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

Case No. ADJ7445107
Regular
Oct 13, 2025

JILLIAN DIFUSCO vs. HANDS ON SPA, EMPLOYERS COMPENSATION INSURANCE GROUP

The Appeals Board, en banc, granted reconsideration of a WCJ's decision regarding disclosure requirements for defendants. The WCJ had ruled that the defendant only needed to disclose the name of its insurance carrier as per WCAB Rule 10390. The Board determined that its prior en banc decisions, Coldiron I and II, are binding precedent and require defendants to disclose all entities liable for payment and any insurance policy provisions affecting liability. Consequently, the WCJ's Findings of Fact and Order were rescinded, and the matter was returned to the trial level for further proceedings consistent with this comprehensive disclosure mandate.

En Banc DecisionWCAB Rule 10390Coldiron IColdiron IIDiscovery RequestInsurance Carrier DisclosureSelf-Insured RetentionLarge DeductibleEntity Liable for CompensationThird-Party Administrator
References
25
Case No. ADJ4274323, ADJ1601669
Significant
Oct 06, 2014

Jose Dubon vs. World Restoration, Inc., State Compensation Insurance Fund

This en banc decision holds that a utilization review (UR) decision is invalid and not subject to independent medical review (IMR) only if it is untimely. Timeliness disputes are resolved by the WCAB, while all other disputes about a UR decision must be resolved by IMR.

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewTimelinessMedical NecessityLabor Code Section 4610Labor Code Section 4610.5Senate Bill 863En Banc DecisionAdministrative Director
References
37
Case No. ADJ425881 (MON 0349358) ADJ1664800 (MON 0330278)
Regular
Feb 23, 2009

Jerry Salmeron vs. COCA COLA ENTERPRISES

This case concerns an applicant's admitted industrial injuries to his low back, psyche, and hernias, and his subsequent permanent disability ratings. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes regarding the proper application of the 2005 Schedule for Rating Permanent Disabilities, particularly concerning diminished future earning capacity (DFEC). The WCAB rescinded the prior awards and remanded the cases to the trial level to allow the judge and parties to apply recent en banc decisions clarifying how the DFEC and AMA Guides portions of the schedule can be rebutted. The decision emphasizes that rebuttal must be consistent with Labor Code section 4660 and specific en banc rulings on evidence and methodology.

WCABSalmeronCoca Cola EnterprisesDecision After ReconsiderationFindings and Awardpermanent disabilityrebutted2005 Schedulediminished future earning capacityDFEC
References
3
Case No. GRO 0032261
Regular
Jul 16, 2008

RAYMUNDO ARREOLA vs. JLG HARVESTING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision that denied injury to the applicant's left arm and hand, awarding 33% permanent disability. The WCAB affirmed the original decision regarding the injury and disability rating, noting that the 2005 Permanent Disability Rating Schedule was deemed valid in prior en banc decisions. However, the WCAB amended the award of costs for applicant's expert witness, increasing reimbursement for report preparation and testimony preparation, while reducing the hourly rate for travel time, resulting in a total award of $1,625.00. Finally, the WCAB corrected a technical heading error in the original decision to accurately reflect the Appeals Board's authority.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability Rating Schedule (PDRS)Diminished Future Earning Capacity (DFEC)Expert Witness TestimonyReimbursement of CostsWCJ DecisionEn Banc DecisionApportionmentLaborer
References
5
Case No. ADJ1735018
En Banc
Jun 03, 2010

CYNTHIA BLACKLEDGE vs. BANK OF AMERICA, ACE AMERICAN INSURANCE COMPANY

An en banc decision clarifying the respective roles of the evaluating physician, the workers’ compensation administrative law judge (WCJ), and the disability rater in determining whole person impairment (WPI). The Appeals Board amended the WCJ's decision and remanded the matter for further proceedings.

AMA GuidesWhole Person ImpairmentPhysician's RoleWCJ's RoleRater's RoleFormal Rating InstructionsSubstantial Medical EvidenceDisability Evaluation UnitNon-Formal RatingsEx Parte Communication
References
32
Case No. SJO 0245781
Significant

Michael A. Willette vs. Au Electric Corporation, State Compensation Insurance Fund

The Appeals Board, in an en banc decision, outlines the mandatory procedure for resolving post-utilization review medical treatment disputes for unrepresented employees, requiring the use of a panel Qualified Medical Examiner (QME). The prior decision was rescinded and the case was remanded to follow this new procedure.

Workers' Compensation Appeals BoardEn Banc DecisionReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryTailbone InjuryAlarm InstallerState Compensation Insurance FundUtilization Review Reports
References
26
Case No. SDO 244774
En Banc
Dec 11, 2003

Walter Faust vs. City of San Diego

The Appeals Board, in an en banc decision, clarifies the burden of proof under Labor Code §3212.1 for cancer claims by firefighters, holding that once exposure to a carcinogen is shown, the burden shifts to the defendant to prove no reasonable link. The prior decision was rescinded and the case returned for re-evaluation under this standard.

Labor Code section 3212.1en bancreconsiderationcumulative industrial injurycancerfirefighterpresumptionrebutting presumptionqualified medical evaluator (QME)Prakash Jay
References
16
Case No. ADJ7232076
Regular
Nov 22, 2011

TSEGAY MESSELE vs. PITCO FOODS, INC., CALIFORNIA INSURANCE COMPANY

This case concerns a prior en banc decision that clarified timelines for selecting Agreed Medical Evaluators (AMEs) and Qualified Medical Evaluator (QME) panels. Due to confusion and potential for reopening cases, the Appeals Board granted reconsideration on its own motion. The Board ultimately modified its prior decision to apply prospectively from September 26, 2011, preventing challenges to previously obtained QME panels based on prematurity unless timely objected to before that date. This modification aims to avoid widespread reopening and preserve settlements based on prior interpretations.

WCABen bancreconsiderationprospective applicationQME panelagreed medical evaluatorAMEprematurityLabor Code section 4062.2(b)DWC Newsline
References
3
Case No. SRO 99047, SRO 100453, SRO 100595
Regular
May 28, 2008

CAROLYN FITZGERALD vs. DAVE'S PIT STOP, SUPERIOR NATIONAL, CIGA, BROADSPIRE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision and returned the case for further proceedings. The WCJ's calculation of permanent disability and apportionment was found to be inconsistent with the California Supreme Court's decision in *Brodie* and subsequent WCAB en banc decision in *Benson*. The WCAB stated that the trial judge must reconsider permanent disability and apportionment in light of these rulings, potentially requiring further medical evidence development.

CIGASCIFSuperior NationalliquidationSROindustrial injuryleft kneebackcashierstock clerk
References
7
Case No. ADJ7232076
Significant
Sep 26, 2011

Tsegay Messele, Applicant vs. Pitco Foods, Inc., California Insurance Company

The Appeals Board, in an en banc decision, held that the timeframe for seeking agreement on an Agreed Medical Evaluator (AME) under Labor Code section 4062.2(b) is extended by five calendar days when the initial proposal is served by mail. Consequently, it found that both the applicant's and the defendant's requests for a Qualified Medical Evaluator (QME) panel were premature and rescinded the prior finding.

QME panelagreed medical evaluatorLabor Code 4062.2Code of Civil Procedure 1013WCAB Rule 10507service by mailtime computationremovalen banc decisionmedical evaluation
References
24
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