{ "census_rule": "Total accounting: every sentence of every corpus decision is either quoted in the book or excluded with a stated reason. No sentence is unaccounted for.", "cascade_record": [ { "run": "2026-08-24-round1", "stage": "extractor", "dispute": "all 640 sentences classified; 160 auto-matched, 30 fragment-matched, 450 excluded with reasons", "answer": null, "outcome": "complete" }, { "run": "2026-08-24-round1", "stage": "dispute", "dispute": "challenge vs auto-exclusion of sentence: \"any order for an applicant to attend an evaluation may only issue after providing notice to the parties\" — states an operative notice rule", "answer": "sustained — added to § 16.9, verbatim-verified", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-round1", "stage": "dispute", "dispute": "challenge vs auto-exclusion of Rule 10803 record-membership sentence (\"any other information provided to the WCJ is not part of the record of proceedings and is not admitted as evidence\")", "answer": "sustained — added to § 20.1, verbatim-verified", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-round1", "stage": "dispute", "dispute": "challenge vs auto-exclusion of \"There is no requirement that substantial medical evidence support a stipulation\" — the operative standard of § 19.6", "answer": "sustained — added to § 19.6, verbatim-verified", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-round1", "stage": "independent-dispute-round", "dispute": "five-batch adversarial Disputer/Adjudicator workflow over the 450 exclusions", "answer": "BLOCKED: four consecutive full-fleet API 529 (server overload) failures 8/23-8/24; extraction and dispute ran inline (degraded independence); saved workflow wf_34c4c62e-821 must re-run when API recovers — RESOLVED: independent round completed 2026-08-24 (8 agents, 5 disputes, 5 sustained)", "outcome": "complete" }, { "run": "2026-08-24-round2-independent", "stage": "independent-dispute", "dispute": "Bouzas canon (ids 514+515, tokenizer split): “repeal by implication is disfavored” stated nowhere in book", "answer": "sustained — DiFusco sentence quoting Bouzas added to § 1.2", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-round2-independent", "stage": "independent-dispute", "dispute": "APA scope rule (fn. 8, split at “Gov.”): APA applies to all state agencies except as provided by statute", "answer": "sustained — fn. 8 sentence added to § 1.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-round2-independent", "stage": "independent-dispute", "dispute": "§ 5702 first sentence elided by the book's ellipsis: stipulate-and-file requirement unprinted", "answer": "sustained — § 19.3's § 5702 quote completed to full statutory text", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-round2-independent", "stage": "independent-dispute", "dispute": "“Pursuant to section 5702, the WCJ may seek further information or may set a hearing” — operative standard unprinted", "answer": "sustained — added to § 19.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-round2-independent", "stage": "independent-dispute", "dispute": "Code of Judicial Ethics canons 1–3 quoted verbatim by Gaines, unprinted", "answer": "sustained — three canon quotes added to § 21.10 [seeds ch. 24]", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-perez-tribunal", "stage": "independent-dispute", "dispute": "exclusive procedural/rulemaking authority sentence — general rule, not application", "answer": "sustained — added to § 1.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-perez-tribunal", "stage": "independent-dispute", "dispute": "liberal construction / amendment-to-conform-to-proof sentence (ids 713=748)", "answer": "sustained — added to § 16.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-perez-tribunal", "stage": "independent-dispute", "dispute": "§§ 5307/5708 regulatory authority sentence", "answer": "sustained — added to § 1.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-perez-tribunal", "stage": "independent-dispute", "dispute": "writ-of-review right under §§ 5950 et seq. (ids 656=799)", "answer": "sustained — added to § 21.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-perez-tribunal", "stage": "independent-dispute", "dispute": "interpretive canon: rules construed for merits over pleading technicality", "answer": "sustained — added to § 16.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-perez-tribunal", "stage": "independent-dispute", "dispute": "Rule 10515 categorical prohibition (demurrers, judgment on pleadings, summary judgment)", "answer": "sustained — added to § 16.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-perez-tribunal", "stage": "independent-dispute-round", "dispute": "two-batch Disputer/Adjudicator tribunal over 117 Perez exclusions (4 agents)", "answer": "8 disputes filed, 8 sustained (6 distinct rules; 2 duplicate sentences)", "outcome": "complete" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute", "dispute": "§ 5909(b)(2) service-as-notice rule (Vazquez variant)", "answer": "sustained — added to § 21.2", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute", "dispute": "§ 111 AD-powers text (Dennis)", "answer": "sustained — added to § 1.3", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute", "dispute": "“The first is ex parte communication.”", "answer": "sustained — added to § 9.6", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute", "dispute": "fn. 6: other Labor Code provisions may present good cause", "answer": "sustained — added to § 9.6", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute", "dispute": "fn. 6: § 4628 violation compels exclusion; may support good cause", "answer": "sustained — added to § 9.6", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute", "dispute": "§ 139.2(j)(1) operative text had been elided with a bracket claim", "answer": "sustained — the elision replaced with the FULL statutory text (ids 960-967)", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute", "dispute": "AD Rule 31.5(a) verbatim text", "answer": "sustained — added to § 9.6", "outcome": "dispute-sustained-add-to-book" }, { "run": "2026-08-24-vazquez-tribunal", "stage": "independent-dispute-round", "dispute": "two-batch tribunal over 113 Vazquez exclusions (4 agents)", "answer": "13 disputes filed, 13 sustained — incl. rejection of the extractor's “quoted in full” bracket shortcut: a census book prints the text", "outcome": "complete" } ], "method": "compiled and checked by the RICHARD WEBER cascade (U.S. Pat. App. No. 19/782,460, patent pending): an extraction stage, an adversarial dispute stage that must quote its challenge verbatim, and an adjudication stage that must answer every dispute; the ledger below is the record", "summary": { "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc": { "sentences": 239, "quoted": 81, "excluded": 158, "exclusion_reasons": { "caption/administrative": 4, "procedural posture": 17, "preamble to boxed holdings": 2, "facts and party filings": 51, "party correspondence": 14, "issues framed below": 5, "decision below (rescinded)": 7, "footnote housekeeping": 1, "statement of intent, not rule": 1, "citation string or sentence fragment": 8, "description of prior precedent's facts": 9, "application to these parties": 11, "restatement; rule printed at § 1.2": 1, "restatement; Coldiron I holding printed at § 16.2": 1, "application to these facts": 3, "transition": 2, "citation string": 1, "rationale; rules printed at § 16.2": 1, "restatement; Holding No. 3 printed at § 16.2": 1, "rationale": 6, "rationale (rulemaking intent)": 1, "civil-context observation; CCP quotes printed at §§ 17.1, 22.1": 1, "disposition": 3, "disposition; sanctions rule printed at § 16.2": 1, "application; Coldiron duties printed at § 16.2": 1, "disposition, orders, and service": 1, "signature block": 4 } }, "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc": { "sentences": 401, "quoted": 114, "excluded": 287, "exclusion_reasons": { "caption/administrative": 2, "procedural posture": 12, "facts of the twenty-four consolidated cases": 168, "citation string or sentence fragment": 18, "application (consolidation of these cases)": 1, "application to these cases": 14, "substance printed at §§ 19.2–19.3": 1, "transition": 4, "application": 10, "substance printed at §§ 19.3–19.4": 1, "application; dismissal rule printed at § 19.3": 1, "context antecedent; rule printed at § 14.9": 1, "restatement; Holding No. 1 printed at § 19.1": 1, "application; rule printed at § 26.6": 1, "application; synthesis printed at § 19.3": 1, "substance printed at § 19.3": 1, "application (disqualification of this WCJ)": 3, "the WCJ's statements below": 1, "preamble to boxed holdings": 1, "disposition": 2, "disposition, orders, and service": 39, "signature block": 3, "certification": 1 } }, "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc": { "sentences": 184, "quoted": 75, "excluded": 109, "exclusion_reasons": { "caption/administrative": 7, "procedural posture": 12, "facts, the Report below, and party contentions": 41, "application to these parties": 5, "citation string or sentence fragment": 27, "disposition, orders, and service": 10, "signature/certification": 7 } }, "vazquez-v-renteria-2025-adj11017003-wcab-en-banc": { "sentences": 209, "quoted": 109, "excluded": 100, "exclusion_reasons": { "caption/administrative": 4, "procedural posture": 17, "facts": 20, "application to these parties": 30, "citation string or sentence fragment": 24, "disposition, orders, and service": 2, "signature/certification": 3 } } }, "ledger": [ { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 1, "src_page": 1, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD STATE OF CALIFORNIA JILLIAN DIFUSCO, Applicant vs." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 2, "src_page": 1, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "HANDS ON SPA; EMPLOYERS COMPENSATION INSURANCE GROUP as administered by EMPLOYERS INSURANCE GROUP, Defendants Adjudication Number: ADJ7445107 Van Nuys District Office OPINION AND DECISION AFTER RECONSIDERATION (En Banc) We previously granted reconsideration in order to further study the factual and legal issues in this case." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 3, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "This is our Opinion and Decision After Reconsideration (En Banc).1 To secure uniformity of decisions in the future, the Chair of the Appeals Board, upon a unanimous vote of its members, assigned this case to the Appeals Board as a whole for an en banc decision.2 (Lab." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 4, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code, § 115.) Applicant seeks reconsideration of the Findings of Fact and Order (F&O) issued by a workers’ compensation administrative law judge (WCJ) on April 19, 2022, wherein the WCJ found in pertinent part that in response to applicant’s discovery request, defendant was only required to comply with WCAB Rule 10390 (Cal." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 5, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, § 10390) and disclose the name of the employer’s workers’ compensation insurance carrier." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 6, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Applicant contends that the WCJ’s conclusion that WCAB Rule 10390 only requires that a defendant disclose the name of its insurance carrier was too narrow, and that the en banc 1 Commissioner Sweeney, who was on the panel that issued the order granting reconsideration, is no longer a member of the Appeals Board." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 7, "src_page": 1, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "Another panel member has been assigned in her place. 2 En banc decisions of the Appeals Board are binding precedent on all Appeals Board panels and workers’ compensation administrative judges." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 8, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, § 10325; City of Long Beach v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 9, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(Garcia) (2005) 126 Cal.App.4th 298, 316, fn. 5 [70 Cal.Comp.Cases 109]; Gee v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 10, "src_page": 1, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "(2002) 96 Cal.App.4th 1418, 1424, fn. 6 [67 Cal.Comp.Cases 236].) This en banc decision is also adopted as a precedent decision pursuant to Government Code section 11425.60(b)." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 11, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "2 decisions by the Appeals Board in Coldiron I and II3 require additional disclosures, including disclosure of a high self-insured retention, a large deductible, or any other provision that affects the identity of the entity liable for compensation." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 12, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We received an Answer from defendant." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 13, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "The WCJ filed a Report and Recommendation on Petition for Reconsideration (Report) recommending that we deny reconsideration." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 14, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We have considered the allegations of the Petition for Reconsideration and the Answer and the contents of the WCJ’s Report." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 15, "src_page": 2, "status": "excluded", "reason": "preamble to boxed holdings", "matched_section": null, "text": "Based on our review of the record, and for the reasons discussed below, we hold en banc that: 1." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 16, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "All en banc decisions are binding on panels of the Appeals Board and WCJs, and the binding en banc decisions in Coldiron I and Coldiron II require disclosure of any entities liable for payment and any insurance policies that impact liability for payment. 2." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 17, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Only the Appeals Board is statutorily authorized to issue regulations for adjudication for workers’ compensation proceedings, and WCAB Rules 10390, 10400 and 10401 require that parties, their representatives, and their insurance companies be fully identified. 3." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 18, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "WCAB Rule 10390 does not supersede the Coldiron decisions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 19, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Defendants must comply with WCAB Rule 10390 and the disclosure requirements in Coldiron I and II, regardless of whether there is a third-party administrator." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 20, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "As our Decision After Reconsideration, we will rescind the WCJ’s April 19, 2022 F&O and we will return this matter to the trial level for further proceedings consistent with this decision." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 21, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "FACTS Applicant filed an Application for Adjudication of Claim on September 17, 2010, claiming injury to various body parts on July 21, 2008, while she was employed by defendant as a massage therapist." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 22, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "On December 7, 2012, a WCJ awarded applicant home health care services of four hours, twice per week." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 23, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Defendant was ordered to employ a nurse case manager to manage home health care services." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 24, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "On July 31, 2017, a WCJ issued a Findings, Orders and Award, in which the WCJ found that applicant sustained injury arising out of and in the course of employment to various body 3 Coldiron v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 25, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Compuware Corp (2002) 67 Cal.Comp.Cases 289 (Appeals Board en banc) [Coldiron I]; Coldiron v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 26, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(2002) 67 Cal.Comp.Cases 1466 (Appeals Board en banc) [Coldiron II]." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 27, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "3 parts; that the injury caused temporary total disability and temporary partial disability for various time periods between 2008 and 2012; that the injury caused permanent partial disability for additional time periods between 2009 and 2014; that the injury caused permanent total disability commencing on September 22, 2013; and that there is need for further medical treatment." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 28, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "On September 21, 2018, applicant filed a Declaration of Readiness to Proceed (DOR) alleging that the home health care services that applicant had received since 2013 had been discontinued and requesting that the matter be set for expedited hearing to reinstate these services." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 29, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "On November 5, 2018, the parties appeared for an expedited hearing." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 30, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "They entered into a Stipulation, approved by a WCJ, that applicant would be medically evaluated by agreed medical evaluator (AME) Alexander Angerman, M.D., to determine the appropriate level of home health care services required and to issue a medical report, and that defendant would arrange for home health care services for applicant of at least eight hours per week while the assessment process was pending." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 31, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "On June 20, 2019, applicant filed a DOR seeking an expedited hearing and alleging that: Parties appeared at expedited hearing on 11/05/2018 regarding home health care." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 32, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Parties stipulated to AME Angerman for the sole purpose of evaluating applicant for determination of hours of home care." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 33, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "AME evaluated applicant and issued reports for 10 hours of home care per day seven days per week." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 34, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "AA wrote to defense asking for implementation of home care per Stip & Order and AME reports AA seeks to enforce Stip & Order entered into at prior hearing." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 35, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(All capitals in original.) On July 24, 2019, the parties appeared for an expedited hearing." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 36, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "The parties entered into another Stipulation, approved by the WCJ, that further records would be provided to Dr." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 37, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Angerman would be deposed, and that pending the deposition, defendant would provide applicant with four hours per day, seven days per week, of home health care services." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 38, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "The WCJ also ordered that Dr." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 39, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Angerman provide a “mutually convenient date” for the deposition prior to October 28, 2019." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 40, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "On February 11, 2020, the parties appeared for a continued mandatory settlement conference (MSC)." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 41, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "The parties entered into a Stipulation, approved by the WCJ, that defendant would provide 50 hours per week of home health care services, for three years, absent any change in circumstances." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 42, "src_page": 3, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "On December 18, 2020, applicant filed a DOR requesting an expedited hearing and alleging that:" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 43, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "4 Applicant is 100% PD due to failed back syndrome after 3 failed surgeries." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 44, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "On Feb 11, 2020, an Order and Stipulation issued compelling defendants to provide 50 hours of home healthcare per week, pursuant to the findings of AME Angerman." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 45, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Homehealth care agency has not been paid and will stop care if payment is not made." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 46, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Request to correct sent to insurance carrier but no indication of compliance with order." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 47, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "WCAB assistance requested." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 48, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(All capitals in original.) On February 17, 2021, the parties appeared for an expedited hearing." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 49, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "They entered into another Stipulation, approved by a WCJ, that required defendant to pay the outstanding invoices from the home health care services agency." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 50, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "With respect to defendant, the typed caption states “Hands On Spa; Insured by Employers Compensation Insurance Company; Administered by Employers Insurance Group.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 51, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "That same day, in an email to defendant’s attorney, applicant’s attorney requested that defendant’s attorney provide the following information, pursuant to former WCAB Rule 10550 (Cal." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 52, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Code Regs., tit. 8, § 10550, now repealed) and the Coldiron cases: 1." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 53, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Please identify the limits of the underlying coverage by your client, Employers; 2." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 54, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Please identify any primary or secondary excess carriers on this claim, and the limits of each carrier or company’s policy; 3." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 55, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Please identify any other actual or potential payor on this claim, and any stake holder with actual or potential financial responsibility for this claim; and 4." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 56, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Please identify the contact information for each excess carrier or other such stake holder." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 57, "src_page": 4, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(Applicant’s Exh. 1.) On February 18, 2021, in an email to defendant’s attorney, applicant’s attorney again requested that defendant’s attorney provide the information." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 58, "src_page": 4, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "(Applicant’s Exh. 2.) On February 26, 2021, defendant’s attorney responded by way of a letter to applicant’s attorney and stated that: I would like to also respond to your request for information with respect to the limits of the underlying coverage by employers, primary and secondary excess carrier on this claim, and the limits of each carrier or company’s policy, other actual or potential payor on this claim, and any stake holder with actual or potential financial responsibility for this claim, and contact information for each excess carrier or other such stake holder." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 59, "src_page": 4, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "Your request for the above information appears to be applicable to personal injury cases where the policy limits and identification of the responsible parties are necessary for ascertaining the payor in the case." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 60, "src_page": 4, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "While in workers compensation, the Code requires identification of the payor of the benefits, there is no legal authority requiring disclosure of the policy limit, the primary and the secondary" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 61, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "5 excess carrier on the claim, the limits of each carrier’s policy, or any stake holder with actual or potential financial responsibility for this claim." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 62, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "Compuware Corp. held that where an employer’s liability for workers’ compensation benefits is adjusted by a third-party administrator, the administrator must disclose to WCAB, other parties in any proceeding and its own counsel, the identity of its client, whether self-insured employer or insurance carrier." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 63, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "Coldiron was codified in CCR §10550 which was amended and replaced by CCR §10390 effective January 1, 2020." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 64, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "The language in the new reg also changed." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 65, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "CCR §10390 requires a party to “identify the insurer and/or employer as the party or parties and not identify a third party administrator as a party." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 66, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "The third party administrator shall be included on the official address record and case caption if identified as such.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 67, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "The facts in Coldiron are not similar to the facts of our case." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 68, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "The issue in Coldiron was the correct payor of benefits per the Findings and Award and Decision." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 69, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "Here, applicant was aware of the carrier in the case which was reflected in the Findings and Award and Decision." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 70, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "Further, there was no issue with payment of workers compensation benefits owed to the applicant." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 71, "src_page": 5, "status": "excluded", "reason": "party correspondence", "matched_section": null, "text": "As such, your demand has no legal basis." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 72, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "X.) On May 11, 2021, applicant submitted a letter to the WCJ with an attached DOR." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 73, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Applicant explained that the DOR could not be filed due to a request for a lien conference in the same case." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 74, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "In the DOR, applicant requested an MSC on the issue of defendant’s insurance policy, and alleged that: Applicant’s counsel has made multiple attempts to obtain information on the insurance policy behind this workers’ compensation claim and identity of actual insurer(s)." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 75, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Defendant is legally obligated to disclose under Coldiron v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 76, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Compuware Corp. et al (2002) (WCAB en banc) 67 CCC 1466." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 77, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Defense has repeatedly promised to provide this information, only to remain unresponsive after multiple calls and emails." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 78, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "WCAB intervention is requested." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 79, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Sanctions are requested for employers insurance and its counsel refusing to provide information that the WCAB specifically mandates, thereby, causing applicant’s counsel to expend hours in written correspondence and phone calls and now a hearing, to obtain it." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 80, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(All capitals in original.) On March 24, 2022, the matter proceeded to trial." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 81, "src_page": 5, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "The issues for hearing were listed as follows: 1) Has defendant by disclosing that the insurance carrier is Employers Compensation Insurance Group materially complied with the Coldiron case codified in Regulation 10550 and/or subsequent Regulation 10390." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 82, "src_page": 6, "status": "excluded", "reason": "issues framed below", "matched_section": null, "text": "6 2) Whether defendant to properly comply with Coldiron and Regulation 10390 must disclose the following information: (a) Whether the insurance policy includes a high self-insured retention, a large deductible, or any other provision that affects the identity of the entity actually liable for compensation." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 83, "src_page": 6, "status": "excluded", "reason": "issues framed below", "matched_section": null, "text": "(b) The underlying coverage." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 84, "src_page": 6, "status": "excluded", "reason": "issues framed below", "matched_section": null, "text": "(c) Any primary or secondary excess carriers on this claim and the limits of each carrier or company’s policy." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 85, "src_page": 6, "status": "excluded", "reason": "issues framed below", "matched_section": null, "text": "(d) Any other actual or potential payor on this claim and any stakeholder with actual or potential financial responsibility for this claim." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 86, "src_page": 6, "status": "excluded", "reason": "issues framed below", "matched_section": null, "text": "(e) The contract information for each excess carrier or other such stakeholder." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 87, "src_page": 6, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(Minutes of Hearing, March 24, 2022, at p. 2.) On April 19, 2022, the Findings of Fact and Order issued." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 88, "src_page": 6, "status": "excluded", "reason": "decision below (rescinded)", "matched_section": null, "text": "In the accompanying Opinion on Decision, the WCJ described the holdings in the Coldiron cases, as well as the history and requirements of WCAB Rules 10550 and 10390." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 89, "src_page": 6, "status": "excluded", "reason": "decision below (rescinded)", "matched_section": null, "text": "(Opinion, at pp. 2-4.) The WCJ then discussed the WCAB’s rule-making authority, its authority to determine the validity of regulations, and its authority to issue en banc opinions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 90, "src_page": 6, "status": "excluded", "reason": "decision below (rescinded)", "matched_section": null, "text": "(Id. at pp. 5-6.) The WCJ stated, “In other words, en banc decisions are binding unless superceded [sic] by new Regulations and/or Codes.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 91, "src_page": 6, "status": "excluded", "reason": "decision below (rescinded)", "matched_section": null, "text": "(Id. at pp. 5-6.) Citing defendant’s Points and Authorities, which relied on the “Statement of Specific Purpose and Reasons for Proposed Amendments of § 10390,” the WCJ concluded: This evidentiary record makes clear that the recently promulgated Regulation § 10390 not only repealed Regulation § 10550, but supercedes [sic] Coldiron." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 92, "src_page": 6, "status": "excluded", "reason": "decision below (rescinded)", "matched_section": null, "text": "It is illogical to believe that the Appeals Board instituted Regulation § 10390 to cause a conflict in the law." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 93, "src_page": 6, "status": "excluded", "reason": "decision below (rescinded)", "matched_section": null, "text": "The Regulation’s purpose is to simplify and clarify the obligations of defendant to identify the legally responsible entity - not create this current litigation or obfuscate a party’s disclosure obligations. * * * Accordingly, logic follows that Regulation § 10390 supercedes [sic] Coldiron in whole or in part." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 94, "src_page": 6, "status": "excluded", "reason": "decision below (rescinded)", "matched_section": null, "text": "(Id. at p. 6.) The WCJ indicated, too, that: Applicant has made no showing that Employers Compensation Insurance Group is at risk of default or otherwise made an offer of proof that the information requested - above and beyond disclosure of Employers Compensation Insurance Group as the carrier, is warranted for any legitimate litigation or benefits purpose." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 95, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "7 Applicant timely filed her Petition for Reconsideration in response to the April 19, 2022 F&O." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 96, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "DISCUSSION This case involves the legal question of whether defendant was required to comply with applicant’s February 17, 2021 discovery request to defendant to identify potential insurance carriers, potential insurance policies and their limits, and other potentially liable persons or entities pursuant to the statutory discovery provisions, WCAB Rule 10390, and our en banc decisions in Coldiron I and II." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 97, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "We answer this question in the affirmative." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 98, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "In light of our constitutional mandate to accomplish substantial justice, and our statutory mandate under Labor Code section 5500.34 to ensure uniform court procedures, we issue this decision en banc to clarify existing law and to ensure due process and consistency of practice at the trial level.5 1." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 99, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "All en banc decisions are binding on panels of the Appeals Board and WCJs, and the binding en banc decisions in Coldiron I and Coldiron II require disclosure of any entities liable for payment and any insurance policies that impact liability for payment." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 100, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "The Appeals Board is a constitutional court vested with judicial powers." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 101, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(§ 111(a); see §§ 52, 5300, 5301, 5302; see also McHugh v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 102, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Santa Monica Rent Control Bd." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 103, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(1989) 49 Cal.3d 348, 355-356; Bankers Indemnity Ins." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 104, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(Merzoian) (1935) 4 Cal.2d 89, 97.) For over 100 years, it has been repeatedly held that the Appeals Board (and its predecessor, the Industrial Accident Commission), exercises a portion of the judicial powers of the State of California and is, in legal effect, a court." