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

Case No. ADJ9800810 (MF), ADJ3318010 (SAC 0360125)
Regular
Jun 13, 2025

DONALD HENKE vs. THUMS LONG BEACH COMPANY, CIGA for FREMONT CORPORATION in liquidation, OCCIDENTAL PETROLEUM CORPORATION, NEW HAMPSHIRE INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior Findings and Order (F&O) that directed New Hampshire Insurance Company to administer a claim for CIGA. New Hampshire disputed joint and several liability, arguing no overlap between the applicant's 1998 and 2013 injuries. The WCAB found insufficient medical evidence on the causation of treatment for specific body parts, noting the existing medical opinions were cursory and primarily focused on disability apportionment. Consequently, the Board rescinded the F&O and remanded the case to the trial level for further development of the medical record regarding treatment causation.

CIGAinsolvent insurercovered claimsjoint and several liabilityapportionmentcausation of treatmentlumbar spinethoracic spineright shoulderNew Hampshire Insurance Company
References
19
Case No. ADJ5096605
Regular
May 28, 2013

JACK ODAY vs. WICKES LUMBER CORP., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that deemed a defense medical report admissible but insufficient to justify denial of treatment and ordered treatment consistent with the applicant's treating physician. The WCAB found both Dr. Lipton's report inadmissible as substantial evidence due to its age and lack of examination, and Dr. Dayton's treatment recommendations deficient for not specifying industrial injury causation. Consequently, the WCAB rescinded the previous order, returning the case for further development of the record to determine necessary industrial injury treatment and to allow for a proper medical-legal evaluation. The Board denied removal but granted reconsideration to correct the procedural and substantive issues regarding medical evidence and treatment authorization.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderAdministrative Law JudgeMedical TreatmentStipulated AwardPrimary Treating PhysicianQualified Medical EvaluatorMedical-Legal Evaluation
References
10
Case No. MISSING
Regular Panel Decision

Kurz v. St. Francis Hospital

The defendants moved to preclude plaintiffs' expert testimony on causation or, alternatively, for a pretrial hearing regarding the plaintiff's vision loss. The plaintiff developed visual disturbances shortly after receiving Amiodarone intravenously following cardiac bypass surgery in 2008. Defendants argued a lack of scientific evidence linking short-term Amiodarone use to optic neuropathy, while the plaintiff's expert contended that rapid drug absorption could cause optic disc edema, a known side effect. Furthermore, the plaintiff highlighted medical records where defendant physicians themselves initially attributed the vision loss to the medication. The court, applying the Frye standard, determined that general causation—Amiodarone causing vision loss—is an established medical theory. It further ruled that the specific causation tests from Parker and Cornell, typically applied to toxic tort cases, were not strictly applicable here due to the distinct nature of medical malpractice. Consequently, the court denied the defendants' motion, finding an adequate foundation for the admissibility of the plaintiff's expert testimony, with any disputes regarding specific timing affecting only the weight of the evidence, not its admissibility.

Medical MalpracticeExpert TestimonyCausationAmiodaroneOptic NeuropathyVision LossMotion in LimineFrye StandardParker StandardCornell Standard
References
9
Case No. ADJ9994879
Regular
Mar 07, 2018

LEE HOLMES vs. FIRST GROUP OF AMERICA, NEW HAMPSHIRE INSURANCE CO.

The applicant, a bus driver, sought workers' compensation for injuries sustained during non-industrial eye treatment. The Board affirmed the trial judge's decision that the injury was not industrial because the employer did not require the applicant to undergo the specific medical treatment that led to the injury. The applicant's belief that maintaining vision was a condition of employment was insufficient to establish industrial causation. The Board distinguished this case from situations involving employer-directed medical treatment or off-duty recreational activities.

AOE/COEPetition for ReconsiderationFindings and OrderWCJQMEindustrial causationproximate causereasonable expectancy of employmentoff-duty recreational activityLatourette
References
4
Case No. ADJ10248026 ADJ10248025
Regular
Sep 18, 2019

## VITALINO MAZARIEGOS, vs. ## BRAD HOWE, INCORPORATED; EMPLOYERS COMPENSATION INSURANCE COMPANY,

The Workers' Compensation Appeals Board affirmed the Administrative Law Judge's decision to deny a lien claimant's request for payment for medical treatment. The lien claimant failed to properly disclose crucial exhibits during discovery, and the medical evidence presented did not sufficiently demonstrate that the treatment provided was for an industrially related injury. Specifically, the physician's reports did not conclusively establish treatment for the claimed right shoulder injury or any industrial causation. Therefore, the Board found that the lien claimant did not meet its burden of proof.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantJoint Findings of FactQualified Medical Examiner (QME)Labor Code Section 4600Pre-trial Conference StatementWCAB Rule 10629Mandatory Settlement ConferenceMedical Treatment
References
4
Case No. ADJ7007501
Regular
Dec 24, 2018

