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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. ADJ8668832
Regular

BACILIO ANGEL SALAZAR vs. SAN DIEGO PERSONNEL AND EMPLOYMENT AGENCY, INC., AMTRUST NORTH AMERICA for CASTLEPOINT NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding a prior order that deemed a QME report timely. The Board found Dr. Tahami's psychiatric evaluation report was untimely served on the defendant. As the defendant objected prior to receiving the report, they are entitled to a replacement QME panel in psychiatry.

Petition for RemovalQualified Medical EvaluatorQME paneluntimely reportreplacement QMEAdministrative Director RuleLabor Codepsychiatric injurymedical-legal evaluationsubstantial prejudice
References
Case No. ADJ7242422
Regular
Sep 24, 2013

TRACIE WHITE vs. COUNTY OF SACRAMENTO, DEPARTMENT OF FINANCE

The Workers' Compensation Appeals Board denied the County of Sacramento's Petition for Removal. The County sought to replace a Qualified Medical Evaluator (QME) due to an allegedly untimely supplemental report. The Board affirmed the administrative law judge's denial, interpreting Administrative Director Rule 38(h) to grant QMEs sixty days for supplemental reports. The Board also noted the County objected to the report before receiving it.

Petition for RemovalQualified Medical EvaluatorQME panelsupplemental reportuntimely reportAdministrative Director Rule 38Report and RecommendationFajardo v. Workers' Comp. Appeals Bd.WCJoff calendar
References
Case No. ADJ9292791
Regular
Sep 29, 2015

HIEP LE NGOC NGUYEN vs. OAKS CLUB ROOM, NATIONAL CASUALTY COMPANY, NATIONWIDE AGRIBUSINESS INSURANCE COMPANY

This case concerns applicant's petition for removal after the WCJ denied their request for a new Qualified Medical Examiner (QME) panel. The denial was based on the original QME's failure to issue a timely supplemental report despite two requests. Although the QME claimed non-receipt of the requests, the supplemental report has now been provided. The Appeals Board denied removal, finding that issuing a new panel would only cause further delay given the report is now available.

Petition for RemovalQualified Medical ExaminerSupplemental ReportRule 38(i)Administrative Law JudgeWCJ ReportPrejudiceIrreparable HarmUntimely ReportPanel Qualified Medical Examiner
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. ADJ8109233
Regular
Oct 07, 2013

JOSE CARMONA HERNANDEZ vs. DAVID CARLUCCI, SECURITY NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, reversing the WCJ's order for a new Agreed Medical Evaluator (AME) or Qualified Medical Evaluator (QME). The Board found Dr. Allems' supplemental report was not untimely because the applicant did not properly pursue administrative remedies for an untimely report. Furthermore, the Board determined the ex parte communication was insufficient to warrant a new evaluation, as the applicant failed to provide evidence of its nature and the aggrieved party did not elect to terminate the evaluation. Consequently, the applicant is not entitled to a new AME or QME.

Petition for RemovalAgreed Medical EvaluatorQualified Medical Evaluatoruntimely reportex parte communicationLabor Code section 4062.5Administrative Director Rule 31.5Medical Directorsupplemental reportreplacement QME panel
References
Case No. ADJ1644999 (LAO0880435)
Regular
Dec 11, 2012

, MANUEL FERNIZA, vs. , RENT A CENTER, INC.; FIREMAN'S FUND INSURANCE COMPANY/ASSOCIATED INDEMNITY,

The Workers' Compensation Appeals Board (WCAB) vacated its prior order granting reconsideration and dismissed the applicant's petition. The WCAB determined that the applicant's petition sought reconsideration of an interim procedural order, not a final decision, which is not appealable. Even if the merits were considered, the WCAB would have affirmed the judge's decision, finding the QME report timely and deferring a decision on treatment authorization until a PQME urological report was issued.

Workers' Compensation Appeals BoardReconsiderationFinal OrderInterim OrdersPanel Qualified Medical ExaminerMedical Provider NetworkUrological ConditionIndustrial InjuryAdministrative DirectorWCJ Report
References
Case No. ADJ9163491; ADJ9163494
Regular
Jan 09, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN & COUNTRY

This case concerns an applicant's petition for removal after the WCJ denied his objection to a QME's report. The applicant argued the QME report was untimely and prejudicial because it issued a zero impairment rating. The Appeals Board denied removal, finding the applicant waived his objection by not requesting a replacement QME panel until after receiving the unfavorable report. The Board cited precedent preventing parties from waiting to see if a report is favorable before objecting to its timeliness. Commissioner Zalewski dissented, believing the applicant could object after receipt as long as the objection preceded the replacement panel request.

Petition for RemovalQualified Medical EvaluatorQME reportuntimely filingservice of reportreplacement panelobjectionstatutory timeframesLabor CodeAdministrative Director Rule
References
Case No. ADJ815944
Regular
Jan 14, 2010

LINDALAIVAREZ vs. BLUE DIAMOND GROWERS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied a Petition for Removal, upholding the WCJ's decision to deny a new QME panel. The applicant's attempt to obtain a new panel was deemed impermissible "doctor-shopping" by delaying objection to a late supplemental QME report until after receiving and reviewing it, and finding it favorable. The Board applied the principle that parties cannot exploit delays in medical reports for strategic advantage. Therefore, removal was denied as the conduct did not justify a new panel appointment.

Petition for RemovalQME panelmedical-legal reportdoctor-shoppinguntimely reportsupplemental reportobjectionwrit deniedAppeals Board panel decisionadministrative law judge
References
Case No. ADJ6535347, ADJ6534384
Regular
Nov 02, 2015

CHRISTINE KNAPP vs. COUNTY OF FRESNO

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The applicant sought to overturn findings of $53\%$ permanent disability and disputed the exclusion of vocational expert reports and a claim of $100\%$ disability. The Board found the petition contained numerous factual misrepresentations and violations of WCAB rules and professional conduct by the applicant's attorney. The Board adopted the WCJ's report, which recommended denial due to the petition's legal defects and factual inaccuracies.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardOccupational Group NumberIndustrial InjuryRight ShoulderMigraine HeadachesPermanent DisabilityAgreed Medical ExaminerQualified Medical Examiner
References
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