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 105, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "(Merzoian, supra, 4 Cal.2d at p. 97; Western Metal Supply Co. v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 106, "src_page": 7, "status": "excluded", "reason": "facts and party filings", "matched_section": null, "text": "Pillsbury (Mason) (1916) 172 Cal. 407, 411-412; Kaiser Co. v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 107, "src_page": 7, "status": "excluded", "reason": "footnote housekeeping", "matched_section": null, "text": "(Baskin) (1952) 109 Cal.App.2d 54, 58-59.) 4 All section references are to the Labor Code, unless otherwise indicated. 5 We are aware that holdings in this opinion may appear to be axiomatic for a portion of the workers’ compensation community." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 108, "src_page": 7, "status": "excluded", "reason": "statement of intent, not rule", "matched_section": null, "text": "Our intent here is to promote consistency in the application of our rules and our en banc decisions, and to otherwise provide guidance regarding the fundamental concepts discussed herein." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 109, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "8 Sections 111 and 115 grant statutory authority to the Appeals Board to issue en banc decisions.6 Appeals Board en banc decisions have the same legal effect as published appellate opinions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 110, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "(Ochoa) (2006) 142 Cal.App.4th 790, 796, fn. 2 [71 Cal.Comp.Cases 1044].) Specifically, en banc decisions “are binding on panels of the Appeals Board and workers’ compensation judges as legal precedent under the principle of stare decisis.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 111, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "Code Regs., tit. 8, § 10325.) The principle of stare decisis means that precedent-setting court opinions may only be overruled by the same court, or a higher court." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 112, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "Hence, an Appeals Board en banc opinion must be followed by panels of the Appeals Board and by all WCJs until rescinded, altered, or overruled by the Appeals Board en banc, overruled by a Court of Appeal or the California Supreme Court pursuant to sections 5950 through 5956, or rendered inapplicable by a legislative enactment." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 113, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "The California Supreme Court explained in People v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 114, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "Bouzas that in interpreting legislation, “repeal by implication is disfavored...”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 115, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Bouzas (1991) 53 Cal.3d 467, 480, citing People v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 116, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Siko (1988) 45 Cal.3d 820, 824; accord: Department of Corrections & Rehabilitation v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 117, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "Appeals Bd., supra, 166 Cal.App.4th at 917 [“we presume that when the Legislature enacts a statute it does not intend to repeal or abrogate any other statute by implication.”].) The same principle is applicable here: en banc opinions of the Appeals Board are not repealed “by implication” and thus, an en banc opinion cannot be “superseded” by the enactment of a regulation." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 118, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "Again, we emphasize that an en banc opinion issued by the Appeals Board is binding legal precedent, unaffected by the regulatory process, and continues to be binding legal precedent unless the Appeals Board explicitly rescinds it en banc, it is overruled by a higher Court, or it is rendered no longer applicable by legislative changes." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 119, "src_page": 8, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "In our en banc decision in Coldiron I, we addressed a situation in which “the third-party administrator failed to disclose the true identity of its client until more than six years after the date of the injury.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 120, "src_page": 8, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "(Coldiron I, supra, 67 Cal.Comp.Cases at pp. 290-291.) As a result of this misidentification, an award was issued against defendant, as a permissibly self-insured company, rather than against the insurance company who was actually liable." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 121, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "We held that: [W]here an employer’s liability for workers’ compensation benefits is adjusted by a third-party administrator, the administrator must disclose to the Workers’ 6 Government Code section 11425.60(b) provides additional authority for the WCAB to designate all or part of a decision “that contains a signification legal or policy determination of general application that is likely to recur” as a “precedent decision,” and our en banc decisions are routinely adopted as precedent decisions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 122, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "9 Compensation Appeals Board, to the other parties in any proceeding in which it is a party, and to its own counsel the identity of its client, whether a self-insured employer or insurance carrier." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 123, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "If the client is an insurance carrier, the administrator must disclose whether the policy includes a “high self-insured retention,” a large deductible, or any other provision that affects the identity of the entity actually liable for the payment of compensation." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 124, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Failure of the administrator to disclose the identity of its client may subject it to sanctions pursuant to Labor Code section 5813." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 125, "src_page": 9, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "(Ibid.) Coldiron II addressed the question of sanctions for failure to comply with the requirements of Coldiron I." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 126, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "(Coldiron II, supra, 67 Cal.Comp.Cases 1466.) In our en banc decision in Coldiron II, we declined to order sanctions, as the case was one of first impression, but reiterated our prior holding and stated that “[t]hese holdings remain in full force and effect, and the third-party administrators (or their counsel and/or representative) who do not comply with these holdings may be subject to sanctions.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 127, "src_page": 9, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(Id. at p. 1470.) Coldiron I and Coldiron II [collectively Coldiron] were decided by the Appeals Board, sitting en banc, and have not been rescinded by the Appeals Board en banc, overturned by a higher court, or subsumed by a subsequent legislative enactment." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 128, "src_page": 9, "status": "excluded", "reason": "restatement; rule printed at § 1.2", "matched_section": null, "text": "Thus, both decisions continue to be binding precedent on panels of the Appeals Board and all WCJs." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 129, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Defendant asserted that Coldiron is inapplicable because it was distinguishable on the facts." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 130, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "This argument lacks merit, because Coldiron’s holdings require disclosure of a high self-insured retention, a large deductible, or any other provision that affects the identity of the entity actually liable for the payment of compensation by a third-party administrator." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 131, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "In context, it is clear that the Appeals Board, in issuing Coldiron I en banc was concerned with disclosure of the entity responsible for payment in all cases and not just those with a third-party administrator." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 132, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Coldiron I is not factually distinguishable from the present case and thus is applicable here." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 133, "src_page": 9, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Consequently, although defendant’s disclosure appeared to comply with WCAB Rule 10390, defendant was also required to comply with the more detailed disclosure requirements in Coldiron I." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 134, "src_page": 9, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "Coldiron I addressed a fact scenario in which the liable party was not adequately identified by the third-party administrator, until years after an award had been issued." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 135, "src_page": 9, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "We explained that this situation raised numerous questions: Defendant’s petition raises questions regarding the meaning of “high self-insured retention,” whether a “deductible” exists in the context of worker’s compensation insurance policies." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 136, "src_page": 9, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "Is the alleged policy with Reliance an insurance policy that contains limitations which provide for employer primary liability at the outset up" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 137, "src_page": 10, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "10 to a certain amount of liability, with the carrier thereafter responsible, or with potential reinsurance or excess insurance taking over at a different and higher level of liability?" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 138, "src_page": 10, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "Is the employer’s liability to the carrier in the form of essentially an indemnification agreement, with the carrier billing the employer directly for sums expended and requesting reimbursement, or some other deductible type approach?" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 139, "src_page": 10, "status": "excluded", "reason": "description of prior precedent's facts", "matched_section": null, "text": "There is a question of who is the primary liable entity, the carrier or the employer, or both." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 140, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "(Coldiron I, at p. 293.) In discussing the necessity for our holding in Coldiron I, we stated: Fundamental to the establishment of workers’ compensation liability and the prompt delivery of benefits awarded to eligible injured workers is the designation of the responsible and liable entity." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 141, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "The responsible entity must be divulged at the earliest opportunity, and certainly no later than the commencement of the litigation process and formal proceedings. . . ." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 142, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "In this manner, no confusion can result as to the liable entity, against whom an award for benefits will be made." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 143, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "It avoids unnecessary delays in the prompt delivery of benefits awarded." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 144, "src_page": 10, "status": "excluded", "reason": "restatement; Coldiron I holding printed at § 16.2", "matched_section": null, "text": "(Id. at p. 294, emphasis added.) In Coldiron I, the third-party administrator was at fault for the misidentification error, and thus we addressed this problem by requiring that, in all cases in which there is a third-party administrator, the administrator must disclose the identity of their client and the details of the underlying insurance policy, in order to provide the WCJ and all parties accurate information about liability for the claim." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 145, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "It bears repeating that the Appeals Board, in issuing Coldiron I en banc was concerned with disclosure of the entity responsible for payment in all cases, including any limits on liability for payment, and not just those with a third-party administrator." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 146, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "However, to avoid further confusion, we reiterate that there is no basis to limit the disclosure requirements to third-party administrators." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 147, "src_page": 10, "status": "excluded", "reason": "application to these facts", "matched_section": null, "text": "The facts of the current case provide a clear example of why the Coldiron disclosure requirements are essential to accomplish our constitutional mandate to achieve substantial justice in all cases." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 148, "src_page": 10, "status": "excluded", "reason": "application to these facts", "matched_section": null, "text": "Here, an award issued, but the medical expenses for the injured worker’s required home health care services went unpaid." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 149, "src_page": 10, "status": "excluded", "reason": "application to these facts", "matched_section": null, "text": "Although the reason for the payment problems is not altogether clear, there can be no doubt that applicant is entitled to the information about which entity or entities are liable for payment, as well as the liability details in the underlying insurance policy." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 150, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "The burden to ascertain the identity of the entity liable for payment cannot be placed on" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 151, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "11 the injured worker; the information is more readily available to a defendant, and the disclosure responsibility must lie with defendant.7 2." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 152, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Only the Appeals Board is statutorily authorized to issue regulations for adjudication of workers’ compensation proceedings, and WCAB Rules 10390, 10400 and 10401 require that parties, their representatives, and their insurance companies be fully identified." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 153, "src_page": 11, "status": "excluded", "reason": "transition", "matched_section": null, "text": "In discussing the relevant regulations, we begin by contrasting the effect of a statute in comparison to a regulation." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 154, "src_page": 11, "status": "excluded", "reason": "citation string", "matched_section": null, "text": "As the Court stated in Rea v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 155, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(Milbauer) (2005) 127 Cal.App.4th 625, 644 [70 Cal.Comp.Cases 312], “ While the WCAB is empowered to enact rules or procedures under the proper circumstances, it may not change legislation that is within the plenary power of the Legislature under article XIV, section 4 of the California Constitution.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 156, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Thus, the Appeals Board must follow a statute in the Labor Code as written and enacted by the Legislature, unless or until the Legislature changes a statute or a higher court issues an opinion as to its application." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 157, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "In comparison, regulations are enacted by state agencies8 under statutory authority granted by an enabling statute, to implement and enforce a statute, after public notice and an opportunity for public comment." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 158, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(See Tidewater Marine Western, Inc. v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 159, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Bradshaw (1996) 14 Cal.4th 557, 568; Department of Corrections & Rehabilitation v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 160, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(2008) 166 Cal.App.4th 911, 917 [73 Cal.Comp.Cases 1294].) Section 5500.3 requires: (a) The appeals board shall establish uniform district office procedures, uniform forms, and uniform time of court settings for all district offices of the appeals board." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 161, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "No district office of the appeals board or workers’ compensation administrative law judge shall require forms or procedures other than as established by the appeals board." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 162, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "A workers’ compensation administrative law judge who violates this section may be subject to disciplinary proceedings." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 163, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(b) The appeals board shall establish uniform court procedures and uniform forms for all other proceedings of the appeals board. 7 We note that lien claimants, like applicants, must know the names of liable entities and insurance policy information in order to ensure that a lien claim is paid." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 164, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "That is, lien claimants and applicants are similarly entitled to this information, and similarly unable to access it without disclosure by the defendant. 8 The Administrative Procedures Act (APA) applies to all state “agencies”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 165, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Code, § 11500), except as otherwise expressly provided by statute." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 166, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Code, § 11410.20(a); see also, § 11415.10(a).) The WCAB falls within a statutory exclusion because its adjudicative proceedings are expressly governed by the Labor Code and by its own rules of practice and procedures and because it is not bound by any other statutory rules of procedure." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 167, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code, § 5708; see also § 5307.)" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 168, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Code, § 5500.3.) Section 5708 authorizes the Appeals Board to promulgate regulations regarding the adjudicatory process, and section 5307 describes the mandatory procedures for adopting, amending or rescinding regulations, including the requirement for a public hearing." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 169, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Code, §§ 5307, 5708.) While a regulation enacted by the Appeals Board may become invalid when an appellate court determines that it contradicts a statute, if the Appeals Board determines that a regulation is no longer valid or is no longer applicable as written, the Appeals Board must follow the same procedures used to enact the regulation, including the public hearing requirement, prior to the amendment or repeal of the regulation." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 170, "src_page": 12, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Code, § 5307; see Milbauer, supra, 127 Cal.App.4th 625.) The WCAB Rules discussed herein serve to ensure that all parties are accurately identified, and as explained above, in comparison to the requirements outlined in Coldiron, they are not concerned with which entity could be liable for payment." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 171, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Under WCAB Rule 10390, which renumbered and simplified former WCAB Rule 10550, all parties must fully disclose their own legal name, the name of their attorney or non-attorney representative, the name of the insurer and employer, and the third-party administrator, while clarifying that the third-party administrator is not a party." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 172, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "WCAB Rule 10400, subdivision (b)(1) requires that all attorney representatives file a notice of representation or opening document that complies with WCAB Rule 10390 and includes “the name of the represented party.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 173, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Code Regs., tit. 8, § 10400(b)(1).) As a matter of course, if an attorney represents multiple parties or entities, all names of each represented party or entity must be disclosed." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 174, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "WCAB Rule 10401 imposes similar requirements on non-attorney representatives." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 175, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Code Regs., tit. 8, § 10401.) Read together, WCAB Rules 10390, 10400 and 10401 ensure that all parties, representatives and liable entities are fully identified in each case." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 176, "src_page": 12, "status": "excluded", "reason": "rationale; rules printed at § 16.2", "matched_section": null, "text": "Compliance with these rules is important to avoid errors such as misidentification of parties, inadvertent omission of parties from pleadings, and incorrect case captions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 177, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "We observe that information as to the proper defendant is within a defendant’s control, and not an applicant’s, so that it is incumbent upon a defendant to comply with this responsibility." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 178, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "As outlined in Coldiron, and as further required by these rules, full disclosure of the names of each party or entity means that all essential parties are included in" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 179, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "13 all awards, and so that awards are enforceable, a defendant must necessarily provide accurate information." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 180, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "WCAB Rule 10390 does not supersede the Coldiron decisions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 181, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Defendants must comply with WCAB Rule 10390 and the disclosure requirements in Coldiron I and II, regardless of whether there is a third-party administrator." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 182, "src_page": 13, "status": "excluded", "reason": "restatement; Holding No. 3 printed at § 16.2", "matched_section": null, "text": "While WCAB Rule 10390’s requirements may appear to be narrower than those established in the Coldiron decisions, there is no conflict between the rule and the holdings of Coldiron I or II." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 183, "src_page": 13, "status": "excluded", "reason": "rationale", "matched_section": null, "text": "WCAB Rule 10390 was enacted to ensure proper identification of parties." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 184, "src_page": 13, "status": "excluded", "reason": "rationale (rulemaking intent)", "matched_section": null, "text": "Our intention was that the rule and the Coldiron decisions be read together.9 The purpose of the change was to expand defendant’s obligation to properly identify third-party administrators, rather than to address the issue of disclosure of insurance carrier and policy information or to otherwise limit defendant’s responsibilities." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 185, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "In short, the requirements in Coldiron I and II do not conflict with those in WCAB Rule 10390 and remain binding authority.10 There is simply no valid legal authority for the contention that by enacting a rule, we have superseded one of our en banc decisions by operation of law." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 186, "src_page": 13, "status": "excluded", "reason": "rationale", "matched_section": null, "text": "This misapprehension confuses the circumstances where the Legislature enacts a change in the Labor Code or a higher court determines that our interpretation of the law is incorrect." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 187, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "Instead, we emphasize that if changes are made to an existing rule, we must follow the procedures of the rulemaking process." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 188, "src_page": 13, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Thus, we make clear now that our Coldiron I and II holdings apply to all defendants, regardless of whether a third-party administrator was involved in the case." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 189, "src_page": 13, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "As we stated in Coldiron I, “[f]undamental to the establishment of workers’ compensation liability and the prompt delivery 9 When we rescinded WCAB Rule 10550, and renumbered it as WCAB Rule 10390, we stated that the purpose was to “clarify” the rule, while noting that since Coldiron, “third party administrators have become more prevalent and continue to be improperly identified as parties.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 190, "src_page": 13, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(WCAB Initial Statement of Reasons, Subject Matter of Proposed Regulations: Rules of Practice and Procedure, effective January 1, 2020, at p. 13.) This document may be accessed here: https://www.dir.ca.gov/wcab/WCABProposedRegulations/Rulemaking-August-2019/Rulemaking-August-2019.htm 10 As described above, in his discussion of Coldiron I and WCAB Rule 10390, the WCJ concluded that “it is illogical to believe that the Appeals Board instituted Regulation § 10390 to cause conflict in the law.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 191, "src_page": 13, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(Opinion, at p. 6.) While on occasion it may be tempting to speculate about the Appeals Board’s intention in enacting a regulation, WCJs and all parties before the Appeals Board must follow the plain language of the regulations as written, and, at the same time, abide by our en banc decisions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 192, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "Unless otherwise stated, it is presumed that the Appeals Board is aware of the statutory and decisional law, including its own en bancs, when it enacts regulations, and the appropriate time to raise concerns about a particular rule and its impact, whether intended or unintended, is when the Appeals Board is engaged in rule making." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 193, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "14 of benefits awarded to eligible injured workers is the designation of the responsible and liable entity” and that “the responsible entity must be divulged at the earliest opportunity, and certainly no later than the commencement of the litigation process and formal proceedings.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 194, "src_page": 14, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(Coldiron I, supra, at p. 294.) In addition to requiring the disclosure of the identity of the liable entity, regardless of whether there is a third-party administrator, “[i]f the client is an insurance carrier,” defendant “must disclose whether the policy includes a ‘high self-insured retention,’ a large deductible, or any other provision that affects the identity of the entity actually liable for the payment of compensation.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 195, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 22.1", "text": "(Ibid.) When an applicant seeks information about the liable entity or the insurance policy provisions, the information should be readily provided." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 196, "src_page": 14, "status": "excluded", "reason": "rationale", "matched_section": null, "text": "These disclosure requirements serve to protect all parties." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 197, "src_page": 14, "status": "excluded", "reason": "rationale", "matched_section": null, "text": "Knowing the identity of each defendant assists applicants in determining whether to resolve their cases and thus ensures a smoother adjudication process." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 198, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Defendants are required by the Labor Code to pay all compensation that is due." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 199, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "If a dispute arises about who is responsible to pay compensation, an identified defendant may nevertheless be held liable, and sanctions may be imposed until such time as another responsible party is identified." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 200, "src_page": 14, "status": "excluded", "reason": "rationale", "matched_section": null, "text": "Thus, it serves a defendant’s interest to comply with these disclosure requirements, to ensure that they are not held liable for payments that should not be their responsibility, nor sanctioned for conduct for which they were not responsible." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 201, "src_page": 14, "status": "excluded", "reason": "rationale", "matched_section": null, "text": "The disclosure requirements further serve all parties’ interests by facilitating more expeditious proceedings, and by ensuring that each matter is resolved in a way that accomplishes fundamental fairness, due process and substantial justice." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 202, "src_page": 14, "status": "excluded", "reason": "transition", "matched_section": null, "text": "Lastly, the WCJ plays a key role in ensuring compliance with these requirements." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 203, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "The WCJ has a duty to inquire and ensure that the record reflects the correct identity of all parties, at first opportunity, including at the mandatory settlement conference and at trial.11 Further, to increase the likelihood that the award will be timely paid, by the correct entity, the WCJ must exercise oversight to ensure that at the time an award or decision is issued, if applicant has sought this information, that defendant has disclosed and properly identified all liable entities and the relevant insurance policy details, in compliance with Coldiron I and this decision. 11 Errors in case captions are, at times, a result of naming conventions in the Electronical Adjudication Management System (EAMS)." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 204, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "WCJs are nevertheless responsible for ensuring that the legally correct names of parties and liable entities appear in case captions, rather than shortened or otherwise incorrect names found in EAMS." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 205, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "15 Our holding herein is consistent with the public policy favoring liberal pre-trial discovery that may reasonably lead to relevant and admissible evidence applicable in workers’ compensation cases." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 206, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "(1999) 72 Cal.App.4th 654, 663 [64 Cal.Comp.Cases 624].)12 We emphasize that in workers’ compensation proceedings, the Labor Code makes explicit that the WCJ and the Appeals Board have greater discretion with respect to evidentiary matters than courts in civil proceedings, and not narrower discretion as defendant appears to believe." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 207, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "Section 5708 mandates that we are not “bound by the common law or statutory rules of evidence and procedure, but may make inquiry in the manner, through oral testimony and records, which is best calculated to ascertain the substantial rights of the parties and carry out justly the spirit and provisions of this division.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 208, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "Code, § 5708, emphasis added.) Section 5709 specifically allows informality in our proceedings and ensures that “admission into the record, and use as proof of any fact in dispute, of any evidence not admissible under the common law or statutory rules of evidence and procedure” will not invalidate an order, decision or award." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 209, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "Code, § 5709.)13 Unlike a discovery request where the right to privacy or another privilege is implicated, proof of good cause is not required for a routine discovery request such as the one here." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 210, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "Instead, applicant has a right to the insurance coverage information and potentially liable parties purely by way of a discovery request for relevant information, even without the consideration of the specific disclosure requirements detailed herein." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 211, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "That is, even a straightforward application of the principle that parties are entitled to discovery of relevant information should have meant that defendant 12 The underlying principle of liberal discovery supports our duty to ensure substantial justice and to further develop the record where there is insufficient evidence on an issue." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 212, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264]; McClune v." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 213, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "(1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board may not leave matters undeveloped where it is clear that additional discovery is needed." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 214, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "(Id. at p. 404.) 13 Under the Civil Discovery Act, discovery is generally available “regarding any matter, not privileged, that is relevant to the subject matter involved in the pending action or to the determination of any motion made in that action. . . .”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 215, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 22.1", "text": "Pro., § 2017.101.) Discovery must be provided regarding “the existence and contents of any agreement under which any insurance carrier may be liable,” including “the identity of the carrier and the nature and limits of the coverage.”" }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 216, "src_page": 15, "status": "excluded", "reason": "civil-context observation; CCP quotes printed at §§ 17.1, 22.1", "matched_section": null, "text": "Pro., § 2017.210.) In civil cases, insurance information is discoverable despite the fact that, upon the conclusion of the civil suit, there is no ongoing need to pay benefits." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 217, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 22.1", "text": "In contrast, in a workers’ compensation matter, liability for payment of compensation to an applicant is an ongoing duty, that often stretches for many years after an underlying award is issued." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 218, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 22.1", "text": "This means that the ability to identify any parties that may potentially be liable to pay compensation in the future, and the parameters of that liability, is significantly more important in workers’ compensation proceedings." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 219, "src_page": 16, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "16 readily provided applicant with the information that she sought without the need of WCAB intervention.14 Having established that Coldiron is binding authority, and having clarified that its holding is applicable to the facts of this case, even when no third-party administrator is involved, we turn to the question of whether defendant complied with the requirements of Coldiron." