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

Case No. ADJ6873149
Regular
May 29, 2012

MIRIAN AVILA vs. CANADIAN AMERICAN OIL COMPANY, PACIFIC COMPENSATION INSURANCE COMPANY

This case concerns whether a Qualified Medical Evaluator (QME) improperly interviewed non-party witnesses without the defendant's knowledge or consent, violating Labor Code section 4062.3 and AD Rule 35. The Appeals Board rescinded its order granting reconsideration, affirming the Workers' Compensation Judge's (WCJ) decision that these collateral interviews did not constitute prohibited ex parte communication. The majority held that the statute applies to communications between parties or their representatives and the QME, not to a QME's discussions with non-parties. Conversely, the dissenting commissioner argued that such interviews were impermissible under the spirit and letter of the law, constituting a denial of due process and advocating for the QME's report to be stricken.

PQMEnonparty witnessesex parte communicationLabor Code section 4062.3AD Rule 35oral interviewspetition to strikenew panelsubstantial evidencedue process
References
Case No. ADJ8531754
Regular
Mar 11, 2019

ARTURO TRUJILLO vs. TIC THE INDUSTRIAL COMPANY, THE HARTFORD INSURANCE

The Workers' Compensation Appeals Board (WCAB) vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration. The WCAB granted the defendant's petition for removal, rescinded the WCJ's findings and orders, and returned the case to the trial level for further proceedings. This decision stemmed from a dispute over whether an Agreed Medical Evaluator's (AME) interview with the applicant's wife and the applicant's provision of medical records at the AME's deposition constituted impermissible ex parte communication. The WCAB found that the interview with the wife was permissible as a collateral source to supplement the applicant's potentially impaired memory due to a brain injury, and that the provision of records at the deposition was not ex parte as the defendant was present. However, the WCAB remanded the case for the WCJ to determine if the applicant improperly provided information to the AME, as parties must agree on what information is provided to an AME.

Agreed Medical EvaluatorEx Parte CommunicationPetition for RemovalMedical-Legal ReportingCollateral InterviewApplicant's WifeDepositionsMedical RecordsSubstantial EvidenceLabor Code Section 4062.3
References
Case No. ADJ2172951 (SBR 0322180) ADJ7390511
Regular
Nov 07, 2013

RICHARD ALCALA vs. BOTTLING GROUP, LLC, dba PEPSI BEVERAGES COMPANY, SEDGWICK CLAIMS MANAGEMENT, OLD REPUBLIC INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Removal. The WCAB adopted the WCJ's report, which found that the defendant failed to demonstrate significant prejudice or irreparable harm to justify setting aside the prior discovery order. This order had dictated the conditions for a vocational expert interview, including location and attendance. The WCAB also admonished the defendant for attaching unauthorized documents to their petition.

Petition for RemovalWCJ ReportWCAB Rule 10842(c)Significant PrejudiceIrreparable HarmVocational ExpertDefense CounselApplicant's CounselTape RecordingTranscription
References
Case No. ADJ8005489
Regular
May 30, 2013

CLAUDIA MONTOYA vs. AGE ADVANTAGE HCS, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board denied reconsideration of an order dismissing a lien claim filed by Firstline Health. The lien was dismissed because Firstline failed to pay the required lien activation fee and did not appear at the lien conference. Although Firstline claimed an oral settlement agreement existed, the evidence presented was a settlement demand, not a finalized agreement. The Board upheld the dismissal, finding Firstline violated Labor Code Section 4903.06.

WCABPetition for ReconsiderationWCJLien ClaimantLien Activation FeeLabor Code § 4903.06Dismissal with PrejudiceCompromise and ReleaseOral AgreementLien Claimant Demand Letter
References
Case No. ADJ9426494
Regular
Jun 10, 2015

BARBARA SWENSON vs. COMPASS HEALTH, MURPHY AND BEANE, INC.

In this Workers' Compensation Appeals Board case, the applicant sought interview transcripts and statements of defense witnesses. The judge initially ordered the defendant to produce all such materials. The defendant petitioned for removal, arguing the order was overbroad and violated due process by failing to account for work product and attorney-client privilege. The Appeals Board granted the petition for removal, amending the original order. The amended order requires the defendant to provide requested materials, excluding those protected by privilege, for which a privilege log must be filed.