KENNETH McCRAY vs. RIALTO UNIFIED SCHOOL DISTRICT

This case involves a worker who sustained an industrial injury to his left foot. The Appeals Board found that the applicant also suffered renal failure and hypertensive heart disease as a result of the injury, awarding 14% permanent disability. The defendant sought reconsideration, arguing the Board erred in awarding further medical treatment for these conditions. The Board denied the petition, clarifying that treatment is awarded for conditions *caused by* the industrial injury, not necessarily the underlying pre-existing conditions themselves. The Board noted the evidence suggesting these conditions may have returned to pre-injury levels, leaving open the possibility for defendants to dispute causation for specific treatments.

Workers' Compensation Appeals BoardRialto Unified School DistrictKenneth McCrayPetition for ReconsiderationDecision After Reconsiderationindustrial injuryleft footrenal failurehypertensive heart diseasepermanent disability
References
0
Case No. LBO 0340807
Significant
Jun 17, 2005

Lisa Simmons vs. State of California, Department of Mental Health (Metropolitan State Hospital), State Compensation Insurance Fund (Adjusting Agent)

This case clarifies that a utilization review report cannot determine industrial causation. If a UR physician finds a treatment medically necessary but questions if it's work-related, the employer must either approve it or timely initiate the AME/QME process to resolve the causation dispute.

Utilization reviewACOEM guidelinesEn banc decisionCausation issueMedical necessityLabor Code section 4610AME/QME processTreating physicianAdmissibility of evidenceIndustrial injury
References
9
Case No. MISSING
Regular Panel Decision
Jan 22, 2004

Mete v. New York State Office of Mental Retardation

This class action alleged age discrimination in employment against the New York State Office of Mental Retardation and Development Disabilities (OMRDD). Plaintiffs, former Chiefs of Developmental Center Treatment Services, claimed disparate treatment and disparate impact arising from a 1989 reduction in force (RIF) that eliminated their positions. All 46 Chiefs, who were over 40, were either demoted or retired, and statistical evidence showed a disproportionate impact on employees over 40. The Supreme Court granted defendants’ motion for summary judgment, dismissing all causes of action. The appellate court affirmed, finding that while plaintiffs established a prima facie case, OMRDD provided a legitimate, nondiscriminatory reason for the RIF (economic conditions and long-standing concerns about the position's utility), which plaintiffs failed to adequately prove was a pretext for discrimination.

Age DiscriminationClass ActionSummary JudgmentDisparate TreatmentDisparate ImpactReduction in ForceEmployment LawPretextPrima Facie CaseStatistical Evidence
References
11
Case No. MISSING
Regular Panel Decision

Claim of Evevsky v. Liberty Mutual Group

This case involves an appeal from a Workers’ Compensation Board decision regarding a claimant's unauthorized medical treatment. The claimant, who sustained neck and shoulder injuries in 1993, had her case reopened in 2001 after the employer's carrier objected to her request for authorized massage therapy. Both the Workers’ Compensation Law Judge and the Board determined that the treatment was not authorized under Workers’ Compensation Law § 13-b, as the massage therapist was not Board-authorized nor supervised by an authorized physician. The appellate court reviewed the Board's decision, affirming that there was no legal basis to overturn the finding. The court also considered and dismissed the claimant's constitutional arguments as being without merit.

Workers' CompensationMedical TreatmentMassage TherapyAuthorizationBoard DecisionAppellate ReviewStatutory InterpretationPhysician SupervisionConstitutionalityPermanent Partial Disability
References
3
Case No. ADJ3295022 (LBO 0391215)
Regular
Sep 27, 2017

EUNICE GONZALEZ vs. 99 ONLY STORES, YORK CLAIMS SERVICES

The Appeals Board rescinded the WCJ's decision disallowing Monrovia Memorial Hospital's lien. The employer denied the industrial causation of the applicant's need for surgery, thus forfeiting their right to mandate treatment within their Medical Provider Network. Therefore, the applicant was entitled to seek treatment outside the MPN. The case is returned to the trial level for determination of the surgery's necessity and reasonable fee, considering the hospital's classification for billing purposes.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Lien ClaimReconsiderationFindings and OrderUtilization ReviewIndustrial InjurySurgical Hospital StayLabor CodeAdministrative Director
References
1
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