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

Case No. SAC 355392
Regular
Jan 29, 2008

JANELL J. HASTINGS vs. GEORGE VISMAN dba HIGH HILL RANCH, ZENITH INSURANCE COMPANY

The Appeals Board denied the applicant's Petition for Removal, which sought to compel a psychiatric or psychological consultation. The Board adopted the Workers' Compensation Judge's reasoning that a panel for psychological issues is provided by the Division of Workers' Compensation if parties do not agree on a Qualified Medical Evaluator. Therefore, the applicant's request for removal to obtain this specific consultation was denied.

Petition for RemovalPsychiatric consultationPsychological consultationQualified Medical EvaluatorAdministrative Director Rule 32(c)Agreed Medical EvaluatorDivision of Workers' CompensationMedical UnitPanelWorkers' Compensation Appeals Board
References
Case No. ADJ6671882
Regular
Jul 31, 2009

ANGELICA ALMANZA vs. VOLER TEAM APPAREL, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

In this case, the defendant sought reconsideration of an award requiring neurological and psychiatric consultations for the applicant. The defendant argued that a psychiatric consultation was barred by Labor Code section 3208.3(d) as the applicant had less than six months of employment. However, the Appeals Board found the record inadequate to determine if a psychiatric injury was actually claimed. Therefore, the Board granted reconsideration, rescinded the award, and returned the matter for further proceedings to establish a proper record.

Workers' Compensation Appeals BoardAngelica AlmanzaVoler Team ApparelBerkshire Hathaway Homestate CompaniesADJ6671882ReconsiderationFindings and AwardNeurological consultationsPsychiatric consultationsIndustrial injury
References
Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
Case No. ADJ3605789 (GOL 0101314), ADJ2387995 (GOL 0101316), ADJ460036 (GOL 0101315)
Regular
Jul 26, 2012

JORGE VIVANCO vs. NEVERLAND VALLEY RANCH, ESTATE OF MICHAEL JACKSON, MJJ PRODUCTIONS, TRAVELERS INDEMNITY, UNITED STAFFING ASSOCIATES, AMERICAN HOME ASSURANCE COMPANY, MONARCH CONSULTING dba PES PAYROLL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed the original findings regarding employment for both United Staffing Associates and Monarch Consulting. The Board found that United Staffing Associates was never the applicant's employer, rescinding findings that they were the employer on October 8, 2007, and for a cumulative trauma period. Regarding Monarch Consulting, the Board found they were not the employer on October 2, 2006, but were the general employer from March 2006 through August 30, 2007, with specific exclusions, reversing the prior ruling on the specific injury date. The case was returned for further proceedings consistent with these revised findings.

Workers Compensation Appeals BoardJorge VivancoNeverland Valley RanchEstate of Michael JacksonMJJ ProductionsTravelers IndemnityUnited Staffing AssociatesAmerican Home Assurance CompanyMonarch ConsultingPES Payroll
References
Case No. ADJ1682557
Regular
Jun 30, 2018

PAUL MORAD vs. 2365 OAK RIDGE WAY; ONE BEACON

The Workers' Compensation Appeals Board denied a Petition for Removal because the petitioner failed to demonstrate substantial prejudice or irreparable harm from the WCJ's decision to take the case off calendar. The WCJ correctly removed the case from the trial calendar due to incomplete discovery, specifically the lack of a permanent and stationary report for orthopedic injuries and pending dental/eye consultations. The Appeals Board adopted the WCJ's reasoning, finding that reconsideration would be an adequate remedy if adverse to the petitioner later. Therefore, removal, an extraordinary remedy, was not granted.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ Reportsubstantial prejudiceirreparable harmadequate remedyreconsiderationLabor Code §5502(d)(3)Mandatory Settlement Conferencediscovery
References
Case No. ADJ655912 (SDO 0342137) ADJ677760 (SDO 0342143)
Regular
Feb 11, 2009

MARIA E. GARCIA vs. SAN DIEGO UNIFIED PORT DISTRICT, AMERICAN HOME ASSURANCE COMPANY, AIG DOMESTIC CLAIMS

The Workers' Compensation Appeals Board denied both the applicant's and defendant's petitions for reconsideration. The Board upheld the trial judge's decision to deny massage therapy, finding it not medically necessary per ACOEM guidelines and not supported by the treating physician's reports. Conversely, the Board affirmed the need for a sleep study and orthopedic/psychiatric consults based on the primary treating physician's consistent recommendations, rejecting the defendant's challenges to the exclusion of PQME reports and admission of other evidence. Ultimately, the Board found substantial medical evidence supported the original award and denied both parties' requests for review.

Workers' Compensation Appeals BoardIndustrial InjuryRight ShoulderNeckFurther Medical TreatmentSleep StudyOrthopedic ConsultPsychiatric ConsultMassage TherapyPanel Qualified Medical Examiner
References
Case No. ADJ9683216
Regular
Sep 30, 2016

DUNIA DE LA CRUZ vs. SOOD ENTERPRISES, INC. dba JACK IN THE BOX, SECURITY NATIONAL INSURANCE COMPANY ADMINISTERED BY AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) denied defendant's petition for reconsideration and dismissed its petition for removal. The WCAB found that an additional Qualified Medical Examiner (QME) panel in rheumatology was appropriate to further develop the medical record on causation, as recommended by the initial orthopedic QME. Defendant argued the WCJ erred by ordering this without first determining applicant's credibility and AOE/COE, but the Board deemed the need for a rheumatological evaluation a critical issue justifying reconsideration. Therefore, the WCAB upheld the WCJ's order for an additional QME panel.

QME panelrheumatologyAOE/COEcredibilitymedical causationdepositionsupplemental evaluationgood causethreshold issuesreconsideration
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ3773479 (SAL 0119774)
Regular
Mar 12, 2013

MARTHA MONROY vs. BLACKSTONE CONSULTING, INC., STATE COMPENSATION INSURANCE FUND

This case involves a petition for reconsideration and removal filed by Martha Monroy against Blackstone Consulting, Inc. and State Compensation Insurance Fund. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration, citing that it was not filed from a final order as required by Labor Code sections 5900(a), 5902, and 5903. The WCAB also denied the petition for removal, adopting the WCJ's report, as Monroy failed to demonstrate substantial prejudice or irreparable harm. Therefore, the petition was dismissed and removal denied.

Petition for ReconsiderationFinal OrderSubstantive RightInterlocutory DecisionRemovalWCJ ReportIrreparable HarmInadequate RemedyLabor CodeCal. Code Regs.
References
Case No. ADJ10884813
Regular
Feb 18, 2025

ALICIA RODRIGUEZ vs. DYNAMIC EDGE CONSULTING, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Alicia Rodriguez, applicant, suffered a brain injury during employment with Dynamic Edge Consulting, insured by Travelers Property Casualty Company of America. The initial WCJ decision found the defendant liable for 24-hour home health care due to a failure in timely utilization review of Dr. Roger Bertoldi's prescription, which incorporated Sue Coleman's evaluation. Defendant petitioned for reconsideration, arguing the prescription was non-compliant and their duty was investigative, not to submit to UR. The Appeals Board granted the petition, deferring a final decision for further review and encouraging mediation.

Workers Compensation Appeals BoardDynamic Edge ConsultingTravelers Property Casualty Company of AmericaPetition for ReconsiderationFindings and AwardAOE/COEBrain Injury24-Hour Home Health CareUtilization ReviewDr. Roger Bertoldi
References
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