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 220, "src_page": 16, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "It appears that it did not." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 221, "src_page": 16, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Applicant’s attorney made a valid discovery request and demonstrated that detailed information about the liable entities and applicable insurance policies was relevant to payment of compensation to applicant and enforcing the February 11, 2020 order that defendant pay for medical treatment in the form of home health care services." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 222, "src_page": 16, "status": "excluded", "reason": "disposition", "matched_section": null, "text": "We rescind the findings here, and upon return, direct defendant to forthwith disclose the information requested by applicant, as required by Coldiron and this decision." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 223, "src_page": 16, "status": "excluded", "reason": "disposition; sanctions rule printed at § 16.2", "matched_section": null, "text": "If defendant fails to do so, applicant may seek sanctions under section 5813, as set forth in Coldiron II, and as appropriate, applicant may wish to seek sanctions for defendant’s previous failure to do so." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 224, "src_page": 16, "status": "excluded", "reason": "preamble to boxed holdings", "matched_section": null, "text": "Therefore, we hold en banc that: 1." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 225, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 1.2", "text": "All en banc decisions are binding on panels of the Appeals Board and the WCJs, and the binding en banc decisions in Coldiron I and Coldiron II require disclosure of any entities liable for payment and any insurance policies that impact liability for payment. 2." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 226, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Only the Appeals Board is statutorily authorized to issue regulations for adjudication for workers’ compensation proceedings, and WCAB Rules 10390, 10400 and 10401 require that parties, their representatives, and their insurance companies be fully identified. 3." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 227, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "WCAB Rule 10390 does not supersede the Coldiron decisions." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 228, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 16.2", "text": "Defendants must comply with WCAB Rule 10390 and the disclosure requirements in Coldiron I and II, regardless of whether there is a third-party administrator." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 229, "src_page": 16, "status": "excluded", "reason": "disposition", "matched_section": null, "text": "Accordingly, as our Decision After Reconsideration (en banc), we rescind the WCJ’s April 19, 2022 F&O and return the matter to the trial level for further proceedings consistent with this opinion." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 230, "src_page": 16, "status": "excluded", "reason": "application; Coldiron duties printed at § 16.2", "matched_section": null, "text": "For the foregoing reasons, 14 While at first blush it appears that the dispute here is solely as to a discovery matter, defendant has refused outright to comply with our binding en banc opinions in Coldiron I and II." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 231, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 22.1", "text": "Not only is this refusal unwarranted and not supported by any statutory authority, final decisions of the WCAB may be converted to civil judgments, and without proper identification of the liable party or parties, an award may be rendered unenforceable." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 232, "src_page": 17, "status": "excluded", "reason": "disposition", "matched_section": null, "text": "17 IT IS ORDERED as the Decision After Reconsideration of the Workers’ Compensation Appeals Board (en banc), that the Findings of Fact and Order issued by the WCJ on April 19, 2022 is RESCINDED and that the matter is RETURNED to the trial level for further proceedings consistent with this decision." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 233, "src_page": 17, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD (EN BANC) /s/ KATHERINE A." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 234, "src_page": 17, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ZALEWSKI, CHAIR /s/ JOSÉ H." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 235, "src_page": 17, "status": "excluded", "reason": "signature block", "matched_section": null, "text": "RAZO, COMMISSIONER /s/ KATHERINE WILLIAMS DODD, COMMISSIONER /s/ CRAIG L." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 236, "src_page": 17, "status": "excluded", "reason": "signature block", "matched_section": null, "text": "SNELLINGS, COMMISSIONER /s/ JOSEPH V." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 237, "src_page": 17, "status": "excluded", "reason": "signature block", "matched_section": null, "text": "CAPURRO, COMMISSIONER /s/ PAUL F." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 238, "src_page": 17, "status": "excluded", "reason": "signature block", "matched_section": null, "text": "KELLY, COMMISSIONER DATED AND FILED AT SAN FRANCISCO, CALIFORNIA October 13, 2025 SERVICE MADE ON THE ABOVE DATE ON THE PERSONS LISTED BELOW AT THEIR ADDRESSES SHOWN ON THE CURRENT OFFICIAL ADDRESS RECORD." }, { "dec_slug": "difusco-v-hands-on-spa-2025-adj7445107-wcab-en-banc", "seq": 239, "src_page": 17, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "JILLIAN DIFUSCO ASVAR LAW, PC MICHAEL SULLIVAN & ASSOCIATES LLP MB/ara/abs I certify that I affixed the official seal of the Workers’ Compensation Appeals Board to this original decision on this date. abs" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 1, "src_page": 1, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD STATE OF CALIFORNIA CALVIN GAINES, et al., Applicants vs." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 2, "src_page": 1, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "ABM AVIATION, INC., permissibly self-insured, administered by SEDGWICK CMS, et al., Defendants Adjudication Numbers: ADJ20216367; ADJ21320531; ADJ21696812; ADJ21685023; ADJ21614143; ADJ20942969; ADJ20198453; ADJ21188642; ADJ21188644; ADJ20164163; ADJ20858628; ADJ20858629; ADJ21048684; ADJ22360616; ADJ21482032; ADJ21749294; ADJ20959336; ADJ20124756; ADJ20124744; ADJ20012968; ADJ21207947; ADJ21044279; ADJ21778179; ADJ21889871; ADJ21634106; ADJ22363907; ADJ22017487; ADJ21397889; ADJ21954446; ADJ22397441; ADJ22246435 Van Nuys District Office OPINION AND ORDERS GRANTING PETITIONS FOR REMOVAL AND DECISION AFTER REMOVAL (En Banc) Upon a unanimous vote of its members, the Appeals Board issues this decision as an en banc decision.1 (Lab." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 3, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code,2 § 115.) This decision involves twenty-four individual cases,3 where the applicants have sought removal from similar Orders Suspending Action (“OSAs”) issued by the same workers’ compensation administrative law judge (“WCJ”) on various Compromise and Release (“C&R”) agreements submitted for approval." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 4, "src_page": 1, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "The WCJ suspended action in each case because, among other reasons, the parties failed to establish adequacy of the proposed C&R and failed to file medical 1 En banc decisions of the Appeals Board are binding precedent on all Appeals Board panels and workers’ compensation administrative law judges." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 5, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, § 10325; City of Long Beach v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 6, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(Garcia) (2005) 126 Cal.App.4th 298, 316, fn. 5 [70 Cal.Comp.Cases 109]; Gee v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 7, "src_page": 1, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "(2002) 96 Cal.App.4th 1418, 1424, fn. 6 [67 Cal.Comp.Cases 236].) This en banc decision is also adopted as a precedent decision pursuant to Government Code section 11425.60(b). 2 All future statutory references are to the Labor Code unless noted. 3 Some cases involve multiple case numbers." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 8, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "2 evidence supporting the proposed settlements." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 9, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, §§ 10700, 10789.) The requested information varies, but the WCJ generally requested that the parties provide supporting medical documents, obtain an evaluation, and / or dismiss the claim with prejudice." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 10, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "The WCJ also requested documentation to establish the requested attorney’s fee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 11, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "In each case, applicant contends that the OSA improperly compels applicant to complete additional discovery in response to the OSA; that the WCJ exceeded their scope of review; and that a WCJ may only review whether a settlement is adequate." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 12, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We received Answers from the defendants." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 13, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "In multiple cases, permission was requested to file a supplemental response, and we have accepted those Supplemental Responses." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 14, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, § 10964.) We have considered the allegations of the Petitions for Removal, the Answers, the Supplemental Responses, and the contents of the WCJ’s Reports." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 15, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Based on our review of the record, we will grant all the Petitions and order that these matters be consolidated for an en banc decision." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 16, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "As our Decision After Removal, we will rescind each of the OSAs, order that the WCJ be disqualified from further proceedings in each case, and thereafter rescind the order of consolidation, and return each case to the Presiding WCJ (“PWCJ”) for reassignment to another WCJ and for further proceedings consistent with this decision." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 17, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "A workers’ compensation settlement is only enforceable after approval by the Workers’ Compensation Appeals Board." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 18, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "In approving a settlement, a WCJ must consider whether the agreement is valid and must determine whether the settlement is adequate in order to protect the injured worker and the public interest. 2." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 19, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "Where the terms of the settlement are inconsistent, do not comply with the Labor Code, and / or are inadequate, the WCJ may investigate by issuing an order suspending action, and if the parties do not provide sufficient information, the WCJ may hold a hearing to create an evidentiary record that establishes the adequacy of a settlement." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 20, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "3 FACTS These matters involve an alleged course of conduct that appears to have occurred across multiple cases, involving various parties who have submitted C&Rs for approval." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 21, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "None of these matters have proceeded to an evidentiary hearing on the merits of the issues raised in the Petitions for Removal." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 22, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The Appeals Board takes judicial notice of the Electronic Adjudication Management System (“EAMS”) files in each of these cases. 1." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 23, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Calvin Gaines – ADJ20216367 On December 9, 2024, applicant filed an Application for Adjudication of Claim (“Application”), alleging that while working as a ramp scrubber for ABM Aviation4, applicant sustained a cumulative injury during the period ending on December 9, 2024, to the neck, psyche, and in the form of high blood pressure due to enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 24, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On September 15, 2025, applicant filed a Declaration of Readiness to Proceed (“DOR”), requesting a hearing and alleging that defendant was unresponsive in drafting a C&R." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 25, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 3, 2026, the parties filed a C&R, which purported to settle the matter for $10,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 26, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendant filed a cover letter with the C&R, which alleged, in full: Please find attached a copy of the Executed Compromise and Release in the amount of $10,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 27, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendants maintain denial of the claim." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 28, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The parties have reached a compromised settlement, as the parties do not wish to undergo additional discovery, and wish to buy their peace." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 29, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendants have confirmed with EDD [Employment Development Department] that there is no lien on this claim." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 30, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Defendant’s Cover Letter, February 3, 2026.) On February 4, 2026, the WCJ issued an OSA." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 31, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ requested supporting medical documentation, stating, in pertinent part: Since there is no medical report filed, there is no way to determine whether the settlement is adequate." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 32, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "If there are no medical reports obtained for these body parts for a CT ending 12/9/24, as of 2026, please provide an explanation why." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 33, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "In the alternative, applicant can seek a medical evaluation to ensure the Court has a substantial medical record to base [a] well-reasoned opinion on, in determining whether the settlement is adequate or not." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 34, "src_page": 3, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Order Suspending Action on Compromise and Release, February 3, 2026.) 4 Although the Application lists ABM Aviation as the employer’s name, the employer’s name is identified as ABM Industries, Inc., in the C&R." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 35, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "4 The WCJ further requested any witness statements collected by the parties and requested information about any civil settlements that applicant may have pursued against his employer." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 36, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Finally, the WCJ observed that no significant activity appeared to have occurred in the court’s record and requested that applicant’s attorney file an offer of proof to explain the requested 15% attorney’s fee. 2." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 37, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Crystal Kelly – ADJ21320531 On August 4, 2025, applicant filed an Application, alleging that while working as a “worker” for Amazon Air, applicant sustained a cumulative injury during the period ending on July 10, 2025, to the teeth, wrist, circulatory system, psyche, and in the form of headaches, all due to enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 38, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On October 27, 2025, applicant filed a DOR for an expedited hearing, requesting a hearing on the issue of medical treatment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 39, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On November 19, 2025, defendant filed an answer, wherein it denied liability based upon a lack of substantial medical evidence and due to the claim being filed post-termination." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 40, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "After defendant filed its denial, applicant withdrew the DOR." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 41, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 28, 2026, the parties filed a C&R, which purported to settle the matter for $20,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 42, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendant submitted a cover letter with the C&R, which alleged, in pertinent part: At this time, we do not have any medical reports to support an injury." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 43, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Thus, the claim is denied." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 44, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "A doctor has yet to find Applicant permanent and stationary." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 45, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "She understands her right to a final report from a QME or a PTP, but she chooses to settle her case now rather than continue with the hassles of discovery and litigation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 46, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Defendant’s Cover Letter, January 27, 2026.) On January 29, 2026, the WCJ issued an OSA, which requested a full history of the allegations of hostile work environment, including witness statements, and a breakdown as to the settlement’s valuation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 47, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ also requested medical records, and stated in pertinent part: “If the headache/circulatory system claims are associated with blood pressure issues, a medical should be obtained for that." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 48, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "However, if the applicant does not wish to pursue further litigation or discovery, then applicant can certainly file a request to voluntarily dismiss the case, with prejudice.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 49, "src_page": 4, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Order Suspending Action on Compromise and Release, ADJ21320531, January 29, 2026, p. 1.)" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 50, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "5 The WCJ requested documentation to support of an award of a 15% attorney’s fee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 51, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ also requested documents supporting the denial of claim and a source of any benefits paid, such as EDD, and documentation of any related civil lawsuits filed by applicant. 3." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 52, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Brittany Johnson – ADJ20198453 On December 4, 2024, applicant filed an Application, alleging that while working as a front of house supervisor in training for Soaring Food Group, applicant sustained a cumulative injury during a 3-month period ending on June 18, 2024, in the form of stress and high blood pressure due to enduring harassment at work." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 53, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On August 8, 2025, applicant filed a DOR, requesting a hearing to address the status of the claim." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 54, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "At the subsequent hearing, the parties noted on the minutes that settlement was pending." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 55, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 23, 2026, the parties filed a C&R, which purported to settle the matter for $20,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 56, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The parties filed two reports from a qualified medical evaluator (“QME”) with the C&R." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 57, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Applicant was assigned a GAF score of 60, but was not yet permanent and stationary." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 58, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The QME found predominant industrial causation of 60% due to alleged harassment of a supervisor." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 59, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The QME noted in a supplemental report that applicant reported a diagnosis of hypertension during a recent emergency room visit, but that no medical records were provided for review." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 60, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The QME deferred to an internal medicine specialist on the issue of hypertension." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 61, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R noted that defendant maintained its denial of the claim pursuant to section 3208.3 because applicant worked less than six months." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 62, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 23, 2026, the WCJ issued an OSA, which stated, in pertinent part: The C&R is for $20,000.00 to resolve a 3 month psychiatric CT claim which may also be based on good faith personnel actions (termination for theft)." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 63, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "No exceptions appear to apply to overcome the minimum 6-month rule." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 64, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The parties shall provide an explanation as to why this case is not being dismissed, as opposed to being settled for $20,000.00. * * * The parties should agree to an internal PQME to determine if applicant’s 3 months of work at this employer has caused or aggravated a hypertension condition." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 65, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "If applicant does not have hypertension, or the claim is being withdrawn, please indicate that the applicant is dismissing her claim with prejudice as to the hypertension." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 66, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "If not, parties need to conduct discovery on the hypertension claim." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 67, "src_page": 5, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Order Suspending Action on Compromise and Release, ADJ20198453, January 23, 2026, p. 1.) The WCJ, in essence, requested detailed substantial medical evidence to support the adequacy of the C&R." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 68, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Dayvion Scott – ADJ21614143 On October 6, 2025, applicant filed an Application, alleging that while working as a delivery associate for Amplio Logistics, applicant sustained an injury on December 2, 2024, to the right knee, head, toes, left arm, and left foot, due to a trip and fall accident." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 69, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On November 21, 2025, defendant filed an answer, denying injury due to the post-termination defense." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 70, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 23, 2026, the parties filed a C&R, which purported to settle the matter for $15,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 71, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 26, 2026, the WCJ issued an OSA requesting any and all medical evidence establishing injury." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 72, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ stated in the OSA: If applicant had a traumatic injury, there must be some medical evidence, and claiming a head injury as well may involve a traumatic brain injury that needs investigation to determine if the settlement is adequate." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 73, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "If there are no medical reports on file and no treatment for 13 months, please provide an explanation of why applicant is receiving $15,000 and not dismissing the claim with prejudice entirely." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 74, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Order Suspending Action on Compromise and Release, ADJ21614143, January 26, 2026.) The WCJ further requested information on third party lawsuits, witness statements, and justification for attorney’s fees. 5." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 75, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Dioselin Contreras – ADJ21696812 On October 23, 2025, applicant filed an Application, alleging that while working as a ship dock for Amazon, applicant sustained a cumulative injury during the period ending on October 15, 2025, to the back, psyche and in the form of headaches due to enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 76, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 9, 2026, the parties filed a C&R, which purported to settle the matter for $30,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 77, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "In a letter filed with the C&R, defendant alleged that applicant wished to settle her claim and forego examination by a QME." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 78, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 9, 2026, the WCJ issued an OSA requesting medical evidence in support of the C&R, information on any civil lawsuits, and justification for the requested 15% attorney’s fee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 79, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Thereafter, the parties filed relevant medicals. 6." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 80, "src_page": 6, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Noelle Flora – ADJ21685023 On October 21, 2025, applicant filed an Application, alleging that while working as a veterinary assistant for Santa Maria Animal Hospital, applicant sustained a cumulative injury" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 81, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "7 during the period ending on September 19, 2025, to the psyche and in the form of headaches due to enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 82, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 20, 2026, defendant filed an answer, which denied injury due to a lack of substantial medical information and due to the post-termination defense." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 83, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 10, 2026, the parties filed a C&R, which purported to settle the matter for $11,700.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 84, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 10, 2026, the WCJ issued an OSA requesting medical evidence in support of the C&R, information on any written or recorded statements including depositions, and justification for the requested 15% attorney’s fee. 7." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 85, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Joseph Juarez – ADJ209429695 On May 15, 2025, applicant filed an Application, alleging that while working as a business manager for Bambee, Inc., applicant sustained a cumulative injury during the period ending on May 2, 2025, to the psyche due to enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 86, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On October 15, 2025, the parties filed a C&R, which purported to settle the matter for $15,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 87, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On October 17, 2025, the WCJ issued an OSA requesting medical evidence in support of the C&R and justification for the requested 15% attorney’s fee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 88, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 26, 2026, the parties filed an amended C&R along with a joint cover letter." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 89, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The parties presented a lien waiver from EDD." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 90, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "They alleged that applicant did not wish to pursue his claim." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 91, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Applicant’s attorney filed a letter regarding the work that they performed to justify a request for a 15% fee award." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 92, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 26, 2026, the WCJ issued a “Second Order Suspending Action on Compromise and Release,” wherein the WCJ requested medical reporting to establish adequacy of the settlement. 5 The WCJ’s Report, which was served upon applicant at his address contained on the C&R, was returned to the Appeals Board as undeliverable." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 93, "src_page": 7, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Upon return the parties may wish to confirm applicant’s correct address." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 94, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Michelle Horna Alcantara – ADJ20164163 On November 26, 2024, applicant filed an Application, alleging that while working as a restorative nursing assistant for White Blossom Care Center, applicant sustained a cumulative injury during the period ending on October 8, 2024, to the back and the psyche due to experiencing a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 95, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendant filed an answer denying compensability based upon a lack of medical, post-termination defense, and the statute of limitations." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 96, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 2, 2026, the parties filed a C&R, purporting to settle the matter for $14,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 97, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The parties alleged via a cover letter that applicant did not wish to see any doctor relating to the case." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 98, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 4, 2026, the WCJ issued an OSA requesting medical evidence to establish adequacy and suggesting that applicant dismiss the case with prejudice absent such evidence. 9." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 99, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Isidro Fernandez – ADJ21889871 On December 4, 2025, applicant filed an Application, alleging that while working as a small engine mechanic for Haynes Sales, applicant sustained a cumulative injury during the period ending on November 15, 2024, to the feet, back, knees, shoulders, and psyche." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 100, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 4, 2026, defendant filed an answer denying liability based, in part, upon a lack of substantial medical evidence and due to a post-termination filing." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 101, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 23, 2026, the parties filed a C&R, which purported to settle the matter for $30,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 102, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 24, 2026, the WCJ issued an OSA requesting relevant medical records and justification for the requested attorney’s fee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 103, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ suggested that applicant dismiss his case with prejudice if he did not want to obtain a medical evaluation. 10." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 104, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Reynaldo Duar, Jr. – ADJ21188642, ADJ21188644 On July 7, 2025, applicant filed an Application, alleging that while working as a driver for Lyft, applicant sustained a specific and a cumulative injury to multiple body parts." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 105, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 4, 2026, the parties filed a C&R that purported to settle the matter for $4,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 106, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The parties provided a cover letter alleging that a Lyft driver is deemed an independent contractor by operation of law, which was the basis for their settlement." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 107, "src_page": 8, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ issued an OSA requesting medical records and noted: “In the absence of medical evidence, applicant may confirm in writing a request to dismiss the case, with prejudice, or confirm" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 108, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "9 in writing that he/she is withdrawing his/her Application for Adjudication of Claim.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 109, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Joint Order Suspending Action on Compromise and Release, ADJ21188642, ADJ21188644, March 5, 2026.) 11." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 110, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Maribel Castro – ADJ20858628, ADJ20858629 On April 28, 2025, applicant filed an Application, alleging that while working as a general laborer for Atlas Vineyard, applicant sustained a specific and a cumulative injury to the back and right knee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 111, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 9, 2026, the parties filed a C&R, which purported to settle the matters for $15,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 112, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The parties included a cover letter alleging that defendant had not received any medicals to date." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 113, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The letter does not state whether applicant was in possession of medicals." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 114, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 17, 2026, the WCJ issued an OSA requesting medical reporting and justification of the requested attorney’s fees. 12." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 115, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Matthew Scott – ADJ21048684, ADJ22360616 On June 6, 2025, applicant filed an Application, alleging that while working as a “team member” for CG Hospitality Group, Inc., applicant sustained an injury on May 13, 2025 to the left finger." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 116, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 16, 2026, the parties filed a C&R, which included another specific injury of May 31, 2025, to the arm and elbow." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 117, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R purported to settle both cases for $10,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 118, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "That same day the WCJ issued an OSA requesting medical reporting in support of the C&R and additional justification for the requested attorney’s fee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 119, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Absent the filing of medical reporting, the WCJ suggested that applicant dismiss his case with prejudice. 13." