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Case Law Database

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

Case No. ADJ2328508 (FRE 0173522)
Regular
Mar 09, 2009

BETTY DORN vs. HEILIG MANUFACTURING, LUMBERMENS MUTUAL CASUALTY COMPANY

This case involves a lien claimant seeking reconsideration of a WCJ's decision to deny most of its claim for chiropractic services. The WCJ limited the award to treatment rendered before the applicant was notified to seek care within the employer's Medical Provider Network (MPN). The lien claimant argued the WCJ improperly relied on a QME's report and should have considered a second QME's report finding a "serious chronic condition" justifying out-of-MPN treatment. The Appeals Board affirmed the WCJ's decision, finding the first QME's report constituted substantial evidence, the request for a second QME was improperly made by the lien claimant after objections to the first report's timeliness were waived, and the lien claimant failed to prove its MPN membership.

Medical Provider Network (MPN)Qualified Medical Evaluator (QME)Serious Chronic ConditionLien ClaimantPetition for ReconsiderationFindings of Fact and AwardLabor Code Section 4616.2Substantial Medical EvidencePanel QMETimeliness of Report
References
3
Case No. ADJ15605011 ADJ16563992
Regular
Sep 02, 2025

ATEFA SAMADI vs. AMAZON

The applicant, Atefa Samadi, filed a Petition for Disqualification against the WCJ following an expedited hearing. The Appeals Board reviewed the petition and the WCJ's Report and Recommendation. The Board adopted the WCJ's report and denied the petition on the merits, citing Labor Code section 5311 and Code of Civil Procedure section 641, which govern the grounds for disqualification. The WCAB found that the petition did not present sufficient facts to establish disqualification, and a judge's expressions of opinion or erroneous rulings in the discharge of official duties are not evidence of bias. The WCJ's report detailed past hearings where the applicant exhibited disruptive behavior and the WCJ's attempts to ensure due process while managing complex issues.

Petition for DisqualificationLabor Code section 5311Code of Civil Procedure section 641WCJ biasunqualified opinionenmitybiasWCAB Rule 10960affidavitdeclaration
References
14
Case No. ADJ7948651
Regular
May 09, 2016

Barbara Tom vs. CITY OF OAKLAND, JT2 INTEGRATED

This case involves a petition for reconsideration by the defendant, City of Oakland, following an award of permanent disability to applicant Barbara Tom. The defendant argued the Workers' Compensation Judge (WCJ) erred by not deferring to the Agreed Medical Evaluator's (AME) opinion and by not developing the record with the AME. The WCAB denied reconsideration, adopting the WCJ's report which found the AME's opinion deficient. The WCJ's report detailed how the primary treating physician's report was more persuasive and thoroughly reasoned, supporting the WCJ's findings over the AME's.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Primary Treating Physician (PTP)AMA GuidesPermanent Disability RatingCarpal Tunnel SyndromeSubstantial EvidenceWCJ OpinionMedical Opinion Deference
References
2
Case No. ADJ9919365, ADJ9919392, ADJ10564628
Regular
Aug 25, 2017

ALFREDO JORDAN RAMOS vs. BEN'S ROOFING, INC., REDWOOD FIRE AND CASUALTY COMPANY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded the WCJ's decision due to improperly identified exhibits and a lack of specific record citations in the opinion. The WCJ improperly admitted grouped medical reports and failed to cite which specific reports formed the basis of the Findings and Award. While the Appeals Board acknowledges the potential admissibility of the applicant's treating physician's later report, the WCJ retains discretion over its admission. The case is returned for further proceedings to allow for proper development of the record and a clearer articulation of the WCJ's reasoning.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardQualified Medical EvaluatorTreating Physician ReportLabor Code Section 5703Develop the RecordAdmissibility of EvidencePermanent DisabilityPanel QME
References
5
Case No. ADJ12320361
Regular
Feb 18, 2025

LINDA ERNEST vs. TRADER JOE'S, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Appeals Board considered a Petition for Reconsideration filed by Defendant Trader Joe's, administered by Sedgwick Claims Management Services. The petition challenged the Workers' Compensation Judge's (WCJ) decision dated November 26, 2024, which found that the defendant did not meet its burden of proof regarding apportionment for injuries to the applicant's left hand, left wrist, and left knee. The WCJ's decision awarded 51% permanent disability based on the medical reporting of PQME Michael Slutzker, MD, but only found apportionment for the low back injury. The defendant specifically contended that the WCJ erred in not allowing apportionment for the left knee. The Appeals Board denied the petition, adopting and incorporating the WCJ's report, which concluded that the Qualified Medical Evaluator's (QME) report lacked sufficient explanation and detail to support the proposed apportionment for the left knee, thus failing to meet the defendant's burden of proof.

