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

Case No. ADJ9467074; ADJ9468922
Regular
Jul 15, 2018

THEODORE DAVIS vs. CITY OF MODESTO, Permissibly Self-Insured, administered by YORK INSURANCE SERVICES GROUP, INC.

This case involves applicant Theodore Davis's claims of industrial injury to his prostate. The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for removal and dismissed their petition for reconsideration. The WCAB rescinded the judge's finding that Dr. Besses' inadmissible report could be reviewed by the PQME, citing Labor Code section 4061(i) and Regulation 35(e). The Board affirmed that inadmissible medical-legal reports, obtained outside statutory procedures, cannot be reviewed by the PQME.

WCABRemovalReconsiderationPetitionAdmissibilityMedical-legal reportPQMELabor CodeBattenQualified Medical Evaluator
References
9
Case No. ADJ16773219; ADJ16653843
Regular
Jun 03, 2025

LAKEISHA HOWARD vs. OPTUM 360 SERVICES, A UNITED HEALTH GROUP COMPANY; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The applicant, Lakeisha Howard, sought reconsideration after the WCJ denied her claims for cumulative injury to her left knee and ankle, and deemed Dr. Granado's reports inadmissible. The Appeals Board affirmed the WCJ's decision, finding that Dr. Granado's reports were obtained to rebut the panel QME's opinion rather than for medical treatment and were therefore inadmissible. The Board also upheld the finding that the applicant failed to prove a cumulative injury arising out of her employment, citing Dr. Welborn's opinion that her sedentary job would not cause such trauma. Consequently, the Petition for Reconsideration was denied.

Labor Code Section 5909Petition for ReconsiderationAdmissibility of Medical ReportsCumulative Trauma InjuryCompensable Consequence InjurySubstantial EvidenceCausationPanel Qualified Medical EvaluatorTreating PhysicianMedical-Legal Evaluation
References
10
Case No. 9420257 [MF]; 8802141 [2] 8802135 [3]
Regular
Nov 02, 2019

RICHARD GLASSMAN vs. STATE OF CALIFORNIA DEPT OF CORRECTIONS & REHABILITATION

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant permanently and totally disabled. The defendant contended the Administrative Law Judge erred by relying on the applicant's vocational expert, psychiatric AME, and inadmissible reports, and making a determination contrary to *Fitzpatrick*. The Board found the ALJ's reliance on the vocational expert and AME was supported by evidence, and the applicant's credibility was not impeached. While an inadmissible report was considered for jaw injury, it was deemed inconsequential to the permanent disability rating. The Board found the decision was consistent with the facts and medical opinions presented.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanently Totally DisabledVocational ExpertAgreed Medical ExaminerPsychiatric AMETreating PhysicianLabor Code § 5903Admitted InjuryCombined Values
References
3
Case No. ADJ6526775
Regular
Jul 26, 2011

KEITH TYRELL vs. WARNER BROS. STUDIO FACILITIES, INCORPORATED; Permissibly Self-Insured, Administered by WARNER BROS. RISK MANAGEMENT

Lien claimants sought reimbursement for medical treatment provided to the applicant, arguing the defendant employer failed to properly notify the applicant of their medical network and claim procedures. The Workers' Compensation Appeals Board denied the lien claimants' petition for reconsideration, affirming the judge's decision that their medical reports were inadmissible. This inadmissibility was due to the applicant's failure to properly dispute the findings of the initial primary treating physician and obtain a Qualified Medical Evaluator. Without admissible evidence supporting their claims, the lien claimants failed to meet their burden of proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantsFindings of FactMedical Provider Network (MPN)Primary Treating PhysicianQualified Medical Evaluator (QME)Labor Code Section 4062Admissibility of EvidenceBurden of Proof
References
1
Case No. ADJ7062572
Regular
Apr 28, 2011

ANA LILIA RODRIGUEZ vs. COUNTRY VILLA HEALTH SERVICES, ZURICH AMERICAN INSURANCE CO. administered by TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration of an award of temporary disability indemnity to an applicant who received treatment outside a valid Medical Provider Network (MPN). The Board overturned the original award, ruling that reports from physicians outside the MPN are inadmissible under current case law, *Valdez v. Warehouse Demo Services*. Consequently, the applicant is not entitled to temporary disability indemnity, reimbursement to the EDD, or attorney's fees based on those inadmissible reports. However, the applicant's unauthorized departure from the MPN was not deemed an unreasonable refusal of medical treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Labor Code Section 4616.6Unauthorized Medical TreatmentAdmissibility of Medical ReportsTemporary Disability IndemnityEmployment Development Department (EDD)Attorney's FeesUnreasonable Refusal of Medical TreatmentLabor Code Section 4056
References
2
Case No. MISSING
Regular Panel Decision
Apr 17, 1985

Kollmer v. Slater Electric, Inc.