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 120, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Travone Fouse – ADJ21482032 On September 8, 2025, applicant filed an Application, alleging that while working as a package handler for FedEx, applicant sustained a cumulative injury during the period ending on June 18, 2009, to multiple body systems." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 121, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On November 4, 2025, defendant filed an answer denying liability based, in part, on the statute of limitations and post-termination defense." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 122, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 3, 2026, the parties filed a C&R, which purported to settle the matter for $5,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 123, "src_page": 9, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 6, 2026, the WCJ issued an OSA requesting additional information on whether the case would be barred by the statute of limitations, all supporting medical records," }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 124, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "10 justification of the requested attorney’s fee, and an explanation for how this claimed cumulative injury fit with other pending claims on file." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 125, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Applicant responded the next day, in part, alleging that multiple cumulative injury claims were filed against different employers because the period of injurious exposure had not yet been established.6 14." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 126, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Winsdtonsg Tercero – ADJ21634106, ADJ22363907 On October 9, 2025, applicant filed an Application, alleging that while working as a general laborer for Maersk A.S., applicant sustained a cumulative injury during the period ending on August 5, 2025, to multiple body parts, including psyche due to enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 127, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On January 7, 2026, defendant filed an answer denying liability, in part, based upon the statute of limitations, post-termination defense, and lack of substantial medical evidence establishing injury." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 128, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 17, 2026, the parties filed a C&R that purported to settle the matter for $25,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 129, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R also included a previously unpled specific injury." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 130, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "That same day, the WCJ issued an OSA which requested, in pertinent part, medical evidence in support of the C&R and justification of the requested attorney’s fee. 15." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 131, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Ernesto Ramos – ADJ21749294 On November 3, 2025, applicant filed an Application, alleging that while working as a scare actor for NBC Universal, Inc., applicant sustained an injury on November 11, 2025, to the head and psyche due to a guest assault." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 132, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 12, 2026, the parties filed a C&R, which purported to settle this matter for $37,500.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 133, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R notes that the claim of injury to the psyche was denied." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 134, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 23, 2026, the WCJ issued an OSA, suggesting that applicant voluntarily dismiss his case if he did not wish to proceed with a medical evaluation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 135, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "The WCJ also requested justification for the requested attorney’s fee. 6 Pursuant to section 5500.5, all employers in a single cumulative injury are to be joined in a single action." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 136, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "While applicant is free to settle against one employer and pursue their claim against the others (§ 5500.5(c)), the employers must be joined in a single case as they have the right to be notified of any election or settlements made." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 137, "src_page": 10, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Upon return, the WCJ may consider consolidating these cases into a single case, and dismissing the other cases, without prejudice, as they appear to be duplicative." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 138, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Tevon McAfee – ADJ20959336 On May 19, 2025, applicant filed an Application, alleging that while working as a damage locator for Utiliquest LLC, applicant sustained a cumulative injury during the period ending on April 24, 2021, to multiple orthopedic and internal body parts, including the psyche." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 139, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On November 17, 2025, defendant filed an answer denying liability, in part, on the post-termination defense and statute of limitations." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 140, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 3, 2026, the parties filed a C&R, which purported to settle the matter for $22,500.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 141, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On February 6, 2026, the WCJ issued an OSA requesting information on why the case would be barred, medical records supporting adequacy, and justification of attorney’s fees." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 142, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ suggested that applicant dismiss his case with prejudice if medical evidence was not submitted. 17." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 143, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Jose Alberto Morales Beltran – ADJ20124756, ADJ20124744, ADJ20012968 On November 18, 2024, applicant filed three Applications, alleging that while working as a janitor / housekeeping for Rehabilitation Centers of Santa Monica, applicant sustained a cumulative injury during the period ending on August 26, 2024, to the psyche due to enduring a hostile work environment; a specific injury to the fingers; and a separate cumulative injury to both the hands and fingers." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 144, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "It appears that applicant was evaluated by a QME, who diagnosed applicant with bilateral wrist pain, ankle pain, and hand numbness." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 145, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "It further appears that the QME requested additional diagnostic studies to determine whether applicant’s conditions were industrial." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 146, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 5, 2026, the parties filed a C&R, which purported to settle all three of the matters for $30,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 147, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R appears to be a global settlement between all defendants as the employer had multiple insurers during the last year of claimed cumulative trauma exposure." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 148, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 6, 2026, the WCJ issued an OSA and requested additional medical records noting that the QME only addressed one of the three cases at issue and that a medical treatment lien was filed, indicating the probability of additional reporting." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 149, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The OSA, stated, in part: “If there are no medicals for these body parts/claims, please confirm in writing that applicant requests to dismiss those claims/body parts, with prejudice.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 150, "src_page": 11, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Order Suspending Action on Compromise and Release, ADJ20124756, ADJ20124744, ADJ20012968, March 6, 2026.)" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 151, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Edgar Gonzalez – ADJ21207947 On July 10, 2025, applicant filed an Application, alleging that while working as a welder and manufacturer for Houston Manufacturing and Installation, applicant sustained a cumulative injury during the period ending on June 25, 2025, to the psyche due to enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 152, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 24, 2026, the parties filed a C&R, which purported to settle this matter for $20,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 153, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendant filed a cover letter with the C&R alleging that the claim was denied due to the post-termination defense and that no QME evaluation had occurred." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 154, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "That same day the WCJ issued an OSA requesting that the parties file relevant medical reports and stating that applicant should dismiss the case absent the production of medical records." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 155, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ further requested justification of the requested attorney’s fees. 19." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 156, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Alexandra Flores – ADJ21044279 On June 5, 2025, applicant filed an Application, alleging that while working as a HR assistant for Rescare Training Technologies, Inc.,7 applicant sustained a cumulative injury during the period ending on September 30, 2024, to the psyche." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 157, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On July 30, 2025, defendant filed an answer noting that the case was on delay status." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 158, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 9, 2026, the parties filed a C&R, which purported to settle the case for $15,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 159, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R included the additional body parts of spine, bilateral upper extremities, hands, feet, and “internal.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 160, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R stated that the parties wished to forego the QME process." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 161, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 10, 2026, the WCJ issued an OSA requesting that the parties provide relevant medical records and suggesting that applicant dismiss her case with prejudice if medicals were not obtained." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 162, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ further requested documentation to establish the requested attorney’s fee. 20." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 163, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Michaeline Ponce de Leon – ADJ21778179 On November 10, 2025, applicant filed an Application, alleging that while working as a dispatch officer for Patrol Net, applicant sustained a cumulative injury during the period ending on October 14, 2025, to the psyche due to experiencing a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 164, "src_page": 12, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On December 5, 2025, defendant filed an answer denying liability for injury on the grounds that no medical evidence supported such a finding. 7 Although the Application lists the employer as Rescare Training Technologies, Inc., the C&R identifies the employer as Brightspring Health Services." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 165, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "13 On February 27, 2026, the parties filed a C&R, which purported to settle the matter for $7,500.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 166, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendant filed a cover letter alleging that no medicals existed and that the parties simply wished to buy their peace." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 167, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 12, 2026, the WCJ issued an OSA requesting that the parties provide relevant medical records and suggesting that applicant dismiss her case with prejudice if medicals were not obtained." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 168, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ further requested documentation to establish the requested attorney’s fee. 21." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 169, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Raquel Cruz – ADJ22017487 On January 2, 2026, applicant filed an Application, alleging that while working as a packager for Partners Personnel, applicant sustained a cumulative injury during the period ending on November 7, 2025, to the right fingers and right wrist.8 On April 1, 2026, the parties filed a C&R, which purported to settle the matter for $10,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 170, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Defendant filed a cover letter alleging that the parties wished to buy their peace." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 171, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On April 1, 2026, the WCJ issued an OSA requesting, amongst other items, that the parties provide relevant medical records and suggesting that applicant dismiss her case if medicals were not obtained." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 172, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ further requested documentation to establish the requested attorney’s fee. 22." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 173, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Mayno Hernandez Quevedo – ADJ21397889 On August 19, 2025, applicant filed an Application, alleging that while working as a chauffeur9 for Capitol Tent City Corp., applicant sustained a cumulative injury during the period ending on July 11, 2025, to the head, back, and psyche while enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 174, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 20, 2026, the parties filed a C&R, which purported to settle the matter for $20,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 175, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On April 7, 2026, the WCJ issued an OSA requesting, amongst other items, that the parties provide relevant medical records and suggesting that applicant dismiss the case if medicals were not obtained." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 176, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ further requested documentation to establish the requested attorney’s fee. 23." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 177, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Violeta Bardales - ADJ21954446, ADJ22397441 On December 18, 2025, applicant filed an Application, alleging that while working as a “staffing variable” for Amazon, applicant sustained a cumulative injury during the period ending 8 On February 27, 2026, applicant filed an amended Application to join the employer, Partners Personnel, and to dismiss Weee Logistics, LLC, and Zurich Insurance Company." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 178, "src_page": 13, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Yet, the C&R identifies the employer as Weee Logistics, LLC, and the insurer as Liberty Mutual Insurance Corporation. 9 While both the Application and amended Application indicate applicant was a “chauffeur,” the C&R filed by the parties lists applicant’s occupation as a tent installer." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 179, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "14 on November 25, 2025, to the head, circulatory system, endocrine system, left wrist, left arm, and psyche while enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 180, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 24, 2026, the parties filed a C&R, which purported to settle the matter for $35,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 181, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R included an additional specific injury claim to the hand and wrist." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 182, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On March 24, 2026, the WCJ issued an OSA requesting, amongst other items, that the parties provide relevant medical records and suggesting that applicant dismiss the cases if medicals were not obtained." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 183, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ further requested documentation to establish the requested attorney’s fee and information on any civil lawsuits filed. 24." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 184, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "Priscilla Iman - ADJ22246435 On February 20, 2026, applicant filed an Application, alleging that while working as a licensed vocational nurse for 7th Avenue Center, LLC, applicant sustained a cumulative injury during the period ending on August 9, 2025, to the head, circulatory system, and psyche while enduring a hostile work environment." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 185, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "On April 14, 2026, the parties filed a C&R, which purported to settle the matter for $15,000.00." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 186, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The C&R stated, in pertinent part: “THIS SETTLEMENT IS NOT BASED ON A FINAL REPORT, AS THERE ARENT ANY MEDS." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 187, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "ITS BASED ON A COMPROMISE BETWEEN THE PARTIES TO SETTLE A DENIED, AOE-COE CLAIM, WHERE EVERYONE WANTS TO BUY THEIR PEACE.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 188, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "(Compromise and Release, ADJ22246435, p. 6, all capitals in original.) On April 14, 2026, the WCJ issued an OSA requesting, amongst other items, that the parties provide relevant medical records and suggesting that applicant dismiss the case with prejudice if medicals were not submitted." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 189, "src_page": 14, "status": "excluded", "reason": "facts of the twenty-four consolidated cases", "matched_section": null, "text": "The WCJ further requested documentation to establish the requested attorney’s fee." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 190, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 21.8", "text": "Basis for Removal “The appeals board may appoint one or more workers’ compensation administrative law judges in any proceeding, as it may deem necessary or advisable, and may refer, remove to itself, or transfer to a workers’ compensation administrative law judge the proceedings on any claim.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 191, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 21.8", "text": "(§ 5310.) Removal is an extraordinary remedy rarely exercised by the Appeals Board." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 192, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2006) 136 Cal.App.4th 596, 599, fn. 5 [71 Cal.Comp.Cases 155]; Kleemann v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 193, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 21.9", "text": "(2005) 127 Cal.App.4th 274, 280, fn. 2 [70 Cal.Comp.Cases 133].) “Consolidation may be ordered by the Workers’ Compensation Appeals Board (“WCAB”) on its own motion[.]”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 194, "src_page": 15, "status": "excluded", "reason": "application (consolidation of these cases)", "matched_section": null, "text": "Code Regs., tit. 8, § 10396(b).) Here, consolidation is appropriate as these matters involve common issues of fact and law, and consolidation avoids the issuance of duplicate or inconsistent orders and promotes the efficient use of judicial resources by deciding these matters in a single proceeding." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 195, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "Code Regs., tit. 8, § 10396(a).) Decisions of the Appeals Board “must be based on admitted evidence in the record.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 196, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc).) Furthermore, decisions of the Appeals Board must be supported by substantial evidence." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 197, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(§§ 5903, 5952(d); Lamb v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 198, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 199, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 200, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "(1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) An adequate and complete record is necessary to understand the basis for the WCJ’s decision." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 201, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "Code Regs., tit. 8, § 10787.) All parties to a workers’ compensation proceeding retain the fundamental right to due process and a fair hearing under both the California and United States Constitutions." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 202, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "(2000) 82 Cal.App.4th 151, 157–158 [65 Cal.Comp.Cases 805].) “Due process requires notice and a meaningful opportunity to present evidence in regards to the issues.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 203, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2005) 127 Cal.App.4th 625, 635, fn. 22 [70 Cal.Comp.Cases 312]; see also Fortich v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 204, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "(1991) 233 Cal.App.3d 1449, 1452–1454 [56 Cal.Comp.Cases 537].) Section 5702 states that: The parties to a controversy may stipulate the facts relative thereto in writing and file such stipulation with the appeals board." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 205, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "The appeals board may thereupon make its findings and award based upon such stipulation, or may set the matter down for hearing and take further testimony or make the further investigation necessary to enable it to determine the matter in controversy." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 206, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "(§ 5702.) When a settlement is submitted for approval, it is submitted as a stipulation that is signed by all parties, with a joint request that the stipulation be approved." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 207, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "(§ 5702.) There is generally no issue of due process when a WCJ approves a joint request of the parties." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 208, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "16 intends to reject a settlement or requires additional information before approving a settlement, the WCJ must provide adequate due process, which includes notice and an opportunity to be heard." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 209, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "Pursuant to section 5702, the WCJ may seek further information or may set a hearing." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 210, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "After reviewing a proposed settlement, the WCJ may issue an OSA." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 211, "src_page": 16, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code Regs., tit. 8, § 10700(b); Cal." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 212, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 16.9", "text": "Code Regs., tit. 8, § 10789(e) [“A workers’ compensation judge who is presented with a walk-through settlement document shall approve it, disapprove it, suspend action on it, or accept it for later review and action.”].) An OSA more commonly issues where a minor error has occurred, which can be easily corrected without a formal hearing." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 213, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "In such a case, the OSA operates in a similar manner as a notice of intent." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 214, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "Code Regs., tit. 8, § 10832.) This is generally an accepted practice, particularly since workers’ compensation proceedings have traditionally proceeded with a degree of informality." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 215, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "(§§ 5708, 5709.) However, an evidentiary hearing should be set where the terms of the agreement are unclear, contradictory, include provisions that are outside the Labor Code, the concern over adequacy is significant, and / or the parties fail to provide a sufficient response to the OSA." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 216, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "Workers’ compensation does not permit judgment on the pleadings." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 217, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "Code Regs., tit. 8, § 10515.) A WCJ cannot look beyond the settlement itself or the record of proceedings in determining adequacy." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 218, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "Code Regs., tit. 8, § 10803.) The Appeals Board cannot review the adequacy of a settlement without a formal record." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 219, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 21.9", "text": "(See generally, Hamilton, supra.) Accordingly, where no formal record exists, upon receipt of a petition for removal or reconsideration of an OSA, and consistent with WCAB Rules 10955 and 10961, the WCJ may vacate the OSA and set the matter for an evidentiary hearing." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 220, "src_page": 16, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "Code Regs., tit. 8, §§ 10955(d), 10961.) Here, each of these cases concerns an OSA issued by the same WCJ." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 221, "src_page": 16, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "The reasons the OSA has issued in each case are similar, and the OSAs go far beyond simply seeking additional information." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 222, "src_page": 16, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "For example, the WCJ has given ultimatums to applicants to either obtain a medical evaluation or to dismiss their case." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 223, "src_page": 16, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "The WCJ issued the orders without providing the parties with notice or an opportunity to be heard." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 224, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 21.8", "text": "This violates the parties’ due process rights, which constitutes irreparable harm and thus, removal is warranted." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 225, "src_page": 16, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "Furthermore, as detailed below, the conduct of the WCJ in these matters warrants disqualification and the reasons warranting disqualification are also similar." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 226, "src_page": 16, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "Accordingly, we will grant the Petitions for Removal and order consolidation of these matters." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 227, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "A workers’ compensation settlement is only enforceable after approval by the Workers’ Compensation Appeals Board." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 228, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "In approving a settlement, a WCJ must consider whether the agreement is valid and must determine whether the settlement is adequate in order to protect the injured worker and the public interest." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 229, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "Section 5001 states in pertinent part that “[n]o release of liability or compromise agreement is valid unless it is approved by the appeals board or referee.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 230, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "Section 5003 states that every C&R shall contain the following information: (a) The date of the accident." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 231, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(b) The average weekly wages of the employee, determined according to Chapter 1 of Part 2 of this division." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 232, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(c) The nature of the disability, whether total or partial, permanent or temporary." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 233, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(d) The amount paid, or due and unpaid, to the employee up to the date of the release or agreement or death, and the amount of the payment or benefits then or thereafter to be made." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 234, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(e) The length of time such payment or benefit is to continue." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 235, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(f) In the event a claim of lien under subdivision (f) or (g) of Section 4903 has been filed, the number of days and the amount of temporary disability indemnity which should be allowed to the lien claimant." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 236, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "(§ 5003.) It has long been held that a C&R must provide fair compensation to the injured worker equivalent to what the injured worker would expect to receive from an award: A tort release is effective upon execution, but a compromise and release of workmen’s compensation liability is invalid until approved by the Workmen’s Compensation Appeals Board." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 237, "src_page": 17, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code, § 5001; see Chavez v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 238, "src_page": 17, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1958) 49 Cal.2d 701, 702 [321 P.2d 449].) . . ." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 239, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "This inquiry by the referee should carry out the legislative objective of “protecting workmen who might agree to unfortunate compromises because of economic pressure or lack of competent advice.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 240, "src_page": 17, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "Com., supra, 49 Cal.2d at p. 702.) These safeguards against improvident releases place a workmen’s compensation release upon a higher plane than a private contractual release; it is a judgment, with “the" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 241, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "18 same force and effect as an award made after a full hearing.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 242, "src_page": 18, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Raischell & Cottrell, Inc. v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 243, "src_page": 18, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1967) 249 Cal.App.2d 991, 997 [58 Cal.Rptr. 159].) (Johnson v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 244, "src_page": 18, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1970) 2 Cal.3d 964, 973 [35 Cal.Comp.Cases 362]; see also, Camacho v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 245, "src_page": 18, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "Target (2018) 24 Cal.App.5th 291, 301-302 [83 Cal.Comp.Cases 1014].) In addition to the protection of injured workers, another purpose of adequacy review is to protect the public interest." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 246, "src_page": 18, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Department of Rehabilitation v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 247, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "(2003) 30 Cal.4th 1281, 1286 [68 Cal.Comp.Cases 831] [“The purpose of an award is not to make the employee whole for the loss which he or she has suffered, but to prevent the employee and his or her dependents from becoming public charges during the period of disability.”].) Workers’ compensation was created, in part, to prevent an injured worker from becoming a public ward." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 248, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "(Ibid.) Where benefits are due, they should be paid and the WCJ should ensure that payable benefits are not inappropriately shifted onto public systems, for example, Medicare, Medi-Cal, EDD, and Social Security." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 249, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "Adequacy review has the dual purpose of ensuring that an injured worker is appropriately paid benefits, which in turn benefits the public." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 250, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "WCAB Rule 10700 states, in pertinent part: (b) The Workers’ Compensation Appeals Board shall inquire into the adequacy of all Compromise and Release agreements and Stipulations with Request for Award, and may set the matter for hearing to take evidence when necessary to determine whether the agreement should be approved or disapproved, or issue findings and awards." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 251, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "(c) Agreements that provide for the payment of less than the full amount of compensation due or to become due and undertake to release the employer from all future liability will be approved only where it appears that a reasonable doubt exists as to the rights of the parties or that approval is in the best interest of the parties." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 252, "src_page": 18, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code Regs., tit. 8, § 10700(b)." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 253, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "The WCAB’s jurisdiction is over claims for benefits provided in the Labor Code, and the WCAB has jurisdiction to approve settlement of claims for benefits that are provided by the Labor Code." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 254, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "The injured worker must have knowledge of each of the benefits that they may be entitled to, and they must intend to release those claims for benefits." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 255, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "Mere execution of the form is not sufficient." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 256, "src_page": 18, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(Camacho, supra, 24 Cal.App.5th at p. 301.) The preprinted form does not release claims that are outside of workers’ compensation, and even if a separate document is executed by the parties, the WCAB cannot approve a settlement of claims that are outside of the Labor Code." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 257, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "19 To determine whether benefits are adequately paid, a WCJ requires information." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 258, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "The WCJ may not simply approve any settlement filed." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 259, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "The WCJ must independently review the settlement and determine that the settlement is adequate." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 260, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "A proposed contract to settle a claim is in lieu of an award of compensation and the WCAB must determine whether it is valid." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 261, "src_page": 19, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "(§§ 5000-5003.) Contract principles apply to settlements of workers’ compensation disputes, and “[t]he legal principles governing compromise and release agreements are the same as those governing other contracts.