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

Case No. ADJ1457992 (AHM 0084718)
Regular
Dec 26, 2014

DARLENE HELLER vs. COWELL BAKER'S STRIPPING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS, FREMONT INSURANCE COMPANY

This case concerns a dispute over the correct procedure for obtaining medical reevaluations for a worker's injury with a date prior to January 1, 2005. The Appeals Board denied the applicant's petition for reconsideration, reversing an earlier decision that had directed the parties to use the panel QME process. The Board clarified that for pre-2005 injuries, the pre-Senate Bill 899 AME/QME procedures apply, not the current section 4062.2 QME process. One Commissioner dissented, arguing the prior award should be reinstated.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order DenyingFindings and AwardLabor Code section 4062.2panel qualified medical examinationQMEdisputed body partsadmitted liabilitydate of injury
References
Case No. ADJ1056275 (MON 0257175)
Regular
Sep 20, 2011

NATALIE RHYMES-MALLARD vs. COUNTY OF LOS ANGELES, DCFS DEPARTMENT

The WCAB dismissed the defendant's Petition for Removal as improperly filed, but granted reconsideration of the WCJ's order for a reevaluation by an AME. The Board rescinded the prior order and returned the case to the trial level due to an incomplete record, specifically the absence of crucial documents related to the applicant's husband's home health care lien. This allows for the proper creation and development of the record before addressing the substantive issues of the lien's necessity and reimbursement.

Petition for RemovalPetition for ReconsiderationAgreed Medical EvaluatorHome Health CareLien ClaimPermanent DisabilityIndustrial InjuryPsycheInternal OrgansNeurological System
References
Case No. ADJ17378619
Regular
Mar 24, 2025

NAOMI RIVERS vs. UNITED PARCEL SERVICE, LIBERTY MUTUAL INSURANCE CORPORATION

The applicant, Naomi Rivers, sought reconsideration of a Findings, Award, and Order (FA&O) from December 23, 2024, which found an injury to her left leg but no permanent disability based on a Qualified Medical Evaluator's (QME) report. The applicant contended that the QME, Dr. Anthony Fenison, failed to adequately account for her current medical condition and relied on outdated information by not reviewing updated medical records from Dr. James Rho. The Appeals Board granted the petition for reconsideration, rescinded the original FA&O, and substituted it with an order deferring permanent disability, apportionment, and attorney's fees pending further development of the record. This includes a reevaluation of the applicant by Dr. Fenison, incorporating all updated medical records.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical Evaluator (QME)Substantial Medical EvidencePermanent DisabilityApportionmentFuture Medical TreatmentComplex Regional Pain Syndrome (CRPS)NeuropathyNerve Conduction Study (NCV/EMG)
References
Case No. ADJ6973321
Regular
Jan 24, 2012

CONSTANCE PHILLIPS vs. UNITED HEALTH CARE SERVICES, INC., UNITED STATES FIDELITY & GUARANTY INSURANCE

In this workers' compensation case, the defendant sought removal of an order denying their petition to compel the applicant to attend a medical evaluation with Dr. Blau. The defendant argued irreparable harm, as the prior QME was no longer serving and could not reevaluate the applicant's impairment. The Workers' Compensation Appeals Board denied the petition, adopting the reasoning of the WCJ and prior decisions. The denial upheld the order preventing the compelled medical evaluation.

Petition for RemovalOrder Denying Petition to Compel AttendanceLabor Code section 4050Qualified Medical EvaluatorDr. Robert Blausleep disorderincreased impairmentirreparable harmprejudiceWorkers' Compensation Appeals Board
References
Case No. ADJ8336291
Regular
Feb 11, 2015

AIDA RAMOS vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration in this case. The Board adopted the findings of the Administrative Law Judge, concluding that the employer unreasonably neglected to furnish medical treatment to the applicant. This unreasonable neglect stemmed from the employer misdirecting an authorization for medical treatment by faxing it to the wrong number, resulting in a significant delay in the applicant receiving necessary orthopedic reevaluation. The Board emphasized that any consequences of such delays will be borne by the employer, not the injured employee, citing Labor Code § 4616.3(b).

