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

Case No. ADJ18027061
Regular
Sep 10, 2025

HEATHER TILLER KELLEY vs. SACRAMENTO CITY UNIFIED SCHOOL DISTRICT

Defendant Sacramento City Unified School District sought reconsideration of a WCAB decision that found applicant Heather Tiller Kelley sustained industrial injuries and that reports from her treating physicians (Mark Zuber, D.C., Adrienne Pasek, Psy.D., and Kasra Maasumi, M.D.) were admissible. Defendant argued these physicians lacked a proper treatment relationship and that the reports were improperly obtained. The Workers' Compensation Appeals Board denied the petition for reconsideration, affirming that defendant relinquished medical control by denying liability, allowing applicant to self-procure treatment, and thus the treating physician reports were admissible in proceedings.

WCABPetition for ReconsiderationOpinion and Order Granting PetitionAdmissible EvidenceTreating PhysiciansMedical-Legal ReportsLabor Code Section 4062.2Self-Procured TreatmentRemoval StandardPermanent and Stationary Status
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. ADJ3543065 (AHM 0145064)
Regular
Jan 18, 2011

RAMON MARTINEZ vs. JUICE HARVEST CORP., PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the disallowance of Dr. Vazquez's lien. The Board agreed with the administrative law judge that there was insufficient evidence Dr. Vazquez provided medically necessary treatment to the applicant. Furthermore, as a secondary treating physician, Dr. Vazquez lacked the authority to provide treatment beyond the initial course recommended by the primary treating physician, Dr. Aun. The Board found that treatment provided outside Dr. Aun's authorization was not compensable.

Workers Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and OrderCompromise and ReleaseMachine OperatorIndustrial InjuryRight ShoulderRight ElbowRight Hand
References
Case No. ADJ10274750
Regular
Feb 09, 2017

LILLIAN MONTEIRO JOHNSON vs. ENERGY SALVAGE, INC., INSURANCE COMPANY OF THE WEST

This case involves Lillian Johnson's appeal of a WCJ's decision denying her right shoulder injury claim. Johnson argued the QME's opinion lacked substantial evidence and her treating doctors' reports supported a cumulative trauma injury. The Appeals Board granted reconsideration, rescinded the initial findings, and returned the case to the WCJ for further proceedings. This likely includes further development of the medical record.

Petition for ReconsiderationFindings and OrderWorkers' Compensation Appeals BoardQualified Medical EvaluatorTreating doctorsCumulative trauma injuryRight shoulderLabor Code section 5701Regular physicianFurther development of the record
References
Case No. ADJ1555913 (LAO 0880260)
Regular
Nov 09, 2016

Larry Joseph Madrid vs. P&O Cold Logistics, The Travelers Insurance Company

This case concerns the applicant's petition for reconsideration regarding the replacement of a Qualified Medical Evaluator (QME) in neurology. The Workers' Compensation Appeals Board (WCAB) dismissed the petition as a petition for reconsideration and treated it as a petition for removal, which was subsequently denied. The majority found that the order for a new QME panel was not a final decision and that the applicant failed to show substantial prejudice or irreparable harm warranting removal. The dissenting opinion argues that there was insufficient evidence of a disqualifying conflict of interest for the neurologist and that the defendant waived any objection by their delay and "doctor shopping" tactics.

QME paneldisqualifying conflict of interestsecondary treating physicianPetition for RemovalPetition for ReconsiderationAdministrative Director Rule 41.5(d)(4)discovery ordersubstantial prejudiceirreparable harmwaiver
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. VNO 0506664 VNO 0506924
Regular
Nov 06, 2007

MICHAEL SOUTH vs. CITY OF GROVER BEACH, CITY OF ATASCADERO

The Workers' Compensation Appeals Board denied reconsideration of an applicant's petition regarding two industrial injuries: irritable bowel syndrome and bilateral upper extremity injuries. While the Board noted the petition was timely filed, it adopted the WCJ's report which found no permanent disability for the irritable bowel syndrome based on the treating doctor's opinion. The Board also upheld the use of the 2005 Permanent Disability Rating Schedule for the upper extremity injury, as the applicant's medical reports predating January 1, 2005, did not establish permanent and stationary status or permanent disability.

Workers' Compensation Appeals BoardReconsideration DeniedIrritable Bowel SyndromeBilateral Medial EpicondylitisBilateral Cubital Tunnel SyndromePolice OfficerPermissibly Self-InsuredJoint PetitionTimely FiledPermanent Disability Rating Schedule
References
Case No. ADJ6948621 ADJ7946738
Regular
Apr 22, 2013

STEFANO MUSETTI vs. GOLDEN GATE DISPOSAL & RECYCLING dba RECOLOGY, permissibly self-insured, administered by CORVEL CORP.

In this workers' compensation case, the employer sought reconsideration of an award ordering a total knee replacement. The applicant's treating physician recommended the surgery, but the employer argued the award was premature as a panel qualified medical evaluator's report was pending and the treating physician's report lacked proper authorization markings. The Appeals Board denied reconsideration, finding the employer had sufficient time to obtain the PQME report and that the treating physician's report constituted substantial medical evidence supporting the surgery. The Board also noted that the employer failed to initiate utilization review despite being aware of the treatment request.

Workers' Compensation Appeals Boardindustrial injuryright kneegarbage collectortotal knee replacementsupplemental reportpanel qualified medical evaluator (PQME)treating physiciansubstantial medical evidencePetition for Reconsideration
References
Case No. ADJ3207867
Regular
Apr 21, 2011

JACKIE PLASKETT vs. SAFEWAY INC.

The Workers' Compensation Appeals Board denied Safeway Inc.'s petition for reconsideration of an award for applicant Jackie Plaskett. Safeway argued a Utilization Review (UR) doctor's opinion should have overridden the Agreed Medical Examiner (AME) and primary treating physician's recommendations for aquatherapy. The Board found the UR doctor misapplied treatment guidelines and was internally inconsistent, while the AME's opinion, corroborated by the treating physician, constituted substantial evidence for the necessary treatment. The Board also noted an improperly filed reply brief.

Workers' Compensation Appeals BoardSafeway Inc.Petition for ReconsiderationReport of Workers' Compensation Administrative Law JudgeWCAB Rule 10848Utilization ReviewAgreed Medical ExaminerPrimary Treating PhysicianMedical Treatment Utilization ScheduleMTUS
References
Case No. ADJ9317724
Regular
Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal. The applicant sought to overturn a Minute Order compelling an orthopedic QME evaluation, arguing the existing orthopedic panel was improperly obtained and preferred a treating doctor. The Board adopted the WCJ's recommendation, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy not warranted here. The applicant's preference for a treating doctor did not override the WCJ's order for a QME evaluation requested to clarify a prior medical opinion regarding potential knee surgery.

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration
References
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