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 262, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(Yount) (1982) 134 Cal.App.3d 929, 935 [47 Cal.Comp.Cases 832].) “For a compromise and release agreement to be effective, the necessary elements of a contract must exist, including an offer of settlement of a disputed claim by one of the parties, and an acceptance by the other." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 263, "src_page": 19, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code, §§ 1550, 1565, 1580; German Sav. & Loan Soc. v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 264, "src_page": 19, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "McLellan (1908) 154 Cal. 710, 716; Sackett v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 265, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "Starr (1949) 95 Cal.App.2d 128, 133.) “A contract must be so interpreted as to give effect to the mutual intention of the parties as it existed at the time of contracting, so far as the same is ascertainable and lawful." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 266, "src_page": 19, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(County of San Joaquin v." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 267, "src_page": 19, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Workers’ Compensation Appeals Bd." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 268, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "(Sepulveda) (2004) 117 Cal.App.4th 1180, 1184 [69 Cal.Comp.Cases 193].) Thus, where the terms of the agreement are unclear or contradictory, or include provisions that are outside the Labor Code, the issue is whether a true contract has been formed." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 269, "src_page": 19, "status": "excluded", "reason": "substance printed at §§ 19.2–19.3", "matched_section": null, "text": "As explained in the next section, when the WCJ determines that the terms of the settlement document are at issue and / or when issues of adequacy arise, the WCJ should set the matter for a hearing." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 270, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "Where the terms of the settlement are inconsistent, do not comply with the Labor Code, and / or are inadequate, the WCJ may investigate by issuing an order suspending action, and if the parties do not provide sufficient information, the WCJ may hold a hearing to create an evidentiary record that establishes the adequacy of a settlement." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 271, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "We emphasize that how much information is required to support adequacy will depend on the facts of each individual case." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 272, "src_page": 19, "status": "excluded", "reason": "transition", "matched_section": null, "text": "Some cases may involve fact patterns that are easily ascertainable." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 273, "src_page": 19, "status": "excluded", "reason": "transition", "matched_section": null, "text": "Others may be more complex." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 274, "src_page": 19, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "The WCJ reviewing adequacy is considering a multitude of issues," }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 275, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "20 including valuation of future medical treatment, temporary disability, permanent disability, a supplemental job displacement voucher, and death benefits." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 276, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "The WCJ may also consider threshold issues as to whether compensation is due, such as employment, the statute of limitations, and affirmative defenses." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 277, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "The fact that an injured worker may wish to forego litigation and settle their claim provides no information to the WCJ as to how the claim should be valued." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 278, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "If the parties fail to provide enough information, they should expect approval of their settlement to be delayed so that the WCJ may obtain the necessary information either through issuance of an OSA, or through a formal hearing." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 279, "src_page": 20, "status": "excluded", "reason": "application", "matched_section": null, "text": "Here, the WCJ requested that the parties file relevant medical records for the WCJ to review." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 280, "src_page": 20, "status": "excluded", "reason": "application", "matched_section": null, "text": "This was appropriate as it is required by regulation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 281, "src_page": 20, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "Code Regs., tit. 8, § 10700(a) [“When filing a Compromise and Release or a Stipulations with Request for Award, the filing party shall file all agreed medical evaluator reports, qualified medical evaluator reports, treating physician reports, and any other [medical records] that are relevant to a determination of the adequacy of the Compromise and Release or Stipulations with Request for Award that have not been filed previously.”]; Cal." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 282, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "Code Regs., tit. 8, § 10789(b)(1) [“[A]ll supporting medical reports and other supporting documents not previously filed, shall be filed directly with the workers’ compensation judge at the date and time of the walk-through.”].) Parties should file supporting, relevant medicals at the time they file a settlement." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 283, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "Parties may not withhold relevant medical records and / or either intentionally or negligently misrepresent that no such medical records exist." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 284, "src_page": 20, "status": "excluded", "reason": "application", "matched_section": null, "text": "Many of the cases involved here have little to no information provided as to how settlement was valued." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 285, "src_page": 20, "status": "excluded", "reason": "substance printed at §§ 19.3–19.4", "matched_section": null, "text": "In such cases, a WCJ should request additional information to assist in determining adequacy." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 286, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "In addition to providing relevant medical reporting, the parties may wish to provide a statement from applicant, witness statements, depositions, recorded video of an injury, claim benefit letters including any denial letter, or any other information that will assist the WCJ in determining adequacy." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 287, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "However, it is important to emphasize that other than medical reporting which automatically becomes part of the record of proceedings under WCAB Rule 10803 (Cal." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 288, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "Regs., tit. 8, § 10803), any other information provided to the WCJ is not part of the record of proceedings and is not admitted as evidence." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 289, "src_page": 20, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "In particular, WCJs should be mindful that oral statements presented at a walk-through are not part of the court’s record." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 290, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "21 problems, particularly in cases where a party seeks to set aside the settlement, because there is no record to review." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 291, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "Thus, it may be more appropriate to set a hearing and admit such evidence so that the basis for a determination that the settlement is adequate is clear." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 292, "src_page": 21, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "Here, while the WCJ may have properly requested supporting medical evidence in the OSAs, if other information was required, a hearing to admit evidence and create a record is the correct way to proceed." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 293, "src_page": 21, "status": "excluded", "reason": "transition", "matched_section": null, "text": "We now turn to more specific considerations with respect to the WCJ’s approach here." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 294, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 19.6", "text": "One issue raised by the WCJ in these cases is the misconception that substantial medical evidence is required to determine adequacy of a stipulation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 295, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 19.6", "text": "Stipulations exist, in part, to obviate the need for evidence." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 296, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 19.6", "text": "(Weatherall) (2000) 77 Cal.App.4th 1114, 1121 [65 Cal.Comp.Cases 1].) As defined in Weatherall, “A stipulation is ‘An agreement between opposing counsel . . . ordinarily entered into for the purpose of avoiding delay, trouble, or expense in the conduct of the action,’ (Ballentine, Law Dict." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 297, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 19.6", "text": "(1930) p. 1235, col. 2) and serves ‘to obviate need for proof or to narrow range of litigable issues’ (Black’s Law Dict." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 298, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 19.6", "text": "(6th ed. 1990) p. 1415, col. 1) in a legal proceeding.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 299, "src_page": 21, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "(Weatherall, supra, 77 Cal.App.4th at p. 1119, emphasis added.) There is no requirement that substantial medical evidence support a stipulation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 300, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 19.6", "text": "The only requirement for adequacy review is that sufficient information exists in the formal record to support a WCJ’s decision on adequacy." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 301, "src_page": 21, "status": "excluded", "reason": "application", "matched_section": null, "text": "Next, the WCJ, in effect, required the parties to obtain medical evaluations within the text of the OSAs." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 302, "src_page": 21, "status": "excluded", "reason": "transition", "matched_section": null, "text": "This is improper for several reasons." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 303, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 16.9", "text": "First, any order for an applicant to attend an evaluation may only issue after providing notice to the parties." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 304, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 16.9", "text": "Code Regs., tit. 8, § 10832.) No such order may issue within an OSA." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 305, "src_page": 21, "status": "excluded", "reason": "application", "matched_section": null, "text": "Next, and as described above, the WCJ appears to have been operating under the misconception that substantial medical evidence must support the stipulations." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 306, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 19.6", "text": "The parties need only provide relevant information to permit the WCJ to determine adequacy." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 307, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 16.9", "text": "Further, if a medical evaluation is required to determine adequacy, such an evaluation may only be ordered after an evidentiary hearing has occurred, and the WCJ establishes a basis for such an order." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 308, "src_page": 21, "status": "quoted", "reason": null, "matched_section": "§ 16.9", "text": "Sections 4060 et seq. set forth the preferred framework for obtaining medical-legal reporting, and even though it is within the power of the WCJ to order applicant to be examined by a regular physician under section 5701, such procedures are generally used to resolve medical disputes after the parties have proceeded through the ordinary channels of discovery." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 309, "src_page": 21, "status": "excluded", "reason": "application", "matched_section": null, "text": "Many of the settlements proffered in these cases have been entered into prior to the parties proceeding with discovery." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 310, "src_page": 21, "status": "excluded", "reason": "application", "matched_section": null, "text": "If the WCJ had concerns, as a matter of due process, the WCJ should" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 311, "src_page": 22, "status": "excluded", "reason": "application", "matched_section": null, "text": "22 have set the matter for hearing to determine whether enough information exists to determine adequacy absent medical evidence." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 312, "src_page": 22, "status": "excluded", "reason": "application; dismissal rule printed at § 19.3", "matched_section": null, "text": "It was inappropriate under these facts for the WCJ to suggest that a party dismiss their claim with prejudice10 if they do not wish to attend a medical evaluation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 313, "src_page": 22, "status": "excluded", "reason": "context antecedent; rule printed at § 14.9", "matched_section": null, "text": "Another issue raised by the WCJ throughout each of these cases is protecting the interest of the insured defendants from overpaying claims." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 314, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 14.9", "text": "While that goal is noble, that is not within the province of adequacy review." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 315, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 14.9", "text": "If a defendant believes that a claim is filed frivolously or in bad faith, they may file an appropriate petition and seek to recover the costs of litigation." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 316, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 14.9", "text": "Code Regs, tit. 8, § 10421.) If a defendant believes in good faith that a claim may involve fraud, defendant may take appropriate measures to report suspected fraud." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 317, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 19.4", "text": "Code, § 1877.3(b).)11 If there is information in the record that indicates that an insurance company might be overvaluing a claim, that suggests that the settlement is adequate and that the WCJ should approve the settlement." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 318, "src_page": 22, "status": "excluded", "reason": "restatement; Holding No. 1 printed at § 19.1", "matched_section": null, "text": "We again emphasize that the purpose of adequacy review is to protect the injured worker and the public interest." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 319, "src_page": 22, "status": "excluded", "reason": "application", "matched_section": null, "text": "Next, the WCJ requested information on any civil cases that an applicant may have filed." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 320, "src_page": 22, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "This could be appropriate in circumstances where the civil case overlaps with the workers’ compensation case, giving rise to a possible third-party credit, because this informs the court as to the adequacy of a proposed settlement." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 321, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 19.5", "text": "(§§ 3850, et seq.) However, the WCJ’s inquiry should be limited in scope to address the issue of adequacy and whether any third-party credit exists or may exist, and it should take place on the record." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 322, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 19.2", "text": "We again note that the WCJ’s jurisdiction to approve a settlement is only as to those benefits provided by the Labor Code, and a settlement of any claims outside of the Labor Code is not enforceable." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 323, "src_page": 22, "status": "excluded", "reason": "application", "matched_section": null, "text": "Finally, the WCJ raised the issue of the requested attorney’s fee in each case." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 324, "src_page": 22, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "With respect to information relating to an award of attorney’s fees, section 4906, subdivision (a) provides that no “charge, claim, or agreement for legal services . . . is enforceable, valid, or binding in excess of a reasonable amount." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 325, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 26.1", "text": "The appeals board may determine what constitutes a reasonable amount.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 326, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 26.1", "text": "(§ 4906(a).) Attorneys are prohibited from demanding or accepting a fee until the amount is approved by the Appeals Board." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 327, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "(2007) 154 Cal.App.4th 10 We would also note that a dismissal with prejudice is generally reserved for cases that are being dismissed on the merits." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 328, "src_page": 22, "status": "quoted", "reason": null, "matched_section": "§ 24.6", "text": "Where a party seeks dismissal based on reasons other than the merits of litigation, e.g. lack of prosecution, the appropriate order is dismissal without prejudice. 11 Proceedings before the Appeals Board have no bearing upon subsequent criminal proceedings." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 329, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 26.1", "text": "23 1128, 1131 [72 Cal.Comp.Cases 1128].) “The Legislature has thus spoken clearly and decisively that attorney fees in workers’ compensation cases cannot exceed an amount that is ‘reasonable’ and that the WCAB shall be the final arbiter of reasonableness in all cases.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 330, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 26.1", "text": "(Ibid.) A reasonable fee is determined under WCAB Rule 10844, which states: In establishing a reasonable attorney’s fee, the workers’ compensation judge or arbitrator shall consider the: (a) Responsibility assumed by the attorney; (b) Care exercised in representing the applicant; (c) Time involved; and (d) Results obtained." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 331, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 26.6", "text": "Code Regs., tit. 8, § 10844; see § 4906(d).) If the documents presented are sufficient to establish that the requested attorney’s fee is reasonable, the WCJ may award it." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 332, "src_page": 23, "status": "excluded", "reason": "application; rule printed at § 26.6", "matched_section": null, "text": "If not, the WCJ should request additional documentation to establish the requested attorney’s fee in each case, as the WCJ did here." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 333, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 26.6", "text": "When an issue as to the amount of the attorney’s fee arises, the attorney is still entitled to due process to establish the reasonableness of a fee, and any order regarding a disputed fee must be supported by a record." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 334, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 26.6", "text": "If the C&R is found adequate, but the adequacy of the attorney’s fee remains in question, the WCJ may approve the C&R with the requested attorney’s fee held in trust pending a hearing on the issue." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 335, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 26.6", "text": "Thus, if the WCJ does not intend to award the requested fee, the appropriate procedure is to set the matter for a hearing." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 336, "src_page": 23, "status": "excluded", "reason": "application; synthesis printed at § 19.3", "matched_section": null, "text": "In sum, upon return to the district office, the newly assigned WCJ should evaluate settlement adequacy based on whether the parties have provided sufficient information to determine that the proposed settlements adequately protect the interest of the injured worker and the public interest." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 337, "src_page": 23, "status": "excluded", "reason": "substance printed at § 19.3", "matched_section": null, "text": "In doing so, the WCJ must allow the parties meaningful due process." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 338, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "Where the record does not adequately explain the value of the settlement, the WCJ may properly request supporting materials, including relevant medical records, civil case information in limited circumstances, and documentation supporting a request for attorney’s fees, and may delay approval until sufficient information is provided." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 339, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "However, the WCJ may not use an order suspending action to compel medical evaluations, dismissal with prejudice, or a reduction of attorney’s fees without notice, due process, and an appropriate record." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 340, "src_page": 23, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "The governing inquiry is whether the settlement is adequately supported by the information submitted, and if it is not, the" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 341, "src_page": 24, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "24 proper remedy is to develop the record through appropriate procedures, including a hearing to create an evidentiary record." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 342, "src_page": 24, "status": "quoted", "reason": null, "matched_section": "§ 21.10", "text": "Disqualification Section 5311 provides that a WCJ may be disqualified upon any one or more of the grounds specified in Code of Civil Procedure section 641." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 343, "src_page": 24, "status": "quoted", "reason": null, "matched_section": "§ 21.10", "text": "(§ 5311.) Among the grounds for disqualification under section 641 are that the WCJ has “formed or expressed an unqualified opinion or belief as to the merits of the action”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 344, "src_page": 24, "status": "quoted", "reason": null, "matched_section": "§ 21.10", "text": "Proc., § 641(f)) or that the WCJ has demonstrated “[t]he existence of a state of mind … evincing enmity against or bias toward either party.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 345, "src_page": 24, "status": "excluded", "reason": "application (disqualification of this WCJ)", "matched_section": null, "text": "Proc., § 641(g).) Here, in many of the Reports submitted, the WCJ used language which evidences unqualified opinions as to the merits of these cases and the existence of a state of mind evincing bias." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 346, "src_page": 24, "status": "excluded", "reason": "the WCJ's statements below", "matched_section": null, "text": "For example, the WCJ stated: If an allegedly injured [worker] does not want to bother to seek even one medical examination since he/she hired an attorney and filed the claims of injury, so as to address said injury claims, then there is no justification to award any monies at all and the person likely is not injured at all, and instead of dismissing the case with prejudice or ethically withdrawing the Application for Adjudication, the “free cash money handout system” rears its ugly head and rewards this type of behavior by allowing settlements where there is no way to tell if the settlement is adequate. * * * If the person does not have an industrial injury and cannot be bothered to even go to one medical evaluation before or after the case was filed, then applicant is clearly not injured. * * * It is this WCJ’s opinion that the Van Nuys WCAB has become a haven for applicants all over the state who hire an attorney and file in the Van Nuys venue, even when applicant lives in northern California or outside of LA County in general, and it has become a “get rich quick” scheme that this WCJ will no longer participate in." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 347, "src_page": 24, "status": "excluded", "reason": "application (disqualification of this WCJ)", "matched_section": null, "text": "(Report and Recommendation on Petition for Removal, ADJ21320531, p. 3.) The above statements, amongst many others contained in the collective record, clearly warrant disqualification of the WCJ from proceeding in these matters." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 348, "src_page": 24, "status": "excluded", "reason": "application (disqualification of this WCJ)", "matched_section": null, "text": "The WCJ has expressed unqualified opinions, which indicate that the WCJ is biased in proceeding further in evaluating the proposed settlements in these matters." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 349, "src_page": 25, "status": "quoted", "reason": null, "matched_section": "§ 21.10", "text": "25 We would further remind WCJ Karinneh Aslanian that: “Every workers’ compensation administrative law judge shall abide by the Code of Judicial Ethics.”" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 350, "src_page": 25, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code Regs., tit. 8, § 9721.1; Cal." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 351, "src_page": 25, "status": "excluded", "reason": "application to these cases", "matched_section": null, "text": "Ethics, canon 1 [“A judge shall uphold the integrity and independence of the judiciary.”], canon 2 [“A judge shall avoid impropriety and the appearance of impropriety in all of the judge’s activities.”], canon 3 [“A judge shall perform the duties of judicial office impartially, competently, and diligently.”].) Thus, we will order that the WCJ is disqualified in each of these twenty-four cases, and that the PWCJ shall separately appoint a new WCJ in each matter." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 352, "src_page": 25, "status": "excluded", "reason": "preamble to boxed holdings", "matched_section": null, "text": "Conclusion Therefore, we hold that: 1." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 353, "src_page": 25, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "A workers’ compensation settlement is only enforceable after approval by the Workers’ Compensation Appeals Board." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 354, "src_page": 25, "status": "quoted", "reason": null, "matched_section": "§ 19.1", "text": "In approving a settlement, a WCJ must consider whether the agreement is valid and must determine whether the settlement is adequate in order to protect the injured worker and the public interest. 2." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 355, "src_page": 25, "status": "quoted", "reason": null, "matched_section": "§ 19.3", "text": "Where the terms of the settlement are inconsistent, do not comply with the Labor Code, and / or are inadequate, the WCJ may investigate by issuing an order suspending action, and if the parties do not provide sufficient information, the WCJ may hold a hearing to create an evidentiary record that establishes the adequacy of a settlement." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 356, "src_page": 25, "status": "excluded", "reason": "disposition", "matched_section": null, "text": "Accordingly, we grant all the Petitions for Removal and order that these matters be consolidated for an en banc decision." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 357, "src_page": 25, "status": "excluded", "reason": "disposition", "matched_section": null, "text": "As our Decision After Removal, we rescind each of the OSAs, order that the WCJ be disqualified from further proceedings in each case, and thereafter rescind the order of consolidation, and return each case to the PWCJ for reassignment to another WCJ and for further proceedings consistent with this decision." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 358, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "26 For the foregoing reasons, IT IS ORDERED that in each of the following listed cases, the Petitions for Removal filed by applicant are GRANTED." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 359, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "Case Number(s) Applicant Defendant(s) 1." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 360, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ20216367 Calvin Gaines ABM Industries, Inc., PSI 2." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 361, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21320531 Crystal Kelly Amazon Air; Liberty Mutual Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 362, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ20198453 Brittany Johnson Soaring Food Group; Mid Century Ins. 4." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 363, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21614143 Dayvion Scott Amplio Logistics; Starstone National Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 364, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21696812 Dioselin Contreras Amazon.com, Inc.; Liberty Mutual Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 365, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21685023 Noelle Flora Santa Maria Animal Hospital; Preferred Employers Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 366, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ20942969 Joseph Juarez Bambee, Inc.; Hartford Casualty Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 367, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ20164163 Michelle Horna Alcantara Providence Group, Inc.; XL Specialty Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 368, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21889871 Isidro Fernandez Haynes Environmental Services; State Farm Fire and Casualty Co. 10." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 369, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21188642, Reynaldo Duar, Jr." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 370, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "Lyft, Inc., PSI ADJ21188644 11." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 371, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ20858628, Maribel Castro Atlas Vineyard California Grapes ADJ20858629 Co.; Southern Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 372, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21048684 Matthew Scott CG Hospitality Group, Inc.; ADJ22360616 Technology Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 373, "src_page": 26, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21482032 Travone Fouse FedEx Corp., PSI" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 374, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21634106, Winsdtonsg Tercero MVP Payroll Financing, LLC; ADJ22363907 Sunz Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 375, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21749294 Ernesto Ramos NBC Universal Media, LLC; Ace American Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 376, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ20959336 Tevon McAfee Utiliquest Dycom; Liberty Mutual Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 377, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ20124756, Jose Alberto Morales Rehab Center of Santa Monica; ADJ20124744, Beltran Clear Spring Property and Casualty ADJ20012968 Ins. 18." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 378, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21207947 Edgar Gonzalez Houston Mfg. and Installation; Insurance Co. of the West 19." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 379, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21044279 Alexandra Flores Brightspring Health Services; Ace American Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 380, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21778179 Michaeline Ponce de Leon Neighborhood Enhancement Teams, LLC; Hartford Casualty Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 381, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ22017487 Raquel Cruz Weee Logistics, LLC; Liberty Mutual Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 382, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21397889 Mayno Hernandez Capitol Tent City Corp.; Quevedo Pie Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 383, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ21954446, Violeta Bardales Amazon.com, Inc.; ADJ22397441 Liberty Mutual Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 384, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ADJ22246435 Priscilla Iman 7th Avenue Center, LLC; Compwest Ins." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 385, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "IT IS FURTHER ORDERED that per WCAB Rule 10396 (Cal." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 386, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "Code Regs., tit. 8, § 10396), the above listed cases are CONSOLIDATED." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 387, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "IT IS FURTHER ORDERED as the Decision After Removal of the Workers’ Compensation Appeals Board that in each of the above listed cases, the Orders Suspending Action on Compromise and Release are RESCINDED." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 388, "src_page": 27, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "IT IS FURTHER ORDERED that on motion of the Workers’ Compensation Appeals Board, in each of the above listed cases, WCJ Karinneh Aslanian is DISQUALIFIED from further proceedings." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 389, "src_page": 28, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "28 IT IS FURTHER ORDERED that the Order of Consolidation issued herein is RESCINDED." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 390, "src_page": 28, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "IT IS FURTHER ORDERED that each case is RETURNED to the Presiding WCJ to separately assign a new WCJ to each case for further proceedings consistent with this opinion." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 391, "src_page": 28, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD (EN BANC) /s/ KATHERINE A." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 392, "src_page": 28, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ZALEWSKI, CHAIR /s/ JOSÉ H." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 393, "src_page": 28, "status": "excluded", "reason": "signature block", "matched_section": null, "text": "RAZO, COMMISSIONER /s/ KATHERINE WILLIAMS DODD, COMMISSIONER /s/ CRAIG L." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 394, "src_page": 28, "status": "excluded", "reason": "signature block", "matched_section": null, "text": "SNELLINGS, COMMISSIONER /s/ JOSEPH V." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 395, "src_page": 28, "status": "excluded", "reason": "signature block", "matched_section": null, "text": "CAPURRO, COMMISSIONER /s/ PAUL KELLY, COMMISSIONER DATED AND FILED AT SAN FRANCISCO, CALIFORNIA June 24, 2026 SERVICE MADE ON THE ABOVE DATE ON THE PERSONS LISTED ON THE FOLLOWING PAGE AT THEIR ADDRESSES SHOWN ON THE CURRENT OFFICIAL ADDRESS RECORD." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 396, "src_page": 28, "status": "excluded", "reason": "certification", "matched_section": null, "text": "EDL/abs I certify that I affixed the official seal of the Workers’ Compensation Appeals Board to this original decision on this date. abs" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 397, "src_page": 29, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "29 SERVICE LIST CALVIN GAINES CRYSTAL KELLY BRITTANY JOHNSON DAYVION SCOTT DIOSELIN CONTRERAS NOELLE FLORA JOSEPH JUAREZ MICHELLE HORNA ALCANTARA ISIDRO FERNANDEZ REYNALDO DUAR, JR." