Adminsure

What they litigate

Disputed issues across the decisions this claims administrator is named in. Every row opens the decisions it counts.

Where they appear

• Van Nuys 12
• Marina del Rey 5
• Anaheim 4
• San Bernardino 4
• Santa Ana 4
• Pomona 2
• Riverside 2
• Los Angeles 1
• Oxnard 1
• San Diego 1

How the appealed decisions came out

These are decisions that were appealed and published — the tail of a system that mostly settles. Most claims end in a compromise and release or a stipulation and never reach a panel, so nothing below describes how this claims administrator does its work. It describes how a set of appealed disputes came out.

• 18 for the applicant
• 13 for the defense
• 5 returned for more record

Counted over 35 appealed decisions. Not this claims administrator’s book of work. A decision that went one way on one issue and the other way on another is counted in both columns, so the figures add up to more than the total.

Decisions

Newest decisions this claims administrator is named in, each with the passage the panel turned on and a link to the official PDF.

• ADJ18038876 · 2025-12-16 · San Bernardino District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.7Dr. Peterson also noted that applicant has weakness in the shoulder as a ratable factor, quoting the AMA Guides, 16.8a (Page 508), which notes that an evaluator may rate loss of strength if strength represents an impairing factor that has not been considered adequately by other methods in the Guides. Dr. Peterson opined that applicant's strength loss should be rated. He felt that applicant gave a maximal effort and that pain did not prevent him from giving maximal effort. Dr. Peterson opined that the rating should be combined with the range of motion impairment and relied upon the Guides (Page 508) which indicates that loss of strength and other impairments may be combined if they are based on unrelated etiological or pathomechanical causes.

  The Board found the PQME's rating of strength loss combined with range of motion impairment persuasive and rejected the outside rater's reduction of strength loss rating as outside the rater's role and unsupported by substantial evidence.

  Official decision · page 7 →
• ADJ13261327 · 2025-09-19 · Van Nuys District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of the Findings of Fact and Orders (F&O) issued by the workers' compensation administrative law judge (WCJ), wherein the WCJ found that applicant's injury arose out of and occurred in the course of employment (AOE/COE).

  The applicant was found to be providing a benefit to the employer at the time of injury, meeting the condition under Labor Code section 3600(a)(2). The injury occurred during a lunch meeting to discuss personnel issues, which was reasonably expected and beneficial to the employer.

  Official decision · page 1 →
• ADJ15018771 · 2025-03-14 · Riverside District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.4II. Turning now to the merits of the Petition, defendant contends that applicant failed to meet his burden of proof pursuant to section 3202.5 in establishing injury AOE/COE to the shoulders, knees, and ankles as the reporting of Dr. Holmes "provides an inadequate medical history, is incomplete, and therefore is not substantial evidence." (Petition, pp. 2-3, 11.) Section 3202.5 states, in relevant part, that parties are to "meet the evidentiary burden of proof on all issues by a preponderance of the evidence. Pursuant to section 5705, the burden of proof rests upon the party holding the affirmative of the issue. The burden therefore rests with the applicant (or lien claimant, who steps into the shoes of the applicant). To meet this burden, the applicant must provide substantial evidence of injury AOE/COE.

  The WCJ found Dr. Holmes's opinions to be substantial medical evidence based on an adequate examination, history, and reasoning, supported by other medical reports, meeting applicant's burden of proof for injury AOE/COE to the shoulders, knees, and ankles. Defendant failed to present contradictory evidence.

  Official decision · page 4 →
• ADJ13610807 · 2025-02-03 · San Bernardino District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.3(1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313], emphasis added.) As discussed by the WCJ, applicant met her burden of proving injury AOE/COE, based in part on the opinions of panel Qualified Medical Evaluator (QME) in cardiology Stuart Fischer, M.D. (Exhibits 1A - 1G) and panel QME in neurology Pedram Navab, M.D. (Exhibits 2A - 2H). Although the WCJ and both QMEs refer to "cardiac arrest" we note that this is not a body part. Additionally, we note that it is axiomatic that an injury must be to a body part and, as such, any finding of injury AOE/COE must identify at least one body part. (See Lab. Code, § 3600(a), 5401(a); Clark, supra, at 297-298.) Therefore we will amend Findings of Fact No. 1 and No. 2 to find that applicant sustained injury to her heart.

  The WCJ and QMEs Fischer and Navab provided substantial medical evidence that applicant's sudden cardiac arrest was industrially related, meeting the burden of proof by a preponderance of the evidence and reasonable probability standard.

  Official decision · page 3 →
• ADJ10981243 · 2025-01-13 · Van Nuys District OfficeApportionmentremanded

  Determinative passage · p.42. Whether the apportionment indicated by AME Dr. Hirsch as to hypertension constitutes substantial medical evidence.

  The WCJ found the apportionment evidence for hypertension failed to meet defendant's burden, but the WCAB granted reconsideration to further develop the record on apportionment.

  Official decision · page 4 →
• ADJ7037201 · 2024-12-06 · Marina Del Rey District OfficePermanent disability ratingremanded

  Determinative passage · p.2Pursuant to Findings and Award issued on May 22, 2013, applicant sustained injury to his psyche, cardiovascular system (in the form of hypertension), cervical-thoracic spine, lumbar spine, and in the form of sleep disorder and sexual dysfunction while employed as a police officer by defendant City of Baldwin Park from May 13, 2002 to November 20, 2009. Applicant's injuries resulted in temporary total disability from November 20, 2009 to May 13, 2011, and thereafter in permanent partial disability of 83 percent. (Findings and Award and Order Following Remand After Reconsideration, dated May 22, 2013.)

