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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ9687796
Regular
Mar 23, 2015

MOHAMMAD RAFIQ vs. VILLAGE NURSERIES, APPLIED RISK

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought treatment outside the defendant's Medical Provider Network (MPN), arguing the MPN lacked toxicologists. The judge found the applicant was not entitled to out-of-MPN treatment as they were not treating with a toxicologist and the MPN had sufficient internal medicine physicians. The applicant also failed to prove medical necessity for a toxicologist through treating physician reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedMPNLabor Code §4616(a)Cal. Code of Reg. §9767.5Medical TreatmentSelf-Procured Medical TreatmentToxicologistInternal Medicine
References
Case No. ADJ2757896
Regular
Sep 24, 2018

JOAQUIN GONZALEZ vs. PENHALL INTERNATIONAL CORP, HARTFORD INSURANCE CO.

The Workers' Compensation Appeals Board affirmed a prior order allowing the applicant to seek treatment outside the employer's medical provider network (MPN) for pain management and internal medicine specialists. This decision was based on the employer's failure to schedule timely appointments with specialists within the MPN, as required by regulations. The Board declined to address the employer's request to limit the duration of out-of-network treatment, as this issue was not raised or adjudicated in the initial proceedings. The applicant had sustained a 2005 injury resulting in 100% permanent disability.

Workers' Compensation Appeals BoardMPNMedical Provider NetworkReconsiderationFindings OrderAdministrative Law JudgePermanent DisabilityFuture Medical TreatmentPain ManagementInternal Medicine
References
Case No. ADJ8876167
Regular
Sep 18, 2015

Manuel Ruiz vs. Schwan's Home Services, Inc., Hartford Insurance Company

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding the Administrative Law Judge's (ALJ) decision. The defendant argued the ALJ erred by admitting a Qualified Medical Evaluator's (QME) reports and by ordering a second QME panel in internal medicine. The Board found no substantial prejudice or irreparable harm to warrant removal, agreeing with the ALJ that the QME substantially complied with reporting deadlines and that an internal medicine evaluation was warranted due to the applicant's alleged stroke. Therefore, removal was deemed an inappropriate and extraordinary remedy.

RemovalPetition for RemovalWorkers' Compensation Appeals BoardWCJ reportsubstantial prejudiceirreparable harmreconsiderationQualified Medical EvaluatorQME panelpsychology
References
Case No. ADJ11629744
Regular
Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

The applicant sought reconsideration after the WCJ denied injury claims to the brain, internal system, psyche, and sexual dysfunction, as well as the issuance of additional QME panels. The Appeals Board granted reconsideration, finding good cause existed for additional QME panels in internal medicine and psychiatry. The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred. The Board concluded that additional QME evaluations were necessary for a full adjudication of the claimed injuries outside of the admitted orthopedic injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche
References
Case No. ADJ8857482
Regular
Jan 28, 2014

RENE QUINTANA vs. NEW ALBERTSONS, INC.; SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involved a petition for reconsideration that was denied by the Workers' Compensation Appeals Board. The Board adopted the findings of the workers' compensation administrative law judge, also denying reconsideration. The applicant's complaints regarding the Agreed Medical Evaluator's (AME) review of medical records, consideration of MRI films, and comments on an "internal injury/hernia" were rejected. The Board found no error in the AME's report or the approval of the compromise and release agreement given the applicant's claimed injuries and representation by counsel.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorOrthopedicsMedical Records ReviewMRI FilmInternal InjuryHerniaCompromise and Release AgreementWCJ Report
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ7729335
Regular
Aug 02, 2011

GLENN CARROLL vs. LAWRENCE LIVERMORE NATIONAL LABORATORY, CHARTIS INSURANCE

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration because the WCJ's order for a new QME panel was not a final decision. The Board also denied the Petition for Removal, finding the defendant failed to show significant prejudice or irreparable harm. The WCJ's order was to further develop the medical record on disputed psyche and internal medicine issues. The defendant sought reconsideration of this interlocutory order.

WCABPetition for ReconsiderationPetition for RemovalFinal OrderQME PanelPsycheInternal MedicineSubstantive RightsIrreparable HarmSignificant Prejudice
References
Case No. ADJ8087609
Regular
Mar 14, 2014

JORGE GUEVARA vs. USA WASTE OF CALIFORNIA, ACE AMERICAN INSURANCE

The Appeals Board dismissed the applicant's Petition for Reconsideration because it was improperly taken from an interlocutory order, not a final decision. However, removal was granted and the WCJ's January 15, 2014 Findings and Orders were affirmed. Specifically, the findings regarding the applicant's date of birth and the specific body parts injured were amended for clarity and to reflect only the issues at trial. The amendment also mandates a new panel in internal medicine.

WCABPetition for ReconsiderationFinal OrderInterlocutory OrderRemovalDecision After RemovalFindings and OrdersMedical UnitInternal MedicineFuel Man
References
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