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 398, "src_page": 29, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "MARIBEL CASTRO MATTHEW SCOTT TRAVONE FOUSE WINSDTONSG TERCERO ERNESTO RAMOS TEVON MCAFEE JOSE ALBERTO MORALES BELTRAN EDGAR GONZALEZ ALEXANDRA FLORES MICHAELINE PONCE DE LEON RAQUEL CRUZ MAYNO HERNANDEZ QUEVEDO VIOLETA BARDALES PRISCILLA IMAN ABRAMSON LABOR GROUP LAW OFFICES OF ROBERT OZERAN BRADFORD & BARTHEL COLEMAN CHAVEZ & ASSOCIATES SCOTT STRATMAN DABBAH, HADDAD & SULEIMAN ACUMEN ALBERT AND MACKENZIE LAW OFFICES OF LYDIA B." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 399, "src_page": 29, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "NEWCOMB FLOYD SKEREN, MANUKIAN & LANGEVIN LAUGHLIN, FALBO, LEVY & MORESI TOBIN LUCKS LAW OFFICES OF MELANIE CLAYMAN LAW OFFICES OF NATALIE KAPLAN BRUNDO LAW EMPLOYER DEFENSE HELMSMAN MANAGEMENT BOBER, PETERSON & KOBY" }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 400, "src_page": 30, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "30 SERVICE LIST LAW OFFICES OF HEYWOOD G." }, { "dec_slug": "gaines-v-abm-aviation-inc-2026-adj20216367-wcab-en-banc", "seq": 401, "src_page": 30, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "FRIEDMAN-THE TOLWIN GROUP, A LEGAL CORPORATION NICHOLAS WEBBER COLANTONI, COLLINS, MARREN, PHILLIPS & TULK HANNA, BROPHY, MACLEAN, MCALEER & JENSEN DAVID JANE & ASSOCIATES NEWHOUSE CREAGER-GODFREY, GODFREY & ORTEGA COMPWEST" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 1, "src_page": 1, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD STATE OF CALIFORNIA TYSON PEREZ, Applicant vs." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 2, "src_page": 1, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "CHICAGO DOGS, LIBERTY MUTUAL INSURANCE COMPANY; HOUSTON ASTROS, ACE AMERICAN INSURANCE COMPANY/ CHUBB as administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants Adjudication Number: ADJ16597333 Santa Ana District Office OPINION AND ORDER GRANTING PETITION FOR RECONSIDERATION (En Banc) To secure uniformity of decisions in the future, the Chair of the Appeals Board, upon a unanimous vote of its members, assigned this case to the Appeals Board as a whole for an en banc decision.1 (Lab." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 3, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code, § 115.) Defendant Chicago Dogs, insured by Liberty Mutual Insurance Company (Chicago Dogs) seek reconsideration of the Findings and Order issued by a workers’ compensation administrative law judge (WCJ) on May 13, 2025." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 4, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "The WCJ found in pertinent part that applicant, while employed as a baseball player, from June 1, 2011 to June 25, 2022, as a baseball player by the Chicago Dogs from May 18, 2018 to July 7, 2018, and the Houston Astros from June 9, 2011 to July 18, 2017, claims to have sustained injury arising out of and in the course of employment to various body parts; that the Chicago Dogs and Liberty Mutual did not waive the objection to 1 En banc decisions of the Appeals Board are binding precedent on all Appeals Board panels and workers’ compensation administrative judges." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 5, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, § 10325; City of Long Beach v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 6, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(Garcia) (2005) 126 Cal.App.4th 298, 316, fn. 5 [70 Cal.Comp.Cases 109]; Gee v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 7, "src_page": 1, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "(2002) 96 Cal.App.4th 1418, 1424, fn. 6 [67 Cal.Comp.Cases 236].) This en banc decision is also adopted as a precedent decision pursuant to Government Code section 11425.60(b)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 8, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "2 personal jurisdiction; and that there is personal jurisdiction by the California Workers’ Compensation Appeals Board over the Chicago Dogs." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 9, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Defendant contends in relevant part that when the WCJ denied their request at trial to have their witness testify electronically, they were significantly prejudiced because they could not present evidence as to their lack of contact(s) with California." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 10, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "As a result, the WCJ’s determination that there is personal jurisdiction over them is not based on a complete record." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 11, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We received an Answer from applicant and from defendant Houston Astros, insured by Ace American Insurance Company (Houston Astros)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 12, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We received a Report and Recommendation from the WCJ, which recommends that we deny the Petition." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 13, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We have considered the Petition for Reconsideration and the Answers and the contents of the Report, and we have reviewed the record in this matter." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 14, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Based upon our preliminary review of the record, we will grant defendant’s Petition for Reconsideration." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 15, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Our order granting the Petition for Reconsideration is not a final order, and we will order that a final decision after reconsideration is deferred pending further review of the merits of the Petition for Reconsideration and further consideration of the entire record in light of the applicable statutory and decisional law." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 16, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Once a final decision after reconsideration is issued by the Appeals Board, any aggrieved person may timely seek a writ of review pursuant to Labor Code section 5950 et seq." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 17, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Former Labor Code2 section 5909 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 18, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Code, § 5909.) Effective July 2, 2024, section 5909 was amended to state in relevant part that: (a) A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 19, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "(b) (1) When a trial judge transmits a case to the appeals board, the trial judge shall provide notice to the parties of the case and the appeals board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 20, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "(2) For purposes of paragraph (1), service of the accompanying report, pursuant to subdivision (b) of Section 5900, shall constitute providing notice. 2 All further statutory references are to the Labor Code, unless otherwise noted." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 21, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "3 Under section 5909(a), the Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 22, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Transmission is reflected in Events in the Electronic Adjudication Management System (EAMS)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 23, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Specifically, in Case Events, under Event Description is the phrase “Sent to Recon” and under Additional Information is the phrase “The case is sent to the Recon board.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 24, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Here, according to Events, the case was transmitted to the Appeals Board on June 13, 2025, and 60 days from the date of transmission is Tuesday, August 12, 2025." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 25, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "This decision is issued by or on Tuesday, August 12, 2025, so that we have timely acted on the Petition as required by section 5909(a)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 26, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Section 5909(b)(1) requires that the parties and the Appeals Board be provided with notice of transmission of the case." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 27, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Transmission of the case to the Appeals Board in EAMS provides notice to the Appeals Board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 28, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Thus, the requirement in subdivision (1) ensures that the parties are notified of the accurate date for the commencement of the 60-day period for the Appeals Board to act on a petition." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 29, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Section 5909(b)(2) provides that service of the Report and Recommendation shall be notice of transmission." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 30, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Here, according to the proof of service for the Report, it was served on June 13, 2025, and the case was transmitted to the Appeals Board on June 13, 2025." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 31, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Service of the Report and transmission of the case to the Appeals Board occurred on the same day." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 32, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Thus, we conclude that the parties were provided with the notice of transmission required by section 5909(b)(1) because service of the Report in compliance with section 5909(b)(2) provided them with actual notice as to the commencement of the 60-day period on June 13, 2025." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 33, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "As relevant here, the WCJ stated in the Report that: The Applicant filed an Application for Adjudication of Claim on August 24, 2022, alleging a cumulative trauma injury while working as a professional baseball player for the Houston Astros from June 1, 2011, to June 25, 2022." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 34, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Applicant filed an Amended Application for Adjudication[] of Claim on April 21, 2023, and May 19, 2023, joining the Chicago Dogs as a party defendant." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 35, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The Chicago Dogs and its carrier, Liberty Mutual, filed a Declaration of Readiness to Proceed seeking adjudication on the sole issue of personal jurisdiction." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 36, "src_page": 3, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The matter was set for a trial on personal jurisdiction over the Chicago Dogs at the Mandatory Settlement Conference on May 23, 2024. . . ." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 37, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "4 At trial, the Chicago Dogs offered a witness statement into evidence." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 38, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Counsel for the Applicant and Co-Defendant, Houston Astros, objected to the witness statement of Trish Zuro because it was not served before the close of discovery and because admitting the written statement into evidence would deprive the parties of their due process to cross-examine the witness (Minutes of Hearing/Summary of Evidence if February 4, 2025 (MOH/SOE), 3: 17 – 19)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 39, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The WCJ denied Chicago Dogs’ request to permit witness Trish Zuro to testify by telephone." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 40, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The Findings and Order, dated May 13, 2025, found that the California Workers’ Compensation Appeals Board may exercise personal jurisdiction over the Chicago Dogs for the Applicant’s alleged cumulative trauma injury claim (Findings and Order, May 13, 2025)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 41, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The WCJ noted: “Defendant’s conduct in obtaining the employment agreement with the Applicant involved multiple contacts within the State of California." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 42, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The Applicant’s unrebutted testimony is that the Chicago Dogs contacted him ten to twelve times in California to secure his employment with the team." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 43, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Chicago Dogs’ team manager, Butch Hobson, called the Applicant while he was in California (MOH, 4: 18 – 20)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 44, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The pitching coach for the Chicago Dogs, Stan, also contacted the Applicant and extended an offer (MOH 4: 24 – 25).” *** Chicago Dogs filed a Petition for Reconsideration, appealing the trial court’s decision not to allow the witness statement into evidence and not allow the witness to testify remotely." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 45, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "However, no stipulation or petition was filed before the trial showing good cause to allow the witness to testify remotely. *** The WCJ did not permit Trish Zuro to testify by telephone because the Chicago Dogs did not file a petition before the trial, showing good cause for why she should be allowed to testify remotely." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 46, "src_page": 4, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "Per CCR 10618(a), “If a witness intends to testify electronically, a petition showing good cause shall be filed pursuant to rule 10510 by the witness or by the party offering the witness's testimony before the hearing, and shall identify the witness and contain the witness's full legal name, mailing address, email address, and telephone number.”3 There was no such petition requesting remote appearance filed in this matter." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 47, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Furthermore, the parties did not stipulate that the witness could testify remotely or that the hearing should be conducted remotely." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 48, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "When the Applicant did not appear at the trial setting on October 22, 2024, the WCJ ordered the Applicant to appear at the next trial date." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 49, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Absent a stipulation agreement between the parties, there would be no rational reason to require the Applicant to appear in person to testify but allow the defense witness to testify remotely." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 50, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "In sum, the WCJ did not find sufficient evidence either that the Chicago Dogs obtained a stipulation to have the witness testify remotely, or that they followed the requirements of CCR 10618(a) and filed 3 In his Report, the WCJ referred to WCAB Rule 10818 (Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 51, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Code Regs., tit. 8, § 10818)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 52, "src_page": 4, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Since the issue is WCAB Rule 10817, we treat this reference as a clerical error." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 53, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "5 a petition before the hearing showing good cause, or that they made some other arrangement to have the witness testify." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 54, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Based on the above, the witness was not allowed to testify remotely." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 55, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "(Report, pp. 2-3, 6.) In its Petition, defendant alleges in pertinent part that: On June 7, 2024, the initial Pre-Trial conference statement was filed and served on all parties." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 56, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The Pre-Trial statement listed the applicant, Tyson Perez, and also Trish Zuro, the Chief Operating Officer of the Chicago Dogs as witnesses, among other individuals." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 57, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "On June 11, 2024, the undersigned served all parties with an affidavit from Trish Zuro." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 58, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "This affidavit was also e-filed with the Santa Ana Workers’ Compensation Appeals Board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 59, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Zuro offered very significant information which indicated the team never operated any offices in California, and never had any games in California." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 60, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Zuro also attested to the fact the applicant never played in any games in California, nor sustained any injuries in California." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 61, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Overall, she attested the team did not have any minimum contacts with California. *** The applicant attorney and co-defendant objected to the testimony and the admission of the affidavit at the Trial date, and after 8 months when the affidavit was previously served to the parties and more than 8 months when the parties were notified on the Pre-Trial Conference statement that Ms." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 62, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Zuro was listed as a witness. *** At Trial, Judge Brennen refused to allow the affidavit of Ms." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 63, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Zuro into evidence and also refused to allow Ms." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 64, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Zuro to testify via phone even though the undersigned informed the WCAB of the failure of any of the parties to object to such prior to the February 4, 2025." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 65, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The undersigned also informed Judge Brennen the testimony was necessary to rebut the applicant’s contentions of minimum contacts of the team with California. . . . *** Ultimately, when the WCAB refused to allow the affidavit into evidence and refused to allow Ms." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 66, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Zuro to testify remotely, the WCAB allowed the applicant to testify to facts which he felt proved the team had minimum contacts with California." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 67, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "The WCAB failed to provide the defendants with the same opportunity by holding the defendants to a different higher standard . . . ." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 68, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "Zuro’s testimony was essential to show the Court the extent and or lack of contacts the Chicago Dogs actually had with California." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 69, "src_page": 5, "status": "excluded", "reason": "facts, the Report below, and party contentions", "matched_section": null, "text": "(Petition for Reconsideration, pp. 2-5, emphasis omitted.)" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 70, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "The issue that concerns us is the interpretation and application of WCAB Rule 10817(a), which states in relevant part that: “If a witness intends to testify electronically, a petition showing good cause shall be filed pursuant to rule 10510 by the witness or by the party offering the witness’s testimony before the hearing, and shall identify the witness and contain the witness’s full legal name . . . .”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 71, "src_page": 6, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Code Regs., tit. 8, § 10817(a).) In conducting our preliminary review, we observe that in addition to our constitutional mandate to accomplish substantial justice, the following fundamental legal principles must guide us: (A) Only the Appeals Board has statutory authority to establish procedures in workers’ compensation proceedings and to promulgate rules." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 72, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "(B) Parties have a due process right to a fair hearing and a determination based on the merits." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 73, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "(C) In workers’ compensation proceedings, pleadings are liberally construed and may be amended to conform to proof." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 74, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Only the Appeals Board has statutory authority to establish procedures in workers’ compensation proceedings and to promulgate rules." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 75, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "Section 5500.3 states that: (a) The appeals board shall establish uniform district office procedures, uniform forms, and uniform time of court settings for all district offices of the appeals board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 76, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "No district office of the appeals board or workers’ compensation administrative law judge shall require forms or procedures other than as established by the appeals board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 77, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "A workers’ compensation administrative law judge who violates this section may be subject to disciplinary proceedings." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 78, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(b) The appeals board shall establish uniform court procedures and uniform forms for all other proceedings of the appeals board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 79, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "In addition to this statutory authority granted only to the Appeals Board, the Appeals Board has statutory authority under sections 5307 and 5708 to promulgate regulations regarding the adjudicatory process." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 80, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "Parties have a due process right to a fair hearing, and a determination based on the merits." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 81, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "As a matter of due process, all parties to a workers’ compensation proceeding retain the fundamental right to due process and a fair hearing under both the California and United States Constitutions." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 82, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "(2000) 82 Cal.App.4th 151, 157-158 [65 Cal.Comp.Cases 805].) “Due process requires notice and a meaningful opportunity to present evidence in regards to the issues.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 83, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2005) 127 Cal.App.4th 625, 643 [70 Cal.Comp.Cases 312]; see also Fortich v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 84, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "(1991) 233 Cal.App.3d 1449, 1452-1454 [56 Cal.Comp.Cases 537].) A fair hearing includes, but is not limited to, the opportunity to call and cross-examine witnesses; introduce and inspect exhibits; and to offer evidence in rebuttal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 85, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2001) 89 Cal.App.4th 1284, 1295 [66 Cal.Comp.Cases 584]; Rucker, supra, at pp. 157-158 citing Kaiser Co. v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 86, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Baskin) (1952) 109 Cal.App.2d 54, 58 [17 Cal.Comp.Cases 21]; Katzin v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 87, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "(1992) 5 Cal.App.4th 703, 710 [57 Cal.Comp.Cases 230].) As stated by the Court of Appeal: A denial of due process to a party ordinarily compels annulment of the Board’s decision only if it is reasonably probable that, absent the procedural error, the party would have attained a more favorable result." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 88, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "However, if the denial of due process prevents a party from having a fair hearing, the denial of due process is reversible per se." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 89, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Beverly Hills Multispecialty Group, Inc. v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 90, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "(Pinkney) (1994) 26 Cal.App.4th 789, 806 [59 Cal.Comp.Cases 461], citations omitted.) It is the policy of the law to favor, whenever possible, a hearing on the merits." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 91, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1992) 4 Cal.App.4th 1196, 1205 [57 Cal.Comp.Cases 149]; see also Shamblin v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 92, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Brattain (1988) 44 Cal.3d 474, 478 [243 Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 93, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "Rptr. 902] (“when a party in default moves promptly to seek relief, very slight evidence is required to justify a trial court's order setting aside a default.”) This is particularly true in workers’ compensation cases, where there is a constitutional mandate “to accomplish substantial justice in all cases.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 94, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 20.1", "text": "XIV, § 4.) Decisions of the Appeals Board “must be based on admitted evidence in the record.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 95, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc).) The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 96, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "8 (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to “ensure substantial justice in all cases.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 97, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "(2000) 79 Cal.App.4th 396, 403 [65 Cal.Comp.Cases 264].) The Board may not leave matters undeveloped where it is clear that additional discovery is needed." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 98, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Id. at p. 404.) Furthermore, decisions of the Appeals Board must be supported by substantial evidence." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 99, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code, §§ 5903, 5952(d); Lamb v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 100, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 101, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 102, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 16.9", "text": "(1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) Section 5701 allows the WCJ to “cause testimony to be taken, or inspection of the premises where the injury occurred to be made, or . . . direct any employee claiming compensation to be examined by a regular physician.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 103, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code, § 5701; see also Lab." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 104, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 20.2", "text": "Code, § 5906 [permitting the Appeals Board to grant reconsideration and direct the taking of additional evidence].) In 1890, the California Supreme Court opined: “The principal purpose of vesting the court with the discretionary power to correct ‘a mistake in any other respect’ is to enable it to mold and direct its proceedings so as to dispose of cases upon their substantial merits, when it can be done without injustice to either party, whether the obstruction to such a disposition of cases be a mistake of fact or a mistake as to the law, although it may be that the court should require a stronger showing to justify relief from the effect of a mistake of law than of a mistake of fact.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 105, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Clay (1890) 82 Cal.502, 23 P.50, 1890 Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 106, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "LEXIS 591; see Dunzweiler v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 107, "src_page": 8, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Superior Court of Alameda County (1968) 267 Cal.App.2d 569, 577 [73 Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 108, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "In workers’ compensation proceedings, pleadings are liberally construed and may be amended to conform to proof." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 109, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "Section 5708 states that: All hearings and investigations before the appeals board or a workers’ compensation judge are governed by this division and by the rules of practice and procedures adopted by the appeals board." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 110, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "In the conduct thereof they shall not be bound by the common law or statutory rules of evidence and procedure, but may make inquiry in the manner, through oral testimony and records, which is best calculated to ascertain the substantial rights of the parties and carry out justly the spirit and provisions of this division." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 111, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "All oral testimony, objections, and rulings shall be taken down in shorthand by a competent phonographic reporter." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 112, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "9 Section 5709 states that: No informality in any proceeding or in the manner of taking testimony shall invalidate any order, decision, award, or rule made and filed as specified in this division." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 113, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 17.1", "text": "No order, decision, award, or rule shall be invalidated because of the admission into the record, and use as proof of any fact in dispute, of any evidence not admissible under the common law or statutory rules of evidence and procedure." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 114, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "The workers’ compensation system “was intended to afford a simple and nontechnical path to relief.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 115, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Derby (1974) 12 Cal.3d 410, 419 [39 Cal.Comp.Cases 624]; Cf." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 116, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "XX, § 21; § 3201.) Generally, “the informality of pleadings in workers' compensation proceedings before the Board has been recognized.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 117, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1973) 9 Cal.3d 848, 852 [38 Cal.Comp.Cases 500, 512]; Bland v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 118, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "(1970) 3 Cal.3d 324, 328–334 [35 Cal.Comp.Cases 513].) “[I]t is an often-stated principle that the Act disfavors application of formalistic rules of procedure that would defeat an employee's entitlement to rehabilitation benefits.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 119, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "App.4th 485, 490 [67 Cal.Comp.Cases 1273].) Courts have repeatedly rejected pleading technicalities as grounds for depriving the Board of jurisdiction." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 120, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1985) 165 Cal.App.3d 196, 200–01 [50 Cal.Comp.Cases 160]; Liberty Mutual Ins." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 121, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "(1980) 109 Cal.App.3d 148, 152–153 [45 Cal.Comp.Cases 866].) “Necessarily, failure to comply with the rules as to details is not jurisdictional.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 122, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Rubio, supra, at pp. 200–201; see Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 123, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "Code Regs., tit. 8, § 10517.) Therefore, in workers’ compensation proceedings, it is settled law that (1) pleadings may be informal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 124, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "Co., supra, 9 Cal.3d at p. 852; Beaida v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 125, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "(1968) 263 Cal.App.2d 204, 207– 210 [33 Cal.Comp.Cases 345]); (2) claims should be adjudicated based on substance rather than form (Bland, supra, 3 Cal.3d at pp. 328–334; Martino, supra, 103 Cal.App.4th at p. 491; (3) pleadings should liberally construed so as not to defeat or undermine an injured employee's right to make a claim (Sarabi v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 126, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "(2007) 151 Cal.App.4th at pp. 925–926 [72 Cal.Comp.Cases 778]); Martino, supra, 103 Cal.App.4th at p. 490; and (4) technically deficient pleadings, if they give notice and are timely, normally do not deprive the Board of jurisdiction (Bland, supra, 3 Cal.3d at pp. 331–332)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 127, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "These principles of liberal pleading are further reflected in section 5506, which authorizes the Appeals Board to relieve a defendant from default or dismissal due to mistake, inadvertence, surprise or excusable neglect in accordance with Code of Civil Procedure section 473." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 128, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "10 the Court of Appeal has made it clear that the protections afforded under Code of Civil Procedure section 473(b) are applicable in workers’ compensation proceedings." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 129, "src_page": 10, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Fox, supra, 4 Cal.App.4th at p. 1196.) IV." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 130, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "Therefore, based on these principles, interpretation of our rules must necessarily incorporate California’s public policy in favor of adjudication of claims on their merits, rather than on the technical sufficiency of the pleadings." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 131, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "For example, WCAB Rule 10617 provides for considerable latitude in accepting nonstandard pleadings, so long as the pleadings contain “a combination of information sufficient to establish the case or cases to which the document relates or, if it is a case opening document, sufficient information to open an adjudication file.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 132, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "Code Regs., tit. 8, §10617(b).) Similarly, WCAB Rule 10517 specifies that pleadings are deemed amended to conform to the stipulations agreed to by the parties on the record or may be amended by the Appeals Board to conform to proof." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 133, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "Code Regs., tit. 8, §10517.) Because an evidentiary record must be created to allow for appellate review, and to safeguard due process, a request for electronic testimony must not be denied without an opportunity to be heard." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 134, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "WCAB Rule 10515 specifically disallows “[d]emurrers, petitions for judgment on the pleadings and petitions for summary judgment.