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Case Law Database

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7946888; ADJ7987800
Regular
Jul 12, 2012

PAULA LECOCQ vs. ASSOCIATED FEED & SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

The Appeals Board granted the employer's Petition for Removal, rescinding the prior order compelling a specific QME specialty selection. The Board found the Administrative Law Judge improperly decided the QME specialty dispute at a Mandatory Settlement Conference without party agreement or a proper evidentiary record. The case is returned to the trial level for a formal hearing on the QME specialty issue.

Petition for RemovalQualified Medical Evaluator (QME) panelspecialty designationmandatory settlement conference (MSC)due processevidentiary recordAdministrative DirectorMedical DirectorWorkers' Compensation Appeals Board (WCAB)Finding and Order
References
Case No. ADJ11211443
Regular
Sep 12, 2019

YOLANDA BARROSO vs. HARTNELL COLLEGE, KEENAN \u0026 ASSOCIATES

This case involves a defendant's petition for removal after a Workers' Compensation Appeals Board (WCAB) judge ruled that chiropractic care was an appropriate specialty for the applicant's injuries. The defendant argued that the ruling was premature and prejudicial, seeking a replacement QME panel in a different specialty. However, the WCAB denied the petition, finding the defendant waived its right to challenge the specialty by not raising the issue earlier. The WCAB also determined the defendant failed to demonstrate irreparable harm or significant prejudice.

Workers' Compensation Appeals BoardPetition for RemovalFindings and OrderQualified Medical EvaluatorQME specialtychiropracticcollateral estoppelwaiverres judicatairreparable harm
References
Case No. ADJ752333
Regular
Jul 25, 2011

RICARDO RIVERA vs. COLOR SPOT NURSERIES, INC., CHARITIS, SPECIALTY RISK SERVICES

This case concerns applicant's petition for reconsideration and removal of an administrative law judge's (WCJ) order denying his objection to a replacement orthopedic QME panel. The WCJ allowed the orthopedic panel after finding the defendant had substantially complied with regulations for requesting a specialty change. The Workers' Compensation Appeals Board (WCAB) dismissed the reconsideration petition as the order was interlocutory and denied removal, finding no irreparable harm or prejudice to the applicant. The WCAB upheld the WCJ's decision, deeming the change in specialty appropriate and the defendant's compliance sufficient under the circumstances.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorOrthopedicsChiropracticLabor CodeIndustrial InjuryLeft Knee
References
Case No. ADJ7438047
Regular
Jul 16, 2012

FRANCISCO CORONA-DIAZ vs. MENDOCINO FOREST PRODUCTS COMPANY, XI SPECIALTY INSURANCE COMPANY, INTERCARGO INSURANCE COMPANY, SPECIALTY RISK SERVICES

This case involves a workers' compensation claim where the applicant, Francisco Corona-Diaz, filed a Petition for Reconsideration. The Workers' Compensation Appeals Board dismissed the petition because it was filed untimely. The original Findings and Orders were issued on April 30, 2012, and the petition was not filed within the statutory 20-day period, plus an additional 5 days for mailing. Therefore, the petition was procedurally deficient and dismissed.

Petition for ReconsiderationUntimelyDismissedAdministrative Law JudgeReport and RecommendationFindings and OrdersLabor Code Section 5903Code of Civil Procedure Section 1013Workers' Compensation Appeals BoardMendocino Forest Products Company
References
Case No. ADJ642902 (OXN 0128105)
Regular
Mar 22, 2011

FAWN BUBAN vs. ANDRIA'S SEAFOOD SPECIALTIES, CIGA, SEDGWICK CMS for ALISTAR, EVEREST NATIONAL INSURANCE CO., AMERICAN CLAIMS MGT, COMBINED SPECIALTY INS. CO., VIRGINIA SURETY, XCHANGING, INC.

The Workers' Compensation Appeals Board (WCAB) denied Fawn Buban's Petition for Reconsideration in a consolidated case involving multiple insurance carriers. The Order indicates the Board found no grounds to disturb its prior decision. This denial means the applicant's request for a review and potential reversal of the Board's findings was unsuccessful. The case was served on several law firms, suggesting significant legal representation for all parties involved.

ADJ642902ADJ2864783ADJ257673ADJ1072160ADJ871252FAWN BUBANANDRIA'S SEAFOOD SPECIALTIESCIGAALISTAREVEREST NATIONAL INSURANCE CO.
References
Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
Case No. ADJ9368263, ADJ9380293
Regular
Sep 15, 2015

JOSE MELCHOR vs. BRUTOCAO VINEYARDS, STAR INSURANCE COMPANY

This case involves a defendant's petition for removal regarding an order for a second Qualified Medical Examiner (QME) panel concerning the applicant's head injury. The Workers' Compensation Appeals Board (WCAB) granted removal to correct a clerical error in the original order. The WCAB affirmed the necessity of a second QME to further develop the medical record on the head injury claim, specifically in the specialty of Psychology-Clinical Neuro Psychology.

Petition for RemovalSecond QME PanelHead InjuryMedical Record DevelopmentWCJ Duty to Develop RecordPQME SpecialtyPSNPsychology-Clinical Neuro PsychologyMandatory Settlement ConferenceLack of Diligence
References
Case No. ADJ11426145
Regular
Aug 16, 2019

MARIA RESENDIZ vs. TAMBRO, INC., INSURANCE CO. OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, reversing a WCJ's finding and ruling that a chiropractic QME panel, not an orthopedic one, is appropriate for this claim. The Board found the Medical Director's basis for invalidating the chiropractic panel was insufficient, as QMEs cannot provide treatment or opine on disputed treatment issues. The case now requires the parties to utilize the chiropractic QME panel for evaluation. This decision aligns with persuasive reasoning from a prior panel decision regarding specialty disputes.

QME panelchiropractic specialtyorthopedic surgeryspecialty disputeMedical Directorutilization reviewpermanent and stationary statusscope of practicescope of evaluationAD Rule 31.1(b)
References
Case No. ADJ9796670
Regular
Aug 05, 2016

Virginia Lopez vs. California Pizza Kitchen, Travelers Insurance

Applicant Virginia Lopez sought removal after an administrative law judge (WCJ) invalidated a chiropractic QME panel, ordering an orthopedic replacement. The Workers' Compensation Appeals Board (WCAB) granted removal, finding the original chiropractic panel was properly issued and defendants waived their right to object by failing to follow proper procedures. The WCAB amended the WCJ's decision to affirm the chiropractic panel, deeming removal necessary to prevent substantial prejudice. The WCAB affirmed the WCJ's order to issue a replacement panel in the "specialty previously issued," which was chiropractic.

Petition for RemovalQualified Medical Evaluator (QME)Specialty DesignationCompensability ExamLabor Code § 4060Rule 30(b)Rule 31.1(b)Written ObjectionMedical Director ReviewWaiver of Objection
References
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