Updated Daily

Case Law Database

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

Case No. ADJ3491292, ADJ3821371

Regular

Sep 12, 2017

DAVID COFFMAN vs. EAST BAY MUNICIPAL UTILITY DISTRICT

This case involves a worker with two distinct industrial injuries to his low back and other body parts. The Appeals Board granted reconsideration to review the prior award of partial permanent disability. After review, the Board found the applicant to be permanently totally disabled, determining that his combined injuries and subsequent treatment prevented any return to gainful employment. The Board also found that the employer failed to meet its burden of proof for apportionment between the two injuries and non-industrial causes.

ADJ3491292ADJ3821371permanent total disabilityapportionmentindustrial injuryvocational expertagreed medical evaluatororthopedic injuriespsychiatric impairmentsleep disturbance

References

Case No. ADJ11423609

Regular

Sep 12, 2022

DANIEL SERVIN vs. CERRITOS LEXUS, ACE AMERICAN INSURANCE

This case concerns a defendant's petition for reconsideration of an order authorizing left shoulder surgery. The defendant argued a prior utilization review denial should prevent subsequent authorizations, citing Labor Code section 4610(k). However, the applicant's physician resubmitted the request with additional supporting documentation, triggering a new utilization review. This subsequent review certified the surgery as medically necessary, resolving the medical dispute. The Board denied reconsideration, holding that the defendant voluntarily submitted the resubmitted request, making the February 2, 2022 certification final and precluding further utilization review.

Utilization ReviewFindings and OrderPetition for ReconsiderationMedical NecessityReverse Total Shoulder ArthroplastyRequest for AuthorizationNon-certificationCertificationLabor Code Section 4610Resubmission

References

Case No. ADJ380850 (SAL 0117839)

Regular

Apr 26, 2011

Sandra Corona vs. LOS APTOS CHRISTIAN FELLOWSHIP CHILDCARE, CHURCH MUTUAL INSURANCE COMPANY

This case involves a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The original decision awarded the applicant further medical treatment, including a cervical radiofrequency ablation. The defendant argued that the applicant failed to follow the proper Labor Code Section 4062 process after their utilization review denied the treatment request. The majority of the WCAB denied reconsideration, holding that an applicant is not strictly required to use Section 4062 to dispute a utilization review denial and may proceed to an expedited hearing, especially when the employer failed to provide adequate information for the review. However, one commissioner dissented, arguing that Section 4062 mandates a dispute resolution process following utilization review.

Workers' Compensation Appeals BoardLabor Code Section 4610Labor Code Section 4062Utilization ReviewReconsiderationFindings and AwardPrimary Treating PhysicianExpedited HearingAgreed Medical ExaminerQualified Medical Examiner

References

Case No. ADJ17821210

Regular

Aug 29, 2025

ROGELIO TOSCANO vs. ELITE EARTHWORKS & ENGINEERING, REDWOOD FIRE & CASUALTY INSURANCE COMPANY

Rogelio Toscano, the applicant, suffered a significant brain injury and has been receiving ongoing outpatient rehabilitation. The defendants attempted to discontinue this care via utilization review, but the Workers' Compensation Appeals Board (WCAB) found this action invalid. The WCAB, adopting the WCJ's report, denied the defendants' petition for reconsideration, affirming that the defendants failed to demonstrate a change of circumstances necessary to justify a new utilization review for previously authorized ongoing treatment. Commissioner Razo dissented, arguing that the majority's reliance on the Patterson rule incorrectly carves out an exception to Labor Code section 4610's utilization review requirements.

