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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. 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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
Case No. ADJ7948651
Regular
May 09, 2016

Barbara Tom vs. CITY OF OAKLAND, JT2 INTEGRATED

This case involves a petition for reconsideration by the defendant, City of Oakland, following an award of permanent disability to applicant Barbara Tom. The defendant argued the Workers' Compensation Judge (WCJ) erred by not deferring to the Agreed Medical Evaluator's (AME) opinion and by not developing the record with the AME. The WCAB denied reconsideration, adopting the WCJ's report which found the AME's opinion deficient. The WCJ's report detailed how the primary treating physician's report was more persuasive and thoroughly reasoned, supporting the WCJ's findings over the AME's.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Primary Treating Physician (PTP)AMA GuidesPermanent Disability RatingCarpal Tunnel SyndromeSubstantial EvidenceWCJ OpinionMedical Opinion Deference
References
Case No. ADJ3699477 (OAK 0345390)
Regular
Jul 05, 2011

GARY TOMEI vs. BAY ALARM COMPANY, TRAVELERS PROPERTY AND CASUALTY INSURANCE COMPANY

This case involves an applicant seeking authorization for cervical surgery, which was denied based on the treating physician's request not being properly formatted per AD Rule 9792.6(o). The Appeals Board granted reconsideration, finding the initial denial was due to the applicant's attorney adding a notation to the physician's report instead of the physician clearly marking it as a spinal surgery authorization request. The Board rescinded the original award, deferring the cervical surgery issue and ordering an expedited second opinion from a designated orthopedic surgeon or neurosurgeon.

Workers' Compensation Appeals BoardGary TomeiBay Alarm CompanyTravelers Property and Casualty Insurance CompanyADJ3699477Opinion and Order Granting Reconsiderationcervical surgerylumbar spineAdministrative Director Rule 9792.6(o)treating physician
References
Case No. ADJ9667092
Regular
Jan 12, 2016

Virginia Fernandez vs. KMART, ACE AMERICAN INSURANCE COMPANY

Applicant Virginia Fernandez injured her knee and wrist, but her MPN physician's report was contradictory and failed to address all complaints, leading to a dispute. The defendant denied her request for a second opinion within the MPN, insisting she use the panel QME process. The Appeals Board found the applicant was entitled to a second opinion within the MPN to resolve the dispute over her treatment. However, the Board reversed the lower judge's order, ruling the defendant's refusal did not constitute a denial of medical treatment allowing her to seek care outside the MPN.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNSecond Opinion PhysicianQualified Medical EvaluatorQMEDenial of Medical TreatmentLabor Code section 4616.3Labor Code section 4616.4Independent Medical Review
References
Case No. ADJ3918602 (SAC 0330507) ADJ272371 (SAC 0354775)
Regular
Apr 05, 2010

THOMAS MELTON vs. COUNTY OF SACRAMENTO, SHERIFF'S DEPARTMENT

In this workers' compensation case, the defendant sought reconsideration of an award for spinal surgery recommended by the applicant's treating physician, Dr. Montesano. The defendant argued the administrative law judge should have favored the opinion of Dr. Reynolds, an agreed medical examiner. The Appeals Board denied reconsideration, finding Dr. Montesano's opinion constituted substantial evidence supporting the award. The Board affirmed the judge's discretion to choose among conflicting medical reports.

Workers' Compensation Appeals BoardJoint Findings and AwardPermissibly Self-InsuredDeputy SheriffIndustrial InjuryLow BackSpinal SurgeryTreating PhysicianAgreed Medical ExaminerSecond Opinion Physician
References
Case No. ADJ7507504; ADJ7507542
Regular
Jun 13, 2012

MARIA CARRILLO vs. HELP N TIME BBSI, CORVEL

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing treatment outside the Medical Provider Network (MPN). The Board found that the defendant's MPN physician failed to provide reports, justifying the applicant's treatment elsewhere under Labor Code sections 4605 and 5402(c). The Board also noted that statutory provisions for second opinions or independent medical review were inapplicable as the applicant wasn't disputing diagnosis or treatment, but rather the MPN physician's inaction. The defendant's argument regarding treatment for unpled body parts was dismissed as pleadings could be conformed to proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical Provider Network (MPN)Independent Medical ReviewLabor Code Section 4616.6Labor Code Section 4605Labor Code Section 5402(c)Treating PhysicianSecond OpinionThird Opinion
References
Case No. ADJ7908543
Regular
Nov 13, 2012

JOSE RIVAS vs. CALIFORNIA CARPET, LLC, ICW GROUP

In Rivas v. California Carpet, LLC, the Appeals Board granted the defendant's Petition for Removal, rescinding a prior award of spinal surgery. The WCJ had improperly excluded the second opinion physician's report as untimely. The Board found the applicant waived his objection to the report's untimeliness by not raising it until after the examination. The case was returned to the trial level for reconsideration of the surgery's necessity, including the second opinion report.

Petition for RemovalFindings and AwardSpinal SurgeryPrimary Treating PhysicianSecond Opinion PhysicianLabor Code Section 4062(b)Timeliness ObjectionWaiverExpedited HearingMedical Unit
References
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