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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ4378069 (AHM 0085676) ADJ2997222 (AHM 0085721)
Regular
Jun 09, 2010

LARRY LAZAR vs. HOME DEPOT, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for removal and dismissed his petition for disqualification of the judge. The applicant argued that his treating physician's reports constituted substantial evidence and questioned the need for a court-appointed regular physician. The Board found that the judge correctly followed procedures for supplementing the medical record and that the existing reports lacked substantial evidence. Therefore, the Board upheld the judge's appointment of a regular physician.

Workers Compensation Appeals BoardPetition for RemovalPetition for DisqualificationRegular PhysicianLabor Code Section 5701Findings and OrderIndustrial InjuryPermanent DisabilitySubstantial EvidenceTreating Physician
References
Case No. ADJ9749961
Regular
Oct 11, 2017

ROMEL MAAIA vs. REDNECK TRAILER SUPPLY, INC., NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PA.

In this workers' compensation case, the Appeals Board granted reconsideration to address the applicant's entitlement to treat outside the defendant's Medical Provider Network (MPN). The defendant contested that the applicant's chosen physician, Dr. Shaw, qualified as a "regular physician" under Labor Code section 4600(d). Specifically, the defendant argued the applicant failed to prove the predesignation notice was submitted to the employer before the injury, and that Dr. Shaw was indeed the applicant's regular physician who retained his records. The Board found the record insufficient to definitively rule on these issues and remanded the case to the WCJ for further development of the evidence.

Predesignation of Personal PhysicianMedical Provider NetworkRegular PhysicianLabor Code section 4600Workers' Compensation Appeals BoardFindings of FactOpinion and Decision After ReconsiderationDevelop the RecordDue ProcessNimish Shah M.D.
References
Case No. ADJ7685567
Regular
Feb 12, 2015

KATHLEEN O'NEAL vs. HALE ALOHA/MARK ONE CORPORATION, CALIFORNIA SELF-INSURERS' SECURITY FUND

This case involves a dispute over authorization for cervical surgery for applicant Kathleen O'Neal. The defendant argued that Dr. McCormack, who recommended the surgery, was a one-time consultant, not a treating physician, and thus his request for authorization was not subject to utilization review (UR). The Workers' Compensation Appeals Board (WCAB) affirmed the judge's order, finding Dr. McCormack acted as a treating physician by undertaking to obtain authorization and proceed with the surgery. Therefore, the defendant's failure to submit Dr. McCormack's request for authorization to UR in a timely manner meant the UR denial was invalid. The WCAB concluded the defendant was obligated to provide the surgery as it was supported by substantial medical evidence and reasonably necessary.

Utilization ReviewAuthorization RequestTreating PhysicianConsulting PhysicianPrimary Treating PhysicianSecondary Treating PhysicianWorkers' Compensation Appeals BoardAdministrative Director's RuleTimelinessJurisdiction
References
Case No. SAC 342547
Regular
Jun 06, 2008

CLIFFORD J. FARIA vs. BEST BUY COMPANY, ACE AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior order, returning the case to the trial level for further proceedings. This decision addresses disputes regarding the applicant's right to change treating physicians, the defendant's Medical Provider Network (MPN) obligations, and the calculation of the applicant's average weekly earnings. The Board requires further development of the record on these key issues.

Workers' Compensation Appeals BoardBest Buy CompanyAce American Insurance CompanyClifford FariaOpinion and Order Granting ReconsiderationDecision After ReconsiderationAdministrative Law Judge (WCJ)Treating PhysicianMedical Provider Network (MPN)Temporary Disability Indemnity
References
Case No. SAC 0259091
Regular
Aug 22, 2007

MARK COLLEN vs. NATIONWIDE INSURANCE, EMPLOYERS INSURANCE OF WAUSAU

The Workers' Compensation Appeals Board (WCAB) dismissed the defendants' petition for reconsideration as it was not filed from a final order, and subsequently denied it on its merits. The WCAB reaffirmed its prior decision to appoint a regular physician, Dr. Roy Curry, to further develop the medical record regarding the applicant's insomnia. The defendants' arguments regarding due process and abuse of power were rejected.

Petition for ReconsiderationLabor Code section 5701regular physicianappointed physicianmedical record developmentdenied due processQualified Medical Evaluators (QME)vocational attemptpsychiatric work functionsfinal order
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. ADJ10975151
Regular
Jan 06, 2020

RUSSELL CAMARA vs. TESLA, INC., AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the Applicant sustained an admitted industrial injury to the lumbar spine. The Applicant's primary treating physician (PTP) designated a secondary physician to evaluate permanent and stationary status and impairment, whose report the PTP adopted. The defense challenged the validity of this secondary physician's report, arguing only the Panel Qualified Medical Examiner's (PQME) report was properly obtained. The Workers' Compensation Appeals Board denied the Petition for Reconsideration, affirming that the PTP, or a physician designated by the PTP, is authorized to render opinions on medical issues, provided proper notice and procedural requirements are met. The Board found the designation and subsequent report were compliant with Labor Code and Administrative Director Regulations.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianQualified Medical ExaminerLabor Code Section 4061.5Permanent and Stationary ReportMedical-Legal EvaluationSecondary PhysicianAdministrative Director Rule 9785Designation of Physician
References
Case No. ADJ900432 (SAC 0323091)
Regular
Dec 30, 2011

MARLENE COPUS vs. NORTH SACRAMENTO ELEMENTARY SCHOOL DISTRICT

This case involves a dispute over the necessity of spinal surgery for an applicant who sustained a cumulative trauma injury to her neck and back. While the applicant's treating physician recommended surgery, a second opinion physician disagreed, citing a lack of nerve root compression. The Appeals Board found that the medical evidence was insufficient to determine the necessity of surgery, particularly in light of ACOEM Practice Guidelines which generally recommend against surgery without nerve root compression. Therefore, the Board rescinded the prior award and remanded the case to appoint an independent physician to evaluate the applicant and determine the reasonableness and necessity of the proposed surgery.

Workers' Compensation Appeals BoardMarlene CopusNorth Sacramento Elementary School Districtcumulative traumaspinal surgerynerve root impingementcervical stenosisDr. OrisekDr. GregoriusACOEM Practice Guidelines
References
Case No. ADJ1462684 (SBR 0332199) ADJ4330124 (SBR 0332208) ADJ2350306 (SBR 0333426) ADJ6736405
Regular
Dec 13, 2011

ISABELA AGARONYAN vs. REGENTS, UNIVERSITY OF CALIFORNIA

This case involves defendant's challenge to the Workers' Compensation Judge's (WCJ) appointment of a new physician, Dr. Watkin, after prior medical reports from Dr. Kuschner were deemed not substantial evidence. The WCAB dismissed the petition for reconsideration, finding it challenged an interim procedural order, not a final decision. The petition for removal was denied because the defendant failed to demonstrate significant prejudice or irreparable harm from the appointment of Dr. Watkin. The Board affirmed the WCJ's discretion to appoint a new physician to develop a substantial medical record, especially given concerns about the adequacy of Dr. Kuschner's previous reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAdministrative Law JudgeSpecial PhysicianRegular PhysicianPanel Qualified Medical ExaminerSubstantial Medical EvidenceJoint LetterBias
References
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