Petition for ReconsiderationLabor Code Section 5909Electronic Adjudication Management SystemUtilization ReviewPatterson v. The Oaks FarmNational Cement Co. v. Workers' Comp. Appeals Bd. (Rivota)Allied Signal Aero. v. Workers' Comp. Appeals Bd. (Wiggs)Request for AuthorizationMedical TreatmentBrain Injury Rehabilitation

References

Case No. ADJ1 798995 (SAC 0324817)

Regular

Mar 08, 2016

Richard Hill vs. Tuttle Interior Systems, State Compensation Insurance Fund

The Workers' Compensation Appeals Board (WCAB) reversed a finding that an Independent Medical Review (IMR) determination was moot due to untimeliness. The Board held that while the Utilization Review (UR) decision expired, the subsequent IMR determination, even if issued outside statutory timeframes, remained valid. The WCAB emphasized that untimeliness is not a statutory ground to appeal an IMR decision and that IMR timeframes are directory, not mandatory. Consequently, the case was returned to the trial level, with the existing IMR decision binding unless grounds for appeal under Labor Code section 4610.6(h) are established.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewIndependent Medical ReviewLabor Code § 4610.6SB 863Medical NecessityDirectory vs. Mandatory TimeframesAdministrative DirectorMaximus Federal Services

References

Case No. ADJ3211441 (POM 0273310)

Regular

Jun 26, 2015

JOSE CONTRERAS vs. MACDONALD CARBIDE, STATE COMPENSTION INSURANCE FUND

This case concerns defendant's petition for removal following a WCJ's finding of an untimely utilization review (UR) decision. The WCJ determined that due to the defendant's failure to timely deny a treatment request, the WCAB could determine medical necessity, citing *Dubon II*. The defendant argued the WCAB loses jurisdiction after an Independent Medical Review (IMR) determination. The Appeals Board denied removal, affirming the WCJ's authority to address medical necessity when UR is untimely and concluding no substantial prejudice would result from denial.

Petition for RemovalFindings of Factindustrial injurybilateral kneesbilateral hipsspinepsycheprimary treating physicianRequest For AuthorizationUtilization Review

References

Case No. ADJ7324170, ADJ9797150

Regular

May 10, 2016

Beverly Bolton vs. COUNTY OF SAN BERNARDINO

The Appeals Board granted reconsideration to review the WCJ's finding that the applicant was entitled to requested medical treatment due to the employer's untimely utilization review. The employer argued the request was defective and the review was timely. The Board dismissed the employer's Petition for Removal and, after reconsideration, amended the Findings and Award. The Board affirmed the WCJ's finding that the utilization review was untimely, thus waiving objections to the request, but deferred the issue of medical necessity due to an insufficient record.

Workers Compensation Appeals BoardReconsiderationUtilization ReviewTimelinessRequest for Authorization (RFA)JurisdictionMedical NecessityRemovalAdministrative Law Judge (WCJ)Petition for Removal

References

Case No. ADJ8494806

Regular

Mar 09, 2017

Elgin Ball vs. Industrial Waste Utilization, Meadowbrook Insurance Group

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review a Supplemental Findings of Fact which had found that the defendant complied with a stipulation regarding medical treatment, transportation, and housing. The applicant had petitioned for reconsideration, disputing compliance. Following a Commissioners' Settlement Conference, the parties executed a new Compromise and Release agreement. The WCAB found this new agreement adequate and in the applicant's best interest, rescinding the prior findings and approving the Compromise and Release.

WCABSupplemental Findings of FactStipulation and OrderCompromise and ReleaseMedical TreatmentTransportation ExpenseHousing ExpenseModified VanIndustrial InjuryNeck Injury

References

Case No. ADJ6939280

Regular

Nov 08, 2018

ROBIN GONZALEZ vs. FIRST PRESBYTERIAN CHURCH OF SANTA BARBARA, STATE COMPENSATION INSURANCE FUND

This case concerns applicant Robin Gonzalez's claim for ongoing home health care services following a spinal injury. The employer's insurer denied these services via a timely Utilization Review (UR) based on the Medical Treatment Utilization Schedule (MTUS). The Workers' Compensation Appeals Board (WCAB) affirmed the trial judge's decision, holding that the WCAB lacks jurisdiction to review the UR denial because the process was timely and the dispute over medical necessity must be resolved through the Independent Medical Review (IMR) process, as established in Dubon II. Applicant's treating physician can submit a new request if medically necessary, as the prior UR denial is effective for 12 months.