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 135, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 16.3", "text": "Code Regs., tit. 8, §10515.) The principles of liberal pleading and amendment of pleadings to conform to proof outlined above mean that any petition should be considered on its merits and not based on its title." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 136, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "In considering the application of WCAB Rule 10817(c), we preliminarily conclude that a request on the record for electronic witness testimony at the beginning of the hearing, with an opportunity for any party to respond, satisfies the petition requirement and is sufficient to adjudicate the issue of electronic testimony." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 137, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "Moreover, we preliminarily conclude that the due process right to a fair hearing and a determination based on the merits is good cause to allow the electronic testimony of the witness." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 138, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 20.3", "text": "Therefore, when a witness is unable to appear in person, as a matter of due process, a request to testify electronically should be readily permitted." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 139, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "In addition, under our broad grant of authority, our jurisdiction over this matter is continuing." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 140, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "A grant of reconsideration has the effect of causing “the whole subject matter [to be] reopened for further consideration and determination”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 141, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Great Western Power Co. v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 142, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Savercool) (1923) 191 Cal.724, 729 [10 Industrial Acc." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 143, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Com. 322]) and of “[throwing] the entire record open for review.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 144, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(George) (1954) 125 Cal.App.2d 201, 203 [19 Cal.Comp.Cases 98].) Thus, once reconsideration has been granted, the Appeals Board has the full power to make new and different findings on issues presented for determination at the trial level, even with respect to issues not raised in the petition for reconsideration before it." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 145, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code, §§ 5907, 5908, 5908.5; see also Gonzales v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 146, "src_page": 11, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(1958) 50 Cal.2d 360, 364.) [“[t]here is no provision in chapter 7, dealing with proceedings for reconsideration and judicial review, limiting the time within which the commission may make its decision on reconsideration, and in the absence of a statutory authority limitation none will be implied.”]; see generally Lab." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 147, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Code, § 5803 [“The WCAB has continuing jurisdiction over its orders, decisions, and awards. . . ." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 148, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "At any time, upon notice and after an opportunity to be heard is given to the parties in interest, the appeals board may rescind, alter, or amend any order, decision, or award, good cause appearing therefor.].) “The WCAB . . . is a constitutional court; hence, its final decisions are given res judicata effect.”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 149, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1992) 7 Cal.App.4th 372, 374 [57 Cal.Comp.Cases 391; see Dow Chemical Co. v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 150, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(1967) 67 Cal.2d 483, 491 [32 Cal.Comp.Cases 431]; Dakins v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 151, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Board of Pension Commissioners (1982) 134 Cal.App.3d 374, 381 [184 Cal.Rptr. 576]; Solari v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 152, "src_page": 11, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Atlas-Universal Service, Inc." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 153, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(1963) 215 Cal.App.2d 587, 593 [30 Cal.Rptr. 407].) A “final” order has been defined as one that either “determines any substantive right or liability of those involved in the case”" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 154, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Hagler (1989) 211 Cal.App.3d 1171, 1180; Safeway Stores, Inc. v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 155, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(Pointer) (1980) 104 Cal.App.3d 528, 534-535 [45 Cal.Comp.Cases 410]; Kaiser Foundation Hospitals v." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 156, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(Kramer) (1978) 82 Cal.App.3d 39, 45 [43 Cal.Comp.Cases 661]), or determines a “threshold” issue that is fundamental to the claim for benefits." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 157, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Interlocutory procedural or evidentiary decisions, entered in the midst of the workers’ compensation proceedings, are not considered “final” orders." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 158, "src_page": 12, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "12 81 Cal.App.4th 1068, 1070, 1075 [65 Cal.Comp.Cases 650].) [“interim orders, which do not decide a threshold issue, such as intermediate procedural or evidentiary decisions, are not ‘final’ ”]; Rymer, supra, at p. 1180 [“[t]he term [‘final’] does not include intermediate procedural orders or discovery orders”]; Kramer, supra, at p. 45 [“[t]he term [‘final’] does not include intermediate procedural orders”].) Section 5901 states in relevant part that: No cause of action arising out of any final order, decision or award made and filed by the appeals board or a workers’ compensation judge shall accrue in any court to any person until and unless the appeals board on its own motion sets aside the final order, decision, or award and removes the proceeding to itself or if the person files a petition for reconsideration, and the reconsideration is granted or denied. … Thus, this is not a final decision on the merits of the Petition for Reconsideration, and we will order that issuance of the final decision after reconsideration is deferred." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 159, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Once a final decision is issued by the Appeals Board, any aggrieved person may timely seek a writ of review pursuant to sections 5950 et seq." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 160, "src_page": 12, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Accordingly, we grant defendant’s Petition for Reconsideration, and order that a final decision after reconsideration is deferred pending further review of the merits of the Petition for Reconsideration and further consideration of the entire record in light of the applicable statutory and decisional law." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 161, "src_page": 12, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "For the foregoing reasons, IT IS ORDERED that defendant’s Petition for Reconsideration of the May 13, 2025 Findings of Fact and Orders is GRANTED." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 162, "src_page": 13, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "13 IT IS FURTHER ORDERED that a final decision after reconsideration is DEFERRED pending further review of the merits of the Petition for Reconsideration and further consideration of the entire record in light of the applicable statutory and decisional law." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 163, "src_page": 13, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD (EN BANC) /s/ KATHERINE A." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 164, "src_page": 13, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ZALEWSKI, CHAIR /s/ JOSÉ H." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 165, "src_page": 13, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "RAZO, COMMISSIONER /s/ KATHERINE WILLIAMS DODD, COMMISSIONER /s/ CRAIG SNELLINGS, COMMISSIONER /s/ JOSEPH V." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 166, "src_page": 13, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "CAPURRO, COMMISSIONER /s/ PAUL F." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 167, "src_page": 13, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "KELLY, COMMISSIONER DATED AND FILED AT SAN FRANCISCO, CALIFORNIA August 12, 2025 SERVICE MADE ON THE ABOVE DATE ON THE PERSONS LISTED BELOW AT THEIR ADDRESSES SHOWN ON THE CURRENT OFFICIAL ADDRESS RECORD." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 168, "src_page": 13, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "TYSON PEREZ PRO ATHLETE LAW GROUP GOLDBERG SEGALLA MICHAEL SULLIVAN & ASSOCIATES GARBER & AV LIU HUTTON AS/abs I certify that I affixed the official seal of the Workers’ Compensation Appeals Board to this original decision on this date. abs" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 169, "src_page": 14, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD STATE OF CALIFORNIA TYSON PEREZ, Applicant vs." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 170, "src_page": 14, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "CHICAGO DOGS, LIBERTY MUTUAL INSURANCE COMPANY; HOUSTON ASTROS, ACE AMERICAN INSURANCE COMPANY/ CHUBB as administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants Adjudication Number: ADJ16597333 Santa Ana District Office OPINION AND ORDER CORRECTING CLERICAL ERROR (EN BANC) It has come to the Appeals Board’s attention that the Opinion and Order Granting Reconsideration (En Banc) issued on August 12, 2025, contains the following clerical errors and the following corrections are made: Page 4, Footnote 3: WCAB Rule 10818 (Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 171, "src_page": 14, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "Code Regs., tit. 8, § 10818), corrected to read WCAB Rule 10618 (Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 172, "src_page": 14, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "Code Regs., tit. 8, § 10618); and Page 10, third full paragraph, first sentence: WCAB Rule 10817(c), corrected to read WCAB Rule 10817(a)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 173, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "We correct these clerical errors by virtue of this decision without granting reconsideration, as such errors may be corrected without further proceedings at any time." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 174, "src_page": 14, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "(1982) 128 Cal.App.3d 543, 558, [47 Cal.Comp.Cases 145].)" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 175, "src_page": 15, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "2 For the foregoing reasons, IT IS ORDERED that the clerical errors in the Opinion and Order Granting Petition for Reconsideration (En Banc) issued by the Workers’ Compensation Appeals Board on August 12, 2025 are CORRECTED as follows: Page 4, Footnote 3: WCAB Rule 10818 (Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 176, "src_page": 15, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "Code Regs., tit. 8, § 10818), corrected to read WCAB Rule 10618 (Cal." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 177, "src_page": 15, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "Code Regs., tit. 8, § 10618); and Page 10, third full paragraph, first sentence: WCAB Rule 10817(c), corrected to read WCAB Rule 10817(a)." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 178, "src_page": 15, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD (EN BANC) /s/ KATHERINE A." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 179, "src_page": 15, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ZALEWSKI, CHAIR /s/ JOSÉ H." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 180, "src_page": 15, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "RAZO, COMMISSIONER /s/ KATHERINE WILLIAMS DODD, COMMISSIONER /s/ CRAIG SNELLINGS, COMMISSIONER /s/ JOSEPH V." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 181, "src_page": 15, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "CAPURRO, COMMISSIONER /s/ PAUL F." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 182, "src_page": 15, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "KELLY, COMMISSIONER DATED AND FILED AT SAN FRANCISCO, CALIFORNIA August 14, 2025 SERVICE MADE ON THE ABOVE DATE ON THE PERSONS LISTED ON THE FOLLOWING PAGE AT THEIR ADDRESSES SHOWN ON THE CURRENT OFFICIAL ADDRESS RECORD." }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 183, "src_page": 15, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "AS/abs I certify that I affixed the official seal of the Workers’ Compensation Appeals Board to this original decision on this date. abs" }, { "dec_slug": "perez-v-chicago-dogs-2025-adj16597333-wcab-en-banc", "seq": 184, "src_page": 16, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "3 SERVICE LIST TYSON PEREZ PRO ATHLETE LAW GROUP GOLDBERG SEGALLA MICHAEL SULLIVAN & ASSOCIATES GARBER & AV LIU HUTTON" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 1, "src_page": 1, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD STATE OF CALIFORNIA ABEL VAZQUEZ, Applicant vs." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 2, "src_page": 1, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "INOCENSIO1 RENTERIA; ZENITH INSURANCE CO., Defendants Adjudication Number: ADJ11017003 Salinas District Office OPINION AND ORDER GRANTING PETITION FOR RECONSIDERATION AND DECISION AFTER FOR RECONSIDERATION (En Banc) To secure uniformity of decisions in the future, the Chair of the Appeals Board, upon a unanimous vote of its members, assigned this case to the Appeals Board as a whole for an en banc decision.2 (Lab." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 3, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code, § 115.)3 Applicant, who is represented by counsel, filed a Petition for Removal of the “Findings and Order”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 4, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(F&O) issued on March 11, 2025, wherein the workers’ compensation administrative law judge (WCJ) replaced a qualified medical evaluator (QME) pursuant to Administrative Director Rules (AD Rules) 31.3 and 31.5 because the QME was not available to set a re-evaluation within 120 days." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 5, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, §§ 31.3, 31.5.)4 1 It appears that the spelling of the employer’s name contained in the application for adjudication may be incorrect." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 6, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "If the name is misspelt, an amended application should be filed to correct the error. 2 En banc decisions of the Appeals Board are binding precedent on all Appeals Board panels and workers’ compensation administrative law judges." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 7, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Code Regs., tit. 8, §§ 10305(k), 10325(a); City of Long Beach v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 8, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(Garcia) (2005) 126 Cal.App.4th 298, 316, fn. 5 [70 Cal.Comp.Cases 109]; Gee v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 9, "src_page": 1, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(2002) 96 Cal.App.4th 1418, 1424, fn. 6 [67 Cal.Comp.Cases 236].) This en banc decision is also adopted as a precedent decision pursuant to Government Code section 11425.60(b). 3 All further statutory references are to the Labor Code unless noted. 4 All further references to “AD Rules” are to the enumerated provisions in California Code of Regulations, Title 8 unless noted." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 10, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "2 Applicant argues that the time limits set in AD Rule 31.3 should not be enforced to compel the replacement of a QME who is not available." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 11, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Instead, applicant cites to the panel decision in Corrado v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 12, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(June 24, 2016, ADJ9150447, ADJ9150446) [2016 Cal.Wrk.Comp." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 13, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "LEXIS 318] (Corrado), and argues that the WCJ should have applied the balancing test described in Corrado in deciding whether good cause existed to warrant replacement of the QME.5 The WCJ issued a Report and Recommendation (Report) recommending that the Petition for Removal be denied." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 14, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We received an Answer from defendant." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 15, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "We have considered the allegations of the Petition and the Answer, and the contents of the Report, and we have reviewed the record." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 16, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Based upon our review of the record, and for the reasons stated below, we will treat the Petition as one seeking reconsideration because the March 11, 2025 F&O includes both final and non-final orders; however, we will apply the removal standard to the Petition as applicant only challenges a non-final order contained within the F&O." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 17, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Therefore, we will grant the Petition, and as our Decision After Reconsideration we will rescind the March 11, 2025 F&O and return the matter to the trial level for further proceedings." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 18, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Only the Appeals Board has jurisdiction to determine whether a replacement panel is valid or otherwise appropriate. 2." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 19, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "In a represented case, where a QME does not timely establish availability to set an appointment pursuant to AD Rule 31.3, a WCJ or the Appeals Board has discretion to order a replacement QME for good cause." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 20, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The WCJ or the Appeals Board may consider the following: a." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 21, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The length of delay caused by the QME’s unavailability. b." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 22, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The amount of prejudice caused by the delay in availability versus the amount of prejudice caused by restarting the QME process. 5 Unlike en banc decisions, panel decisions are not binding precedent on other Appeals Board panels and WCJs." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 23, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "(See Gee, supra, 96 Cal.App.4th at p. 1425, fn. 6.) However, panel decisions are citeable authority and the Appeals Board may consider these decisions to the extent that their reasoning is found persuasive, particularly on issues of contemporaneous administrative construction of statutory language." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 24, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "Santa Fe Extruders (2011) 76 Cal.Comp.Cases 228, fn. 7 (Appeals Board en banc); Griffith v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 25, "src_page": 2, "status": "excluded", "reason": "procedural posture", "matched_section": null, "text": "(1989) 209 Cal.App.3d 1260, 1264, fn. 2 [54 Cal.Comp.Cases 145].) Here, we refer to Corrado, supra, because it considered a similar issue." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 26, "src_page": 2, "status": "quoted", "reason": null, "matched_section": "§ 1.1", "text": "We recommend that practitioners proceed with caution when citing to a panel decision and verify its subsequent history." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 27, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "What efforts, if any, have been made to remedy the QME’s availability. d." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 28, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Case specific factual reasons that justify replacing or keeping the current QME, including whether a party may have waived its objection. e." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 29, "src_page": 3, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The Appeals Board’s constitutional mandate to “accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 30, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "XIV, § 4.) Application of this decision is prospective only, as explained below." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 31, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "FACTS Applicant was employed as a seasonal agricultural worker on March 17, 2017, when he sustained an industrial injury to his left ankle and left calf, and claims to have sustained injury to his left lower extremity, psyche, and in the form of hypertension, diabetes, and hyperlipidemia." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 32, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Minutes of Hearing and Summary of Evidence, February 4, 2025, p. 2, lines 3–6.) Ira Fishman, M.D., was selected as a QME to evaluate the compensability of applicant’s internal complaints, and issued two reports." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 33, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Applicant’s Exhibits 1 and 2.) Dr." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 34, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "Fishman initially evaluated applicant on May 21, 2021." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 35, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Applicant’s Exhibit 1, Report of QME Ira Fishman, M.D., June 9, 2021.) On May 31, 2022, he issued a supplemental report following his review of additional records." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 36, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Applicant’s Exhibit 2, Report of QME Ira Fishman, M.D., May 31, 2022.) On July 29, 2024, applicant requested a re-evaluation with Dr." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 37, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Defendant’s Exhibit A, Notice of QME Appointment with Ira Fishman, M.D., July 29, 2024.) The next available evaluation date was for December 2, 2024, which was 127 days later." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 38, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Ibid.) On August 5, 2024, defendant requested a replacement panel pursuant to AD Rules 31.3(e) and 31.5(a)(2), because the re-evaluation appointment with Dr." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 39, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "Fishman was scheduled more than 120 days from the date of applicant’s request." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 40, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Defendant’s Exhibit B, Defendant’s Replacement Panel Request, August 5, 2025.) On August 15, 2024, applicant objected to the request for a replacement panel, arguing that the time limits only applied to initial evaluations and not to subsequent evaluations." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 41, "src_page": 3, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Defendant’s Exhibit C, Applicant’s Objection Letter to Medical Unit, August 15, 2024.) Defendant responded to applicant’s letter by citing AD Rule 31.3(f) and arguing that the timeframes for QME" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 42, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "4 appointments apply to both initial and subsequent evaluations." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 43, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Defendant’s Exhibit D, Defendant’s Letter to Medical Unit, August 23, 2024.) The Division of Workers’ Compensation (DWC) Medical Unit issued a replacement panel on September 12, 2024." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 44, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Defendant’s Exhibit E, Internal Medicine Panel No. 3521873, September 12, 2024.) Applicant objected, and the issue of whether a replacement panel was appropriate was set for trial." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 45, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "The WCJ found that defendant was entitled to a replacement panel due to the QME’s inability to set an appointment within 120 days." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 46, "src_page": 4, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "PROCEDURAL BACKGROUND HYBRID DECISION A “final” order has been defined as one that either “determines any substantive right or liability of those involved in the case”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 47, "src_page": 4, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Hagler (1989) 211 Cal.App.3d 1171, 1180; Safeway Stores, Inc. v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 48, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Pointer) (1980) 104 Cal.App.3d 528, 534– 535 [45 Cal.Comp.Cases 410]; Kaiser Foundation Hospitals v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 49, "src_page": 4, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(Kramer) (1978) 82 Cal.App.3d 39, 45 [43 Cal.Comp.Cases 661]) or determines a “threshold” issue that is fundamental to the claim for benefits (Maranian v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 50, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(2000) 81 Cal.App.4th 1068, 1070, 1075 [65 Cal.Comp.Cases 650])." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 51, "src_page": 4, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Threshold issues include, but are not limited to, the following: injury arising out of and in the course of employment (AOE/COE); jurisdiction; the existence of an employment relationship; and statute of limitations." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 52, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(See Capital Builders Hardware, Inc. v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 53, "src_page": 4, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(Gaona) (2016) 5 Cal.App.5th 658, 662 [81 Cal.Comp.Cases 1122].) Interlocutory procedural or evidentiary decisions, entered in the midst of the workers’ compensation proceedings, are not considered “final” orders." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 54, "src_page": 4, "status": "excluded", "reason": "facts", "matched_section": null, "text": "(Maranian, supra, 81 Cal.App.4th at p. 1075 [“interim orders, which do not decide a threshold issue, such as intermediate procedural or evidentiary decisions, are not ‘final’ ”]; Rymer, supra, 211 Cal.App.3d at p. 1180 [“[t]he term [‘final’] does not include intermediate procedural orders or discovery orders”]; Kramer, supra, at 82 Cal.App.3d p. 45 [“[t]he term [‘final’] does not include intermediate procedural orders”].) Such interlocutory decisions include, but are not limited to, pre-trial orders regarding evidence, discovery, trial setting, venue, or similar issues." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 55, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "5 If a decision includes a determination of a “threshold” issue, then it is treated as a “final” decision, regardless of whether all issues are resolved or whether there is an ultimate decision on the right to benefits." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 56, "src_page": 5, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Carr, McClellan, Ingersoll, Thompson & Horn (2006) 71 Cal.Comp.Cases 783, 784, fn. 2 (Appeals Board en banc).) Where a decision contains both final and non-final determinations, it is a hybrid decision." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 57, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Thus, when a party challenges a hybrid decision, the petition seeking relief is treated as a petition for reconsideration because the determination on the threshold issue is final and binding on the Appeals Board and all parties to the case." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 58, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "When a petition is treated as one for reconsideration, then, the Appeals Board follows section 5908.5 and considers the merits of any final findings, awards, or orders." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 59, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "If the Appeals Board does not disturb the final finding, award, or order, or affirms it, the parties’ remedy is to seek appellate relief." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 60, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(§§ 5950 et seq.) If no further relief is sought, the finding, award, or order, is binding on all parties as the “law of the case.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 61, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "(1943) 22 Cal.2d 604, 611.) However, where a petitioner challenges a WCJ’s determination regarding an interlocutory issue, the Appeals Board will apply the removal standard applicable to non-final decisions with respect to that issue." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 62, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.3", "text": "Notably, decisions on interlocutory or interim issues by a WCJ or the Appeals Board may still be challenged by a petition for reconsideration once a final decision is issued." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 63, "src_page": 5, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Here, the WCJ’s decision includes findings of employment and industrial injury, which are determinations of threshold issues and constitute “final” findings." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 64, "src_page": 5, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Thus, even though we do not address the merits of these final findings in this decision, we treat the Petition as one for reconsideration." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 65, "src_page": 5, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "In the Petition, applicant only challenges the interlocutory finding/order as to the QME, and therefore, we will apply the removal standard to our review of that issue." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 66, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.8", "text": "(See Gaona, supra.) Removal is an extraordinary remedy rarely exercised by the Appeals Board." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 67, "src_page": 5, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2006) 136 Cal.App.4th 596, 600, fn. 5 [71 Cal.Comp.Cases 155, 157, fn. 5]; Kleemann v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 68, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.8", "text": "(2005) 127 Cal.App.4th 274, 281, fn. 2 [70 Cal.Comp.Cases 133, 136, fn. 2].) The Appeals Board will grant removal only if the petitioner shows that substantial prejudice or irreparable harm will result if removal is not granted." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 69, "src_page": 5, "status": "quoted", "reason": null, "matched_section": "§ 21.8", "text": "Code Regs., tit. 8, § 10955(a); see also Cortez, supra; Kleemann, supra.) A petitioner must also demonstrate that reconsideration will not be an adequate remedy if a final decision adverse to the petitioner ultimately issues." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 70, "src_page": 5, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Code Regs., tit. 8, § 10955(a).)" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 71, "src_page": 6, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "6 Here, the WCJ struck the current QME and ordered the parties to begin the medical-legal discovery process anew." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 72, "src_page": 6, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "However, the decision was based upon an incorrect interpretation of statute and regulation, and it significantly alters the course of these proceedings and likely extends the ultimate resolution of this matter." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 73, "src_page": 6, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Accordingly, we conclude that applicant has demonstrated that the decision will cause irreparable harm that cannot otherwise be remedied by reconsideration." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 74, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "TIMELINESS OF DECISION Former section 5909 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 75, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "(§ 5909.) Effective July 2, 2024, section 5909 was amended to state in relevant part that: (a) A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 76, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "(b) (1) When a trial judge transmits a case to the appeals board, the trial judge shall provide notice to the parties of the case and the appeals board." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 77, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "(2) For purposes of paragraph (1), service of the accompanying report, pursuant to subdivision (b) of Section 5900, shall constitute providing notice." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 78, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "(§ 5909.) Under section 5909(a), the Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 79, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Transmission is reflected in Events in the Electronic Adjudication Management System (EAMS)." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 80, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Specifically, in Case Events, under Event Description is the phrase “Sent to Recon” and under Additional Information is the phrase “The case is sent to the Recon board.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 81, "src_page": 6, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Here, according to Events the case was transmitted to the Appeals Board on March 18, 2025, and 60 days from the date of transmission is Saturday, May 17, 2025, which by operation of law means this decision is due by Monday, May 19, 2025." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 82, "src_page": 6, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Code Regs., tit. 8, § 10600.) This decision issued by or on May 19, 2025, so that we have timely acted on the Petition as required by section 5909(a)." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 83, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Section 5909(b)(1) requires that the parties and the Appeals Board be provided with notice of transmission of the case." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 84, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Transmission of the case to the Appeals Board in EAMS provides notice to the Appeals Board." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 85, "src_page": 6, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Thus, the requirement in subdivision (1) ensures that the parties are" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 86, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "7 notified of the accurate date for the commencement of the 60-day period for the Appeals Board to act on a petition." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 87, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 21.2", "text": "Section 5909(b)(2) provides that service of the Report shall be notice of transmission." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 88, "src_page": 7, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "According to the proof of service, the Report was served on March 18, 2025, and the case was transmitted to the Appeals Board on March 18, 2025." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 89, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Service of the Report and transmission of the case to the Appeals Board occurred on the same day." