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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. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ8677937
Regular
Nov 05, 2015

SHARON ADAMS vs. MERCED CITY SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted by INTERCARE

The Appeals Board vacated its prior order granting reconsideration and dismissed the applicant's petition, finding it was not a final order. The Board treated the petition as a request for removal, which was denied. The Board determined that the defendant's request for a QME panel in "spine" specialty was proper, despite the applicant's treating physician being in "physical medicine and rehabilitation." The dissenting opinion argued that the defendant failed to provide sufficient medical support to deviate from the treating physician's specialty, especially given the claimed injuries to multiple body parts.

WCABReconsiderationRemovalQMESpecialtyPain MedicineSpineOrthopedicPhysical Medicine and RehabilitationTreating Physician
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. 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. ADJ8404025
Regular
Aug 25, 2015

ANA ALVAREZ vs. SERVIS AIR LLC, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Servis Air LLC's petition for removal. The employer sought to overturn an order for an additional Qualified Medical Evaluator (QME) panel in psychology. The Board found good cause for the psyche evaluation, as the applicant's depression was noted by a pain medicine specialist but was outside his expertise. Although the applicant's delay in raising the psyche injury claim was noted, the Board found no substantial prejudice to the defendant. Reconsideration remains an adequate remedy if the issue ultimately leads to an adverse decision.

QME PanelPetition for RemovalMandatory Settlement ConferenceNervous System InjuryPsyche InjuryCompensable ConsequencePain MedicineMedical-Legal IssueAdministrative Director RuleLabor Code 4062.2
References
Case No. ADJ11913752
Regular
Nov 19, 2019

LAURA DOW vs. UCSF, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns a dispute over the proper procedure for requesting a Qualified Medical Evaluator (QME) panel after a workers' compensation claim was denied. The Workers' Compensation Appeals Board (WCAB) granted removal, reversing a WCJ's decision. The WCAB found that the defendant's request for an orthopedic surgery QME panel was valid, initiated after the denial notice and statutory waiting period. They also determined that orthopedic surgery was an appropriate specialty, overriding the WCJ's order for a pain medicine panel. The parties are now directed to proceed with the orthopedic surgery QME panel.

QME panelPetition for RemovalOpinion and OrderFindings and OrdersMedical UnitPain MedicineOrthopedic SurgeryDenial NoticeQualified Medical EvaluatorLabor Code Section 4060
References
Case No. ADJ11134833, ADJ11134852
Regular
Apr 15, 2019

PETER LUCKHARDT vs. CITY OF TRACY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration regarding an order for applicant to proceed with a pain management QME panel. The Board found that the applicant, having become represented by counsel after an initial orthopedic panel issued, was entitled to request a new panel specialty. Defendant's arguments concerning unilateral panel changes and due process were rejected, as the issues addressed were framed for adjudication and the applicant's request for a new panel was permissible under current law. The Board also denied the petition concerning an internal medicine panel, adopting the reasoning of the WCJ.

QME panelremovalreconsiderationinterlocutory orderdue processsubstantial complianceirreparable harmlabor codemedical evaluationmedical unit
References
Case No. ADJ9348004
Regular
May 26, 2015

DOLORES NATIVIDAD vs. SHERBOURNE PROPERTIES, INC., EMPLOYERS COMPENSATION INSURANCE COMPANY

The defendant petitioned for removal, challenging the WCJ's decision to validate a chiropractic QME panel. The applicant failed to follow the rule requiring justification for requesting a specialty other than the treating physician's. However, the defendant's objection to the QME panel was deemed untimely as it was not raised with the Medical Unit promptly. The Appeals Board denied the petition for removal, finding the defendant failed to demonstrate prejudice or irreparable harm.

Petition for RemovalAmended Findings of Fact and OrderQualified Medical Evaluator (QME) panelAdministrative Director Rule 31.1(b)Labor Code section 4060occupational medicinechiropractic medicineorthopedic medicineMedical UnitDeclaration of Readiness to Proceed
References
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