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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7232076
En Banc
Sep 26, 2011

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

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ9011624
Regular
Dec 13, 2019

ELISHA HARDEN vs. COUNTY OF SACRAMENTO

This case concerns whether specific medical reports obtained for a disability retirement claim are admissible in a workers' compensation proceeding. The Appeals Board rescinded the prior ruling, holding these reports are relevant and may be provided to the orthopedic Agreed Medical Evaluator (AME) and psychiatric Qualified Medical Evaluator (QME). The Board found the reports relevant to the medical issues, even though they were not obtained through the standard workers' compensation medical-legal evaluation process. Consequently, the applicant's objection to providing these reports to the evaluators was overruled.

RemovalReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Medical-legal evaluatorsMedical recordsLabor CodeFindings and Orders (F&O)Disability retirementPermanent impairment
References
Case No. ADJ15763825
Regular
Sep 16, 2025

CLAUDIO CARDOZO vs. ROCK AND ROLL CAR WASH, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by Redwood Fire and Casualty Insurance Company dba Berkshire Hathaway Homestate Companies. The petition challenged a lien trial decision concerning a medical-legal evaluation performed by Dr. Michaels of Premier Psychological Services. The WCJ found that a medical dispute regarding psyche existed at the time of the evaluation, Dr. Michaels was validly designated as the Primary Treating Physician, and the evaluation was not barred by the 60-day rule for new claims as it was an amendment to an already accepted claim. The Appeals Board adopted the WCJ's reasoning and denied the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Adjudication NumberOpinion and Order Denying PetitionWCJ ReportEAMS TransmissionNotice of TransmissionProof of ServiceFindings and Order
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ10183065, ADJ10449030
Regular
Mar 21, 2018

DENNIS MOORE (Dec'd), SHIRLEY MOORE (Wife), ERIC MOORE (Son) vs. WAL-MART, ACE AMERICAN INSURANCE COMPANY, YORK RISK SERVICES GROUP, INC.

This case concerns a deceased worker's claim for death benefits, where the employer disputed whether the death was industrially caused. The WCAB granted the employer's petition for removal to address due process concerns regarding discovery closure and the setting of trial. The Board rescinded the trial judge's order, finding that the existing record lacked sufficient admissible medical evidence for a determination of injury arising out of and in the course of employment. The matter was returned to the trial level to allow parties to obtain medical-legal reports through the proper statutory procedures, such as an Agreed Medical Evaluator or Qualified Medical Evaluator process.

Petition for RemovalAOE/COEDeclaration of Readiness to ProceedMandatory Settlement ConferencePetition to DismissNotice of Intention to Dismiss CaseSection 4605 evaluationQualified Medical EvaluatorAgreed Medical EvaluatorCompensability
References
Case No. ADJ9725603
Regular
Nov 23, 2020

LUZ LOZA vs. GOLDBLATT GOLDBLATT/BAY AREA RESTAURANT MANAGEMENT, ARCH INSURANCE COMPANY, administered by YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's order finding the applicant entitled to pre-authorization for their treating physician to issue a PR-4 report at the medical-legal billing rate. While affirming the applicant's right to obtain the report, the Board clarified that the defendant retains the right to object to or raise defenses regarding the physician's billing. The Board reasoned that treating physicians are permitted to provide comprehensive medical-legal evaluations, and such reports are governed by specific medical-legal fee schedules, not the Official Medical Fee Schedule.

PR-4 reportmedical-legal billing ratepre-authorizationprimary treating physician (PTP)Qualified Medical Evaluator (QME)comprehensive medical evaluationOfficial Medical Fee SchedulePetition for ReconsiderationFindings of Fact and Order (F&O)Labor Code
References
Case No. ADJ10955805; ADJ10963100
Regular
Oct 20, 2025

DAVID SCHUPP vs. MAGIC MOUNTAIN LLC, PROPERTY AND CASUALTY INSURANCE COMPANY OF HARTFORD

David Schupp, the applicant, filed workers' compensation claims for injuries to his right ankle, bilateral wrists, and knees while employed by Magic Mountain LLC. The defendant, Magic Mountain LLC, petitioned for removal challenging a Workers' Compensation Judge's (WCJ) findings regarding the Qualified Medical Evaluator (QME) process in pain management. The Appeals Board treated the petition as one for reconsideration, granted it under the removal standard, affirmed the WCJ's findings on employment, injury, and parts of the body, but deferred other interlocutory issues. The case is returned to the WCJ for further proceedings to address the validity of the QME panels, the timeliness and nature of the applicant's objection to a medical report, and potential prejudice to the defendant.

Workers Compensation Appeals BoardPetition for ReconsiderationRemovalJoint Findings and OrderQualified Medical EvaluatorPQMEPain ManagementLabor Code Section 4062.2Agreed Medical EvaluatorMedical Evaluation
References
Case No. ADJ1058308 (VNO 0482296)
Regular
May 28, 2013

DONNA DeRUSSY vs. ANTELOPE VALLEY HEALTH CARE SYSTEM, TRAVELERS INSURANCE, SAFETY NATIONAL, FRONTIER INSURANCE

This case involves a workers' compensation appeal where the defendants seek reconsideration of a prior award. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The primary grounds for this decision were that the defendants were denied due process by not being given an opportunity to cross-examine the rating rater and that the award relied on outdated medical reports. The WCAB also suggested obtaining current medical evaluations due to the time elapsed since the original reports.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardAttorney FeesPermanent Disability RatingApportionmentIndustrial InjuryLumbar SpineTreating PhysiciansMedical Reports
References
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