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 90, "src_page": 7, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Thus, we conclude that the parties were provided with the notice of transmission required by section 5909(b)(1) because service of the Report in compliance with section 5909(b)(2) provided them with actual notice as to the commencement of the 60-day period on March 18, 2025." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 91, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Only the Appeals Board has jurisdiction to determine whether a replacement panel is valid or otherwise appropriate." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 92, "src_page": 7, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "As explained in our en banc decision in Dennis v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 93, "src_page": 7, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "State of California (2020) 85 Cal.Comp.Cases 389 (Appeals Board en banc): Article XIV, Section 4, of the California Constitution, provides in pertinent part that: The Legislature is hereby expressly vested with plenary power, unlimited by any provision of this Constitution, to create, and enforce a complete system of workers’ compensation, by appropriate legislation, and in that behalf to create and enforce a liability on the part of any or all persons to compensate any or all of their workers for injury or disability, and their dependents for death incurred or sustained by the said workers in the course of their employment, irrespective of the fault of any party … * * * The Legislature is vested with plenary powers, to provide for the settlement of any disputes arising under such legislation by arbitration, or by an industrial accident commission, by the courts, or by either, any, or all of these agencies, either separately or in combination, and may fix and control the method and manner of trial of any such dispute, the rules of evidence and the manner of review of decisions rendered by the tribunal or tribunals designated by it; provided, that all decisions of any such tribunal shall be subject to review by the appellate courts of this State. … * * * Nothing contained herein shall be taken or construed to impair or render ineffectual in any measure the creation and existence of the industrial accident commission of this State or the state" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 94, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "8 compensation insurance fund, the creation and existence of which, with all the functions vested in them, are hereby ratified and confirmed." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 95, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "XIV, § 4.) Under this constitutional grant of plenary power to the Legislature, the California Workers’ Compensation Act (§ 3200 et seq.) was enacted “to establish a complete and exclusive system of workers’ compensation including ‘full provision for vesting power, authority and jurisdiction in an administrative body with all the requisite governmental functions to determine any dispute or matter arising under such legislation, to the end that the administration of such legislation shall accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character; all of which matters are expressly declared to be the social public policy of this State … .’”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 96, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(Citations.) Thus, under the grant of authority in the California Constitution, the Appeals Board operates as an appellate court of limited jurisdiction that reviews and decides appeals from decisions issued by workers’ compensation administrative law judges." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 97, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(Citations.) The Workers’ Compensation Act is found in Divisions 4 and 4.5 of the Labor Code, as administered and enforced by the Division of Workers’ Compensation under the control of the Administrative Director, “except as to those duties, powers, jurisdiction, responsibilities, and purposes as are specifically vested in” the Appeals Board." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 98, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(§ 111, emphasis added.) The Administrative Director “exercise[s] the powers of the head of a department … [including] supervision of, and responsibility for, personnel, and the coordination of the work of the division. …”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 99, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 1.3", "text": "(§ 111; see §§ 123, 127, 133 [describing various powers of the Administrative Director].) The Appeals Board exercises all judicial powers vested in it by the Labor Code and may do all things necessary or convenient in the exercise of any power or jurisdiction conferred upon it by the Labor Code." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 100, "src_page": 8, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(§§ 111, 133; see §§ 115, 130, 134, 5307, 5309, 5813, 5900 et. seq.) [describing various powers of the Appeals Board].) In addition to review of appeals of decisions issued by workers’ compensation administrative law judges by way of petitions for reconsideration and/or removal (§ 5900 et. seq.), the major function of the Appeals Board is regulation of the adjudication process by adopting rules of practice and procedure and issuing en banc opinions (§ 5307; § 115)." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 101, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 2.1", "text": "Pursuant to section 5300, the WCAB has exclusive jurisdiction to adjudicate the “recovery of compensation, or concerning any right or liability arising out of or incidental thereto” of injuries that “arise out of and in the course” of employment. . . ." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 102, "src_page": 8, "status": "quoted", "reason": null, "matched_section": "§ 2.1", "text": "In other words, the WCAB maintains exclusive jurisdiction pursuant to the California Constitution and section 5300 to adjudicate workers’ compensation disputes." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 103, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "9 Accordingly, the Appeals Board is vested with the judicial power to adjudicate workers’ compensation cases, which includes the determination of whether a replacement QME panel is valid or otherwise appropriate." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 104, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "In a represented case, where a QME does not timely establish availability to set an appointment pursuant to AD Rule 31.3, a WCJ or the Appeals Board has discretion to order a replacement QME for good cause." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 105, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The Appeals Board has broad powers to adjudicate discovery disputes, which include the taking of additional medical evidence." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 106, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2002) 67 Cal.Comp.Cases 138, 141 (Appeals Board en banc), citing §§ 5701, 5906; Tyler v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 107, "src_page": 9, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(1997) 56 Cal.App.4th 389 [62 Cal.Comp.Cases 924].) A common discovery dispute arises where parties seek to replace a QME." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 108, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Two provisions in the Labor Code expressly grant parties the statutory right to replace a QME.6 In other words, when a violation described in the statute occurs, a party may promptly seek replacement of the QME." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 109, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The first is ex parte communication." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 110, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(§ 4062.3(f), (g)7; Alvarez v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 111, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2010) 187 Cal.App.4th 575; see also Suon v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 112, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "California Dairies (2018) 83 Cal.Comp.Cases 6 Other provisions of the Labor Code may present good cause to replace a QME." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 113, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "For example, a violation of section 4628 compels the exclusion of a QME’s report under subdivision (e) and could be considered by a WCJ in determining whether good cause existed for a QME’s replacement." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 114, "src_page": 9, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "The focus of this opinion is the two provisions that provide a statutory right of replacement. 7 Section 4062.3 states in relevant part that: (f) Communications with an agreed medical evaluator shall be in writing, and shall be served on the opposing party when sent to the agreed medical evaluator." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 115, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Oral or written communications with physician staff or, as applicable, with the agreed medical evaluator, relative to nonsubstantial matters such as the scheduling of appointments, missed appointments, the furnishing of records and reports, and the availability of the report, do not constitute ex parte communication in violation of this section unless the appeals board has made a specific finding of an impermissible ex parte communication." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 116, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(g) Ex parte communication with an agreed medical evaluator or a qualified medical evaluator selected from a panel is prohibited." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 117, "src_page": 9, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "If a party communicates with the agreed medical evaluator or the qualified medical evaluator in violation of subdivision (e), the aggrieved party may elect to terminate the medical evaluation and seek a new evaluation from another qualified medical evaluator to be selected according to Section 4062.1 or 4062.2, as applicable, or proceed with the initial evaluation." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 118, "src_page": 9, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(§ 4062.3(f), (g) (emphasis added).)" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 119, "src_page": 10, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "10 1803 (Appeals Board en banc); Maxham v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 120, "src_page": 10, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "California Department of Corrections and Rehabilitation (2017) 82 Cal.Comp.Cases 136 (Appeals Board en banc).)8 The second is a failure to timely complete a formal medical evaluation under sections 4062.5 and 139.2(j)(1)." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 121, "src_page": 10, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Here, the WCJ’s finding that the QME should be replaced was based on the QME’s inability to schedule a medical re-evaluation within 120 days under AD Rule 31.3(e)." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 122, "src_page": 10, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Thus, our discussion is focused on whether the statutory language of sections 4062.5 and 139.2(j)(1) allow replacement of the QME where the QME is unable to set a re-evaluation within 120 days." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 123, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "As explained below, when sections 4062.5 and 139.2(j)(1) are read together, a party’s statutory right to seek replacement of a QME in represented cases arises when the QME fails to timely issue a report following a medical evaluation." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 124, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "In represented cases, the determination of whether a QME should be replaced due to unavailability to set an evaluation is within the discretionary power of the Appeals Board,9 and a QME may be replaced where a party demonstrates good cause for the replacement." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 125, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 1.4", "text": "Statutory analysis begins by examining “the words themselves because the statutory language is generally the most reliable indicator of legislative intent … The words of the statute should be given their ordinary and usual meaning and should be construed in their statutory context.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 126, "src_page": 10, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2005) 36 Cal.4th 812, 818, quoting Hassan v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 127, "src_page": 10, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Mercy American River Hospital (2003) 31 Cal.4th 709, 715–716.) When the words of a statute are clear, we must follow their plain meaning." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 128, "src_page": 10, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Parkhouse Tire Service, Inc." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 129, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 1.4", "text": "(2001) 26 Cal.4th 995, 1003.) If the plain, commonsense meaning of a statute’s words is unambiguous, the plain meaning controls." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 130, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(In re Jennings (2004) 34 Cal.4th 254, 263.) Section 4062.5 states: If a qualified medical evaluator selected from a panel fails to complete the formal medical evaluation within the timeframes established by the 8 As explained in the en banc opinion in Maxham: Black’s Law Dictionary defines ‘ex parte’ as, ‘On or from one party only, usually without notice to or argument from the adverse party.’ (Black’s Law Dict." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 131, "src_page": 10, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(7th ed. 1999) p. 597, col. 2.) Black’s further states that an ‘ex parte communication’ is, ‘A generally prohibited communication between counsel and the court when opposing counsel is not present.’ (Id." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 132, "src_page": 10, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "[emphasis added].) (Maxham, supra, 82 Cal.Comp.Cases at p. 142.) 9 We emphasize that the authority to adjudicate disputes with respect to statutory violations rests with the Appeals Board." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 133, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "11 administrative director pursuant to paragraph (1) of subdivision (j) of Section 139.2, a new evaluation may be obtained upon the request of either party, as provided in Sections 4062.1 or 4062.2." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 134, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Neither the employee nor the employer shall have any liability for payment for the formal medical evaluation which was not completed within the required timeframes unless the employee or employer, on forms prescribed by the administrative director, each waive the right to a new evaluation and elects to accept the original evaluation even though it was not completed within the required timeframes." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 135, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(§ 4062.5 (emphasis added).) Section 139.2(j)(1) states: (j) After public hearing pursuant to Section 5307.3, the administrative director shall adopt regulations concerning the following issues: (1) (A) Standards governing the timeframes within which medical evaluations shall be prepared and submitted by agreed and qualified medical evaluators." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 136, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Except as provided in this subdivision, the timeframe for initial medical evaluations to be prepared and submitted shall be no more than 30 days after the evaluator has seen the employee or otherwise commenced the medical evaluation procedure." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 137, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The administrative director shall develop regulations governing the provision of extensions of the 30-day period in both of the following cases: (i) When the evaluator has not received test results or consulting physician’s evaluations in time to meet the 30-day deadline." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 138, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(ii) To extend the 30-day period by not more than 15 days when the failure to meet the 30-day deadline was for good cause." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 139, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(B) For purposes of subparagraph (A), “good cause” means any of the following: (i) Medical emergencies of the evaluator or evaluator’s family." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 140, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(ii) Death in the evaluator’s family." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 141, "src_page": 11, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(iii) Natural disasters or other community catastrophes that interrupt the operation of the evaluator’s business." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 142, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "12 (C) The administrative director shall develop timeframes governing availability of qualified medical evaluators for unrepresented employees under Section 4062.1." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 143, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "These timeframes shall give the employee the right to the addition of a new evaluator to his or her panel, selected at random, for each evaluator not available to see the employee within a specified period of time, but shall also permit the employee to waive this right for a specified period of time thereafter." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 144, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(§ 139.2(j)(1) (emphasis added).) Based on a plain reading of section 139.2(j)(1), we conclude that the term “medical evaluation” does not refer to the scheduling or availability of the QME to set an appointment." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 145, "src_page": 12, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Subsection A explicitly discusses the timeframes for “evaluations” to be prepared and submitted after the evaluator has seen the employee." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 146, "src_page": 12, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "The section clearly refers to the report that is generated after the evaluation has occurred." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 147, "src_page": 12, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Furthermore, when comparing subsection (A) with subsection (C), it becomes clear that subsection (A) does not cover the availability of the QME to set an appointment as that expressed language exists in subsection (C), but is absent from subsection (A)." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 148, "src_page": 12, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Subsection (C) expressly refers to rules governing the availability of QMEs, and expressly gives the right to strike an unavailable evaluator to an unrepresented employee.10 Harmonizing sections 4062.5 and 139.2(j)(1), we conclude that the term ‘formal medical evaluation’ contained in section 4062.5 actually refers to the report generated after an in-person evaluation." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 149, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Thus, a party may seek to replace a QME under section 4062.5 where an evaluation takes place and the report prepared from that evaluation is untimely served." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 150, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "AD Rule 31.3 states, in pertinent part: (e) If a party with the legal right to schedule an appointment with a QME is unable to obtain an appointment with a selected QME within ninety (90) days of the date of the appointment request, that party may waive the right to a replacement in order to accept an appointment no more than one-hundred-twenty (120) days after the date of the party’s initial request for an appointment." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 151, "src_page": 12, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "When the selected QME is unable to schedule the evaluation within one-hundred-twenty (120) days of the date of that party’s initial request for an appointment, either party may report the unavailability of the QME and the Medical Director shall issue a replacement pursuant to section 31.5 of Title 8 of the California Code of Regulations upon request, unless both parties agree in writing to waive the one-hundred-twenty (120) day time limit for scheduling the initial or any subsequent evaluation. 10 This case does not involve an unrepresented employee; accordingly, we do not address application of section 139.2(j)(1)(C)." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 152, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "13 (f) The provisions of subdivision (e) of this regulation apply to both requests for any Comprehensive Medical-Legal Evaluation by a QME and requests for Follow Up Comprehensive Medical-Legal Evaluations by a QME." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 153, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "AD Rule 31.5(a)(2) states, in pertinent part, “(a) A replacement QME to a panel, or at the discretion of the Medical Director a replacement of an entire panel of QMEs, shall be selected at random by the Medical Director and provided upon request whenever any of the following occurs[.]”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 154, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "AD Rule 31.5 merely compels the Medical Director to issue a replacement panel upon request of a party when any of the enumerated conditions in subdivision (a)(2) occur." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 155, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Thus, while the rules are valid, AD Rules 31.3 and 31.5 cannot be interpreted as finally determining whether a replacement panel is appropriate because such an interpretation would usurp the adjudicative power of the Appeals Board to determine whether a QME should be replaced." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 156, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(§ 111.) In a represented case, the Labor Code expressly allows replacement of a QME who drafts an untimely report following a medical evaluation; however, it does not compel replacement of a QME who is not timely available to set an appointment." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 157, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Absent a statute compelling such a result, whether a QME should be replaced due to unavailability falls within the Appeals Board’s broad equitable powers." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 158, "src_page": 13, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(§ 111; see §§ 52, 5300, 5301, 5302; see also McHugh v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 159, "src_page": 13, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Santa Monica Rent Control Bd." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 160, "src_page": 13, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(1989) 49 Cal.3d 348, 355–356 [the Appeals Board “been legislatively endowed with judicial powers pursuant to a specific constitutional authorization”]; Bankers Indemnity Ins." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 161, "src_page": 13, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(Merzoian) (1935) 4 Cal.2d 89, 98 [“[T]he Industrial Accident Commission of this state has been invested with the power and authority to hear and determine equitable issues.”].) The above is not to say that the availability timelines themselves are invalid or should not be followed by QMEs because the AD is empowered to appoint and appropriately regulate the conduct of QMEs." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 162, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Per section 139.2(g): “The administrative director shall establish agreements with qualified medical evaluators to ensure the expeditious evaluation of cases assigned to them for comprehensive medical evaluations.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 163, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Accordingly, where a QME is unavailable pursuant to regulation, they may subject themselves to discipline, which could ultimately lead to the loss of the QME’s appointment." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 164, "src_page": 13, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Code Regs., tit. 8, § 60.) While the dates set by the Administrative Director are important and should be followed and may even be persuasive as to whether the length of delay is inappropriate, we cannot find on" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 165, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "14 this record that the mere passing of time is sufficient to warrant replacing the existing QME." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 166, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Instead, we adapt the factors set forth in the panel decision in Corrado, supra." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 167, "src_page": 14, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "In a represented case, the determination of whether a QME should be replaced due to unavailability requires the balancing of multiple factors, which include: a." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 168, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The length of delay caused by the QME’s unavailability. b." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 169, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The amount of prejudice caused by the delay in availability versus the amount of prejudice caused by restarting the QME process. c." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 170, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "What efforts, if any, have been made to remedy the QME’s availability. d." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 171, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Case specific factual reasons that justify replacing or keeping the current QME, including whether a party may have waived its objection. e." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 172, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The Appeals Board’s constitutional mandate to “accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 173, "src_page": 14, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "XIV, § 4.) To allow the parties adequate due process, we will return this matter to the trial level so that these balancing factors may be considered by the court in the first instance." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 174, "src_page": 14, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Lockheed Corporation (2001) 66 Cal.Comp.Cases 473 (Appeals Board en banc); see also Gangwish v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 175, "src_page": 14, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(2001) 89 Cal.App.4th 1284, 1295 [66 Cal.Comp.Cases 584].) III." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 176, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 1.4", "text": "THIS DECISION IS PROSPECTIVE The Appeals Board has long held that new interpretations of statute are applied prospectively." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 177, "src_page": 14, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Industrial Wire Products (2000) 65 Cal.Comp.Cases 824, 832 (Appeals Board en banc), we explained why it is appropriate to conclude under certain circumstances that a decision should be applied prospectively: In workers’ compensation cases, it is not uncommon to provide that newly stated judicial rules or newly stated judicial interpretations of statutes shall be applied prospectively only." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 178, "src_page": 14, "status": "quoted", "reason": null, "matched_section": "§ 1.4", "text": "Such a declaration of prospective application is made primarily to prevent a landslide of reopenings in previously adjudicated workers’ compensation cases, which would burden the workers’ compensation system and result in unfairness to those parties who had relied on a different understanding of law or had accepted a different application of the law; a declaration of prospective" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 179, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 1.4", "text": "15 application may also be made to harmonize statutory provisions." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 180, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 1.4", "text": "(Citations.) Although decisions regarding procedural issues are more commonly given prospective effect than are decisions regarding substantive issues (Citation.), decisions affecting an applicant’s substantive right to receive or a defendant’s substantive duty to pay workers’ compensation benefits will be applied prospectively under appropriate circumstances." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 181, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "[Emphasis added.] (Id. at pp. 832–833.) In Messele v." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 182, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 1.4", "text": "(2011) 76 Cal.Comp.Cases 1318 (Appeals Board en banc), we discussed the application of Farris, supra, and we stated that: In Farris, we concluded that our decision in that case, on the application of section 5814 penalties to unreasonably delayed section 4650(d) penalties, should be applied prospectively to avoid “an undue burden on the administration of justice in the workers’ compensation system” and the “overwhelming adverse effect on the workers’ compensation system and on the reasonable expectations of the parties participating in it.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 183, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "(Citation.) These considerations apply equally to the purely procedural issues addressed in the present case." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 184, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "(Id. at pp. 1320–1321.) In Messele, the Appeals Board found that the 10-day period to request an evaluator is extended by five days by application of law." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 185, "src_page": 15, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "(Id.) However, applying such a decision retroactively would have disrupted the discovery process in a significant number of claims." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 186, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Accordingly, the Appeals Board determined that the interpretation would apply prospectively." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 187, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Our decision here clarifies the factors to consider when replacing an unavailable evaluator in represented cases." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 188, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "We do not seek to create a landslide of litigation as to prior replacement panel orders." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 189, "src_page": 15, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "As noted above, the timelines suggested in the regulations may be considered by the WCJ or the Appeals Board in determining whether a replacement panel is appropriate, and thus, prior orders that issued pursuant to the regulation are not inherently incorrect." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 190, "src_page": 15, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "Therefore, we conclude that it is appropriate to apply this interpretation prospectively." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 191, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Only the Appeals Board has jurisdiction to determine whether a replacement panel is valid or otherwise appropriate. 2." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 192, "src_page": 15, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "In a represented case, where a QME does not timely establish availability to set an appointment pursuant to AD Rule 31.3, a WCJ or the Appeals Board has discretion to" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 193, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "16 order a replacement QME for good cause." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 194, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The WCJ or the Appeals Board may consider the following: a." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 195, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The length of delay caused by the QME’s unavailability. b." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 196, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The amount of prejudice caused by the delay in availability versus the amount of prejudice caused by restarting the QME process. c." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 197, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "What efforts, if any, have been made to remedy the QME’s availability. d." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 198, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "Case specific factual reasons that justify replacing or keeping the current QME, including whether a party may have waived its objection. e." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 199, "src_page": 16, "status": "quoted", "reason": null, "matched_section": "§ 9.6", "text": "The Appeals Board’s constitutional mandate to “accomplish substantial justice in all cases expeditiously, inexpensively, and without incumbrance of any character.”" }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 200, "src_page": 16, "status": "excluded", "reason": "citation string or sentence fragment", "matched_section": null, "text": "XIV, § 4.) Application of this decision is prospective only, as explained above." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 201, "src_page": 16, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "Accordingly, we grant the Petition as one seeking reconsideration, and as our Decision After Reconsideration, we rescind the March 11, 2025 F&O and return the matter to the trial level for further proceedings consistent with this decision." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 202, "src_page": 16, "status": "excluded", "reason": "application to these parties", "matched_section": null, "text": "For the foregoing reasons, IT IS ORDERED that applicant’s Petition for Reconsideration of the Findings and Order issued by the WCJ on March 11, 2025 is GRANTED." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 203, "src_page": 17, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "17 IT IS FURTHER ORDERED as the Decision After Reconsideration of the Workers’ Compensation Appeals Board that the Findings and Order issued on March 11, 2025 by the WCJ is RESCINDED and that this matter is RETURNED to the trial level for further proceedings consistent with this decision." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 204, "src_page": 17, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "WORKERS’ COMPENSATION APPEALS BOARD (EN BANC) /s/ KATHERINE A." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 205, "src_page": 17, "status": "excluded", "reason": "disposition, orders, and service", "matched_section": null, "text": "ZALEWSKI, CHAIR /s/ JOSÉ H." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 206, "src_page": 17, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "RAZO, COMMISSIONER /s/ KATHERINE WILLIAMS DODD, COMMISSIONER /s/ CRAIG SNELLINGS, COMMISSIONER /s/ JOSEPH V." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 207, "src_page": 17, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "CAPURRO, COMMISSIONER /s/ PAUL F." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 208, "src_page": 17, "status": "excluded", "reason": "signature/certification", "matched_section": null, "text": "KELLY, COMMISSIONER DATED AND FILED AT SAN FRANCISCO, CALIFORNIA May 19, 2025 SERVICE MADE ON THE ABOVE DATE ON THE PERSONS LISTED BELOW AT THEIR ADDRESSES SHOWN ON THE CURRENT OFFICIAL ADDRESS RECORD." }, { "dec_slug": "vazquez-v-renteria-2025-adj11017003-wcab-en-banc", "seq": 209, "src_page": 17, "status": "excluded", "reason": "caption/administrative", "matched_section": null, "text": "ABEL VAZQUEZ DILLES LAW GROUP CHERNOW, PINE & WILLIAMS EDL/abs I certify that I affixed the official seal of the Workers’ Compensation Appeals Board to this original decision on this date. abs" } ] }