Medical Provider NetworkMPNauthorizationfax numbermisdirectedunreasonable neglectfurnish medical treatmentdelayinjured employeeLabor Code § 4616.3(b)
References
Case No. ADJ7244539
Regular
Dec 27, 2011

MANUEL GONSALVES vs. COUNTY OF SACRAMENTO

The defendant, County of Sacramento, sought to set aside a stipulation regarding the applicant's whole person impairment (WPI) based on a subsequent Qualified Medical Evaluator (QME) report. The Appeals Board denied the defendant's Petition for Removal, finding no good cause to disturb the WCJ's decision. The WCJ properly excluded the QME report as evidence and denied the request to set aside the stipulation. Defendant's delay in raising the issue after obtaining the report also weighed against them.

Petition for RemovalStipulationGood CauseWhole Person ImpairmentQualified Medical EvaluatorWCJIndustrial InjuryPsycheTemporary DisabilityPrejudice
References
Case No. ADJ14778693
Regular
Oct 29, 2025

DARRELL DICKERSON vs. SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT, ATHENS ADMINISTRATORS, INC.

The Appeals Board granted reconsideration to study legal and factual issues. Defendant sought reconsideration of Findings of Fact and Orders (F&O) issued by the WCJ, which denied a replacement Qualified Medical Evaluator (QME) panel and affirmed Dr. Lucas Campos as the valid QME. The Board applied a removal standard to the interlocutory finding challenged by the petitioner and found that significant prejudice or irreparable harm would result if removal was denied. Consequently, the Board rescinded the F&O and returned the matter to the WCJ for further proceedings consistent with its opinion, specifically to reconsider whether good cause exists to order a replacement QME panel, in light of the Vazquez case factors.

PQMEAD Rule 31.3(e)AD Rule 31.5(a)(2)replacement panelreevaluationunavailabilityAppeals Boardremoval standardthreshold issueinterlocutory issue
References
Case No. ADJ4245398 (GOL 0101151)
Regular
Feb 04, 2013

HEIDI KIRKWOOD vs. VERIZON CALIFORNIA, INC., AMERICAN HOME ASSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration as the WCJ's order was procedural and not a final determination. The Board granted the defendant's petition for removal, rescinded the WCJ's order to reopen discovery, and returned the case for a decision based on the existing record. This action was taken because the discovery closure date had passed, no party requested further development of the record, and reopening would cause undue delay. The Board admonished the defendant for improperly titling their petition as one for reconsideration.

Petition for RemovalPetition for ReconsiderationWCJ OrderVacated SubmissionPsychiatric PQMEReevaluationDiscovery ClosureMandatory Settlement ConferenceSubstantial PrejudiceIrreparable Harm
References
Case No. SAC 0349246
Regular
Dec 10, 2007

LORENZO CIGARROA vs. ENERGETIC LATH & PLASTER, INC., ZURICH NORTH AMERICA

The Applicant requested removal to vacate a trial date and reopen discovery, citing the need for further medical evaluations. The Workers' Compensation Appeals Board denied the petition, finding no significant prejudice or irreparable harm to the Applicant. The Board noted that the judge could order supplementation of the record if necessary and that reconsideration would be available after a final order.

Petition for RemovalRescind OrderVacate Trial DateMandatory Settlement ConferenceQualified Medical EvaluatorDepositionSpinal Range of MotionPsychological Pain EvaluationReevaluationSupplementation of Record
References
Case No. ADJ13703697
Regular
May 22, 2025

VICTOR ROMERO vs. SANTA BARBARA SMOKEHOUSE, COMPWEST INSURANCE COMPANY

Victor Romero, the applicant, sustained a COVID-19 related injury resulting in pulmonary fibrosis and chronic lung disease. The defendant, Santa Barbara Smokehouse and Compwest Insurance Company, sought reconsideration of a Findings and Award (F&A) which entitled the applicant to temporary disability exceeding 104 weeks. The defendant argued that Dr. Gerald Markovitz's medical report was not substantial evidence and that their due process rights were violated. The Workers' Compensation Appeals Board reviewed the petition and the WCJ's report, affirming that Dr. Markovitz's report constituted substantial medical evidence. Consequently, the Board denied the defendant's Petition for Reconsideration.

AOE/COECOVID-19Pulmonary fibrosisChronic lung diseaseTemporary disabilityLabor Code § 4656Permanent and stationaryMMIPetition for reconsiderationSubstantial medical evidence
References
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