The plaintiff appealed a judgment from the Supreme Court, Nassau County, which dismissed her causes of action alleging a violation of Labor Law § 241 (6) in an action for wrongful death. The decedent, an employee of Delta Wells Inc., was fatally injured by a backhoe on land owned by the defendant, Slater Electric, Inc. The trial court had dismissed the Labor Law claim and ruled an OSHA violation inadmissible. The Appellate Division reversed the judgment, holding that Labor Law § 241 (6) imposes a nondelegable duty on owners, irrespective of their control over the worksite, and that the plaintiff's offer of proof established a prima facie case. The court reinstated the plaintiff's causes of action and granted a new trial, but affirmed that the specific OSHA settlement was inadmissible as an admission.

Wrongful DeathLabor Law241(6)Nondelegable DutyConstruction AccidentBackhoe IncidentOSHA RegulationsPrima Facie CaseEvidence AdmissibilityNew Trial Granted
References
14
Case No. MISSING
Regular Panel Decision

In re Stanley C.

This case involves a juvenile respondent in Division For Youth (DFY) custody who absconded and subsequently surrendered. The respondent was questioned by his DFY counselor, David Pankratz, without Miranda warnings, leading to incriminating statements regarding burglary and grand larceny. Later, Monroe County Deputy Sheriff Joseph Bender also questioned the respondent, after Miranda warnings, resulting in another incriminating statement. The court ruled that Pankratz was engaged in law enforcement activity, thus his failure to provide Miranda warnings rendered the first statement inadmissible. The second statement to Deputy Bender was also suppressed as it was tainted by the initial inadmissible statement and because the respondent's parents or guardians were not notified or present during the interrogation. The motion to suppress both statements was granted due to the lack of 'special considerations of care' required for juvenile interrogations.

Miranda warningsjuvenile rightscustodial interrogationself-incriminationdue processsuppression of evidenceDivision For YouthFamily Courtcriminal procedurepolice interrogation
References
31
Case No. ADJ4640837 (GRO 0031810)
Regular
Jan 05, 2009

JOEY M. COSTA vs. HARDY DIAGNOSTIC, STATE COMPENSATION INSURANCE FUND

The Appeals Board reversed the WCJ’s decision and allowed the costs of Ms. Wallace’s report and testimony, finding that inadmissibility is not a basis for disallowing reimbursement and that the standards for reimbursement were met.

Workers' Compensation Appeals BoardPermanent Disability Rating ScheduleReconsiderationVocational Rehabilitation ExpertRebuttal EvidenceLabor Code Section 5811Reasonable and Necessary CostsAdmissibilitySettlement NegotiationsBarr v. Workers' Comp. Appeals Bd.
References
10
Case No. ADJ7048296
Significant
Apr 20, 2011

Elayne Valdez vs. Warehouse Demo Services, Zurich North America, Adjusted by ESIS

The Appeals Board holds that medical reports from unauthorized, non-MPN (medical provider network) physicians are inadmissible and cannot be relied upon to award compensation; consequently, the employer is not liable for the cost of such reports.

MPNnon-MPNadmissibilitymedical provider networkunauthorized treatmentprimary treating physicianen bancWorkers' Compensation Appeals BoardLabor Codetemporary disability
References
5
Case No. RDG 0115958
Significant
Nov 16, 2004

Brice Sandhagen, Applicant vs. Cox & Cox Construction, Inc.; State Compensation Insurance Fund

The Appeals Board held that the utilization review time deadlines are mandatory; if a defendant fails to meet these deadlines, any utilization review report is inadmissible, and the defendant must use the AME/QME procedure as the objecting party.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code Section 4610Time DeadlinesAdmissibility of EvidenceMedical Treatment RecommendationACOEM GuidelinesAgreed Medical EvaluatorQualified Medical EvaluatorSection 4062
References
23
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