Workers Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Transmission of CaseElectronic Adjudication Management SystemReport and RecommendationApportionmentPermanent DisabilityCausationQualified Medical Evaluator
References
11
Case No. ADJ8177191
Regular
Apr 03, 2014

ALEX LOPEZ vs. SUNRIDER CORPORATION, COMPWEST INSURANCE COMPANY

The applicant, Alex Lopez, sought removal from an order rescinding the reopening of discovery, arguing that the exclusion of his physician's report caused irreparable harm. The WCJ recommended denial, finding the applicant failed to demonstrate diligence in obtaining the report or timely objecting to discovery closure. The Appeals Board adopted the WCJ's recommendation and denied removal, but noted the WCJ would consider a motion to admit the physician's report at trial.

Petition for RemovalOrder Rescinding Order Reopening RecordPrimary Treating PhysicianArthur HarrisM.D.Injury AOE/COECompwest InsuranceSunrider CorporationPermanently and StationaryDepositions
References
1
Case No. ADJ7564894
Regular
Jun 07, 2013

FLOR DE MARIA DE LEON vs. PORTO'S BAKERY, INC, TRAVELERS

Here's a summary for a lawyer: This case involves a lien claimant, First Choice Health UBC, whose lien was dismissed for failure to provide proof of timely payment of the lien activation fee at a lien conference. While the claimant's representative appeared for "FCH" and later submitted proof of payment for a different, similarly named entity (First Choice Medical Group), no proof was provided for First Choice Health UBC itself. The WCJ recommended denial of reconsideration, finding that the claimant failed to meet the requirements of Labor Code section 4903.06(a)(4) by not presenting evidence of activation fee payment for the correct entity at the conference, thus warranting dismissal with prejudice. The Appeals Board adopted the WCJ's report and denied the petition.

Lien ClaimantActivation FeePetition for ReconsiderationDismissal with PrejudiceContinuous TraumaServerBack InjuryKnee InjuryLower ExtremitiesNervous/Psyche
References
0
Case No. ADJ1859301 (GOL 0098936) ADJ3495901 (GOL 0101363)
Regular
Nov 05, 2010

SANTIAGO CARRANZA vs. SAFEGUARD ROOFING, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES

The Appeals Board granted removal, rescinding the WCJ's order to reopen discovery and admit new vocational expert reports. The Board found the WCJ erred by allowing further discovery beyond the admission of a specific prior report by Dr. Monguio. The case is returned to the trial level for the WCJ to consider Dr. Monguio's December 29, 2008 report regarding apportionment and permanent disability, but not to re-examine all issues or introduce new evidence.

RemovalWCJ rulings rescindedReopening discoveryVocational rehab expert reportApportionmentPermanent disabilityAMA GuidelinesDr. Monguio's reportCosta casePrior opinion
References
4
Case No. ADJ4237156
Regular
Nov 15, 2011

CON HOWE vs. AMERIGAS by SPECIALTY RISK SERVICES

This case involves an applicant's petition to disqualify a Workers' Compensation Administrative Law Judge (WCJ) due to alleged bias stemming from a prior incident. The applicant's attorney claimed the WCJ harbored enmity and would prejudice his clients. The WCJ, in his report, stated the incident would not affect his impartiality and all cases are decided on evidence. The Appeals Board adopted the WCJ's report and denied the disqualification petition, finding no reason to doubt the WCJ's impartiality.

Petition for DisqualificationWCJ BiasEnmityMandatory Settlement ConferencesReport and RecommendationEvidence-based DecisionWorkers' Compensation Appeals BoardAdministrative Law JudgeApplicant's AttorneyCase ADJ4237156
References
0
Case No. ADJ6950792
Regular
Sep 01, 2015

LILLIAN DUNN vs. COUNTY OF SAN BERNARDINO

This case concerns a petition for reconsideration and removal from a Workers' Compensation Appeals Board order. The Board denied the petition, adopting the reasoning of the Workers' Compensation Administrative Law Judge (WCJ). The WCJ determined that a Qualified Medical Examiner's (QME) report was not substantial evidence due to a failure to issue a supplemental report after reviewing additional medical records. Because the QME was unavailable to provide a supplemental report, the WCJ ordered a replacement QME, a decision upheld by the Board.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalReplacement PanelQualified Medical ExaminerQMESupplemental ReportLabor Code Section 4062.5Rule 38Apportionment
References
1
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