Petition for RemovalInterview TranscriptsWitness StatementsWork ProductAttorney-Client PrivilegePrivilege LogDue ProcessOverbroad OrderAppeals BoardWCJ
References
Case No. ADJ1184992
Regular
Feb 10, 2015

KATHLEEN MURPHY vs. PETSMART, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For FREMONT INSURANCE COMPANY, In Liquidation

The Workers' Compensation Appeals Board (WCAB) rescinded a penalty against Petsmart, Inc. for allegedly unreasonably delaying dental treatment. The Board found that Petsmart had no obligation to pay for the dental surgery in advance, as dictated by Labor Code section 4603.2, which requires payment within 45 days after services are provided. While the treating oral surgeon requested prepayment due to high costs, the WCAB determined that the defendant's utilization review approval for the treatment did not constitute an agreement to advance payment. Therefore, the WCAB concluded there was no unreasonable delay or refusal of treatment, negating the basis for a Labor Code section 5814 penalty.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5814unreasonable delaydental careoral surgeryutilization reviewpre-authorizationpayment in advancefee schedule
References
Case No. ADJ7257085
Regular
Apr 13, 2012

RAMON MACIAS vs. SOUTHWIRE CORPORATION, OLD REPUBLIC RISK MANAGEMENT

This case concerns an applicant claiming back, hip, and ankle injury from May 1, 2009, who reported it during an exit interview on March 22, 2010, after receiving notice of termination. The Board denied reconsideration, affirming the trial judge's findings based on parties' stipulations that the injury was reported post-termination without notice to the employer beforehand. The Board found that Labor Code section 3600(a)(10) bars claims filed after notice of termination unless specific exceptions apply, and the applicant's reported injury date predates termination notice. The issue of potential exceptions under section 3600(a)(10) remains reserved for further proceedings.

Labor Code Section 3600(a)(10)Post-termination claimExit interviewActual notice of terminationStipulationsWCABReconsideration deniedPreponderance of evidenceExceptions to denialCompensable injury
References
Case No. ADJ18376723
Regular
Oct 09, 2025

Miguel Mejinez vs. Substance Abuse Treatment Facility, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal regarding an order that rescinded a prior directive for the applicant to disclose medical history under Labor Code section 4663(d). The defendant argued that section 4663(d) compels disclosure upon request and that they suffered prejudice from the applicant's refusal. However, the Board, concurring with the WCJ's recommendation, found that while section 4663 broadened the scope of discovery, it did not expand the methods of compelled discovery, which are limited to oral testimony and records under Labor Code section 5708. Consequently, the defendant failed to demonstrate substantial prejudice or irreparable harm necessary for removal, concluding that written interrogatories are not an appropriate method for compelled discovery in workers' compensation cases.

Petition for RemovalOrder Rescinding OrderMedical History DisclosureLabor Code Section 4663(d)Previous Permanent DisabilitiesPhysical ImpairmentsSubstantial PrejudiceIrreparable HarmReconsideration Adequate RemedyWritten Interrogatories
References
Case No. ADJ7039301
Regular
Mar 16, 2011

ROBLY HART vs. LA JOLLA PACIFIC/DRR NEFF & ASSOCIATES, OAKS RIVER INSURANCE/BERKSHIRE HATHAWAY HOMESTATE COMPANIES

This case concerns Robly Hart's workers' compensation claim for an injury sustained in a motorcycle accident. The applicant was a construction consultant who used his motorcycle for work, traveling between home, job sites, and interviews. The primary dispute centers on whether the accident occurred during the course and scope of his employment, with conflicting evidence regarding his activities and timeline leading up to the incident. The Workers' Compensation Appeals Board denied reconsideration, adopting the judge's report that found the applicant's testimony lacked credibility due to inconsistent statements and timeline discrepancies.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJGarza v. Workers' Comp. Appeals Bd.Findings and OrderCourse of EmploymentConstruction ConsultantBuilding InspectorMotorcycle TravelJob Sites
References
Case No. ADJ8580851
Regular
Feb 26, 2018

JOSE RODRIGUEZ (Dec'd), MARCELA RODRIGUEZ (Wife), ANDREA RODRIGUEZ (Daughter), ISAAC ESPINOZA (Grandson) vs. KENAN ADVANTAGE GROUP, INC., AMERICAN ZURICH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration. The Board affirmed the administrative law judge's order requiring the agreed medical evaluator (AME) to interview the deceased employee's spouse and daughter to assess causation for his suicide. The Board found the employer acted in bad faith by obstructing these interviews, warranting sanctions, attorney's fees, and costs. The employer's arguments against the interviews and sanctions lacked legal merit.

Workers' Compensation Appeals BoardAgreed Medical EvaluatorSuicideCompensable ConsequenceLabor Code Section 4062.3SanctionsBad FaithDiscovery ObstructionReconsiderationPetition for Reconsideration
References
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