to Control Medical TreatmentPhysician Certification FormMMI (Maximum Medical Improvement)
References
3
Case No. MISSING
Regular Panel Decision

Claim of Quail v. Central New York Psychiatric Center

Claimant appealed a Workers' Compensation Board decision that awarded a 10% schedule loss of use of the right hand. The WCB's decision was based on a September 1998 report from the carrier's consultant, which found a 10% loss. The claimant's treating physician had reportedly found a 20% loss in a July 1998 report, but this report was not properly filed. Despite multiple directives to submit a final medical report from the treating physician, claimant failed to do so before the WCLJ's decision. After the WCLJ's ruling, claimant submitted a newly prepared report from his treating physician indicating a 20% loss. The Board declined to consider this new evidence, citing its discretion to refuse evidence that could have been presented earlier. The appellate court affirmed the Board's decision, finding no abuse of discretion in their refusal to consider the late evidence.

Schedule Loss of UseRight Hand InjuryMedical EvidenceAppellate ReviewBoard DiscretionFailure to Submit EvidenceTreating Physician ReportCarrier Consultant ReportProcedural IssuesPermanency Determination
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
Case No. ADJ4503675 (MON 0306061)
Regular
Apr 18, 2011

ARTHUR WILSON vs. CAPISTRANO UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured, Administered By CORVEL CORPORATION

The Workers' Compensation Appeals Board granted reconsideration to rescind an award for dental treatment. The Board found the administrative law judge erred by admitting and relying on the reports of Dr. Esagoff, a non-treating dentist, as they were not obtained in compliance with relevant Labor Code sections regarding medical-legal procedures and treating physician reports. The case is returned to the trial level for applicant to obtain a proper report from a designated treating physician, with Dr. Esagoff's reports to be stricken. Issues of industrial causation for dental treatment must follow former Labor Code section 4062 procedures.

Workers' Compensation Appeals BoardCapistrano Unified School DistrictCORVEL CORPORATIONInjury to teethCompensable consequenceAdmitted industrial injuryRight kneeCustodianDr. Jacob EsagoffD.D.S.
References
5
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. ADJ9725603
Regular
Nov 23, 2020

LUZ LOZA vs. GOLDBLATT GOLDBLATT/BAY AREA RESTAURANT MANAGEMENT, ARCH INSURANCE COMPANY, administered by YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's order finding the applicant entitled to pre-authorization for their treating physician to issue a PR-4 report at the medical-legal billing rate. While affirming the applicant's right to obtain the report, the Board clarified that the defendant retains the right to object to or raise defenses regarding the physician's billing. The Board reasoned that treating physicians are permitted to provide comprehensive medical-legal evaluations, and such reports are governed by specific medical-legal fee schedules, not the Official Medical Fee Schedule.

PR-4 reportmedical-legal billing ratepre-authorizationprimary treating physician (PTP)Qualified Medical Evaluator (QME)comprehensive medical evaluationOfficial Medical Fee SchedulePetition for ReconsiderationFindings of Fact and Order (F&O)Labor Code
References
3
Case No. ADJ6470549
Regular
Feb 27, 2012

KATHRYN BENSON vs. CITY OF SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, allowing a Qualified Medical Examiner's (QME) report into evidence. The original decision excluded the QME report, finding no ratable permanent disability based on the treating physician's opinion. The Appeals Board found the QME report should have been admitted, as there are no explicit time limits for objecting to a treating physician's report or obtaining a QME evaluation for permanent disability. The case is remanded for further proceedings on permanent disability and attorney's fees with the QME report now part of the record.

Workers Compensation Appeals BoardFindings and AwardPetition for ReconsiderationQualified Medical Examiner (QME)Permanent DisabilityFuture Medical TreatmentTreating PhysicianAgreed Medical Examiner (AME)Labor Code Section 4061Strawn v. Golden Eagle Insurance Co.
References
1
Case No. ADJ18027061
Regular
Sep 10, 2025

HEATHER TILLER KELLEY vs. SACRAMENTO CITY UNIFIED SCHOOL DISTRICT

Defendant Sacramento City Unified School District sought reconsideration of a WCAB decision that found applicant Heather Tiller Kelley sustained industrial injuries and that reports from her treating physicians (Mark Zuber, D.C., Adrienne Pasek, Psy.D., and Kasra Maasumi, M.D.) were admissible. Defendant argued these physicians lacked a proper treatment relationship and that the reports were improperly obtained. The Workers' Compensation Appeals Board denied the petition for reconsideration, affirming that defendant relinquished medical control by denying liability, allowing applicant to self-procure treatment, and thus the treating physician reports were admissible in proceedings.

WCABPetition for ReconsiderationOpinion and Order Granting PetitionAdmissible EvidenceTreating PhysiciansMedical-Legal ReportsLabor Code Section 4062.2Self-Procured TreatmentRemoval StandardPermanent and Stationary Status
References
15
Case No. ADJ7925931, ADJ7925917
Regular
Sep 27, 2017

LUISA SEQUEIRA vs. RANDSTAD PLACEMENT PROS, ACE AMERICAN

This case involved an applicant seeking reconsideration of a workers' compensation award, arguing that the declaration of readiness to proceed was defective due to a lack of a primary treating physician's report on permanent disability. The Appeals Board affirmed the original award, finding that Labor Code section 4061(i) does not require all treating physicians to find maximum medical improvement before proceeding to trial. The Board reasoned that the applicant's Panel Qualified Medical Evaluator (PQME) provided substantial medical evidence sufficient to support the permanent disability award, even though primary treating physicians had not yet found MMI. Therefore, the WCJ correctly relied on the PQME's report.

Declaration of readinessPermanent disabilityPrimary treating physicianQualified Medical EvaluatorMaximum medical improvementLabor Code section 4061(i)Substantial medical evidenceFindings Award and OrderReconsiderationIndustrial injury
References
3
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