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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. 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. 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. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
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. ADJ10230241
Regular
Jul 19, 2019

SAUL ROMERO vs. CARNICERIA NUEVA VALLARTAS, INC.

The WCAB granted reconsideration and rescinded the WCJ's findings, remanding the case for further development of the medical record. The defendant argued the applicant failed to prove an industrial injury, citing a lack of substantial medical evidence. The Board found that no comprehensive medical-legal report from an agreed or panel QME, nor a complete report from the applicant's primary treating physician addressing causation, was present. The case is returned to the trial level for a new decision after a comprehensive medical-legal report is obtained, likely through an agreed or panel QME.

Workers' Compensation Appeals Boardindustrial injuryherniauninsuredsubstantial medical evidencereconsiderationmedical-legal reportprimary treating physiciancausationreasonable medical probability
References
Case No. ADJ2764972
Regular
Sep 25, 2013

HOLLIE NELSON vs. CABRILLO UNIFIED SCHOOL DISTRICT, KEENAN ASSOCIATES REDWOOD CITY

The Workers' Compensation Appeals Board denied a petition for reconsideration, affirming the administrative law judge's decision. The Board agreed that Dr. Newman's reports were reasonable and necessary medical-legal reports, properly requested by the primary treating physician to assess permanent disability. The Board found that the defendant's arguments regarding Dr. Newman's qualifications, timeliness of report adoption, and billing were unsubstantiated and lacked legal basis. Therefore, Dr. Newman's charges were allowed as medical-legal expenses.

WCABPetition for ReconsiderationMedical-legal reportsPrimary treating physicianPermanent and stationary reportLabor Code § 4061.5Designated physicianLien claimantDisputed medical factsOfficial Medical Fee Schedule
References
Case No. ADJ830768
Regular
Apr 09, 2009

MIKE OLSON vs. PACIFIC COAST SERVICES, EMPLOYER COMPENSATION INSURANCE CO.

This case involves a lien claimant, Jennifer Scott, seeking reconsideration after her $\$750.00$ lien for a doctor's report was disallowed. The WCJ found the report not to be an allowable medical-legal cost. The petition for reconsideration was dismissed primarily because it was unverified, a requirement under Labor Code section 5902, and the defect was not cured. Even if considered on the merits, the Board would have denied the petition, adopting the WCJ's reasoning that the report was not a compensable medical-legal expense. The report was procured at the applicant's attorney's request, not by an authorized medical evaluator, and the attorney failed to establish the doctor's qualifications as an expert rater.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderIndustrial cumulative injuryUpper extremitiesTruck mechanicApplicant counsel's lienMedical-legal costLabor Code section 5811Labor Code section 4620(c)
References
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