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewMedical Treatment Utilization ScheduleJurisdictionHome Health CarePermanent DisabilityPetition to ReopenFailed Back SyndromeDubon II

References

Case No. ADJ6719136

Regular

Apr 01, 2011

RICHARD KITE vs. EAST BAY MUNICIPAL UTILITY DISTRICT

This case concerns Richard Kite's claim for workers' compensation for a hip injury sustained while employed by East Bay Municipal Utility District. The Workers' Compensation Appeals Board (WCAB) reconsidered an order mandating the employer restore applicant's sick and vacation leave at a higher rate tied to his later earnings. The WCAB found insufficient evidence to justify using the increased earnings for calculating leave restoration, as per *Grossmont Hospital v. WCAB*. Therefore, the WCAB amended the order to restore leave at the rate of $668.93 per week, based on the applicant's earnings at the time of the initial injury.

Petition for ReconsiderationTemporary Total DisabilityTD RateSick LeaveVacation LeaveEmployment Development DepartmentEDDWCJFindings of FactLabor Code

References

Showing 1-10 of 1,852 results

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Updated Daily

Case Law Database

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

Case No. ADJ3491292, ADJ3821371

Regular

Sep 12, 2017

DAVID COFFMAN vs. EAST BAY MUNICIPAL UTILITY DISTRICT

ADJ3491292ADJ3821371permanent total disabilityapportionmentindustrial injuryvocational expertagreed medical evaluatororthopedic injuriespsychiatric impairmentsleep disturbance

References

Case No. ADJ11423609

Regular

Sep 12, 2022

DANIEL SERVIN vs. CERRITOS LEXUS, ACE AMERICAN INSURANCE

References

Case No. ADJ380850 (SAL 0117839)

Regular

Apr 26, 2011

Sandra Corona vs. LOS APTOS CHRISTIAN FELLOWSHIP CHILDCARE, CHURCH MUTUAL INSURANCE COMPANY

References

Case No. ADJ17821210

Regular

Aug 29, 2025

ROGELIO TOSCANO vs. ELITE EARTHWORKS & ENGINEERING, REDWOOD FIRE & CASUALTY INSURANCE COMPANY

References

Case No. ADJ1 798995 (SAC 0324817)

Regular

Mar 08, 2016

Richard Hill vs. Tuttle Interior Systems, State Compensation Insurance Fund

References

Case No. ADJ3211441 (POM 0273310)

Regular

Jun 26, 2015

JOSE CONTRERAS vs. MACDONALD CARBIDE, STATE COMPENSTION INSURANCE FUND

Petition for RemovalFindings of Factindustrial injurybilateral kneesbilateral hipsspinepsycheprimary treating physicianRequest For AuthorizationUtilization Review

References

Case No. ADJ7324170, ADJ9797150

Regular

May 10, 2016

Beverly Bolton vs. COUNTY OF SAN BERNARDINO

Workers Compensation Appeals BoardReconsiderationUtilization ReviewTimelinessRequest for Authorization (RFA)JurisdictionMedical NecessityRemovalAdministrative Law Judge (WCJ)Petition for Removal

References

Case No. ADJ8494806

Regular

Mar 09, 2017

Elgin Ball vs. Industrial Waste Utilization, Meadowbrook Insurance Group

WCABSupplemental Findings of FactStipulation and OrderCompromise and ReleaseMedical TreatmentTransportation ExpenseHousing ExpenseModified VanIndustrial InjuryNeck Injury

References

Case No. ADJ6939280

Regular

Nov 08, 2018

ROBIN GONZALEZ vs. FIRST PRESBYTERIAN CHURCH OF SANTA BARBARA, STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ6719136

Regular

Apr 01, 2011

RICHARD KITE vs. EAST BAY MUNICIPAL UTILITY DISTRICT

Petition for ReconsiderationTemporary Total DisabilityTD RateSick LeaveVacation LeaveEmployment Development DepartmentEDDWCJFindings of FactLabor Code

References

Showing 1-10 of 1,852 results

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