  The WCJ's finding of 100% permanent and total disability was initially supported by additive approach medical opinions, but the WCAB found the record incomplete under the en banc Vigil and Nunes decisions requiring further analysis of ADLs and valid medical apportionment. The WCAB rescinded the award and remanded for further proceedings and record development.

  Official decision · page 2 →
• ADJ9647382 · 2024-08-22 · Marina del Rey District OfficePermanent disability ratingremanded

  Determinative passage · p.1Applicant seeks reconsideration of the "Findings of Fact and Award" (F&A) issued on September 29, 2021, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that applicant sustained industrial injury in the form of fibromyalgia which caused 65% permanent partial disability.

  The WCJ's permanent disability rating of 65% was found to be unsupported due to lack of sufficient medical evidence to rebut the Combined Values Chart, and the vocational expert's opinion on CVC rebuttal was deemed irrelevant as non-medical. The matter was remanded for further development of the record including medical evidence on CVC rebuttal and clarification of work restrictions for vocational evaluation.

  Official decision · page 1 →
• ADJ13528971 · 2024-05-28 · San Bernardino District OfficeReopening / new and further disabilityapplicant prevailed

  Determinative passage · p.2We agree with the WCJ that section 4664(c)(1) limits the award for applicant's malignant melanoma, coronary heart disease, and pulmonary emboli, as all these conditions fall under the "catch-all" region in section 4664(c)(1)(G). However, applicant's injury to his lower extremity veins arguably fall under a different body region under section 4664(c)(1)(F). We, thus, grant reconsideration and return this matter to the trial level to develop the records as to applicant's injury to his lower extremity veins. (Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal. App.4th 389, 393-395 [62 Cal.Comp.Cases 924]; McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261]; see § 5701 and 5906 and McDuffie v. Los Angeles County Metropolitan Transit Authority (2001) 67 Cal.Comp.Cases 138 (Appeals Bd. en banc).)

  The Board granted reconsideration and remanded the matter to develop the record on the injury to the lower extremity veins, which may fall under a different body region than the other injuries.

  Official decision · page 2 →
• ADJ16695855 · 2024-01-12 · Van Nuys District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.4II FACTS the applicant testified that on July 22, 2022, she was performing her duties tagging and pricing clothing.1 At the moment of the incident, she was tagging garments, approximately 6 to 8 inches away from the clothing rack. She was looking down, as she had to be careful with the pricing gun to avoid the needle going into her hand. Suddenly, the clothing rack was pushed onto her and was on top of her. She "went into the mutt, [which is a wire cage that holds clothing], and then I don't know, I just started holding my head because I was really surprised at all this." She loudly2 announced, "Were you trying to kill me?" She told those present that she had rods in her back and that she was going to go to the hospital. 3 She then left for Kaiser. The clothing rack contacted her body, striking her chest around the top of her rib cage. This caused her to go backwards, and her neck, upper back and left shoulder contacted the mutt behind her.4 the applicant's testimony as to these points was credible, and unrebutted. Defendant has denied applicant's claim of injury and has suggested that the claim is fraudulent.

  The court found credible testimony and medical evidence supporting injury AOE/COE and rejected defendant's contrary video evidence and fraud claim.

  Official decision · page 4 →
• ADJ16268064 · 2023-11-15 · Van Nuys District OfficeQME/AME processremanded

  Determinative passage · p.4In the April 24, 2023 Order granting applicant's Petition for additional QME panels, the WCJ merely states: "IT IS HEREBY ORDERED that The DIR Medical Unit shall issue an additional panels QME List in the area of Internal Medicine (MMM) and Psychiatry (MPD.)" The WCJ does not discuss her reasoning for her decision. Additionally, the Order issued without a hearing, no minutes were filed, no testimony was taken, and the WCJ did not provide a summary of the evidence she relied on in making her decision.

  The WCJ issued an order granting additional QME panels without holding a hearing, creating a record, or providing a summary of the evidence relied upon, as required by law. The Appeals Board found this was improper and rescinded the order, remanding for further proceedings.

  Official decision · page 4 →
• ADJ10799317 · 2023-05-09 · Pomona District OfficeJurisdiction / venuedefendant prevailed

  Determinative passage · p.3Here, we are unable to evaluate the merits of the WCJ's Discovery Order due to the state of the record. The record does not contain any evidence to provide the basis for the WCJ's Order, including applicant's proposed questions for Captain Cooper or the captain's original deposition, and no hearing on applicant's Motion to Compel was held. This raises significant concerns of due process, as neither party has had the opportunity to properly develop the evidentiary record on the issue presented, namely, whether Captain Cooper can be ordered to answer applicant's proposed questions at a deposition. Accordingly, we will grant removal, rescind the WCJ's Discovery Order, and return the matter to the WCJ so that a hearing may be set on applicant's Motion to Compel.

  The record lacked evidence to support the WCJ's Discovery Order, raising due process concerns and necessitating removal and rescission of the order.

  Official decision · page 3 →
• ADJ9962889 · 2022-04-13 · Anaheim District OfficeDiscrimination under Labor Code §132aapplicant prevailed

  Determinative passage · p.8As to the issue of whether defendant deviated from its procedures by seeking a medical report from a non-treating physician, the record reveals that defendant returned applicant to work based upon the treating physician's report in January 2016 and applicant worked full duty for approximately a year and a half. (Report, p. 2.) In early 2017, with applicant's claim in litigation, the parties jointly sought a supplemental report from Dr. Wieseltier as to the issue of permanent disability of the cervical spine. (Ex. X, Report of Dr. Wieseltier, April 6, 2017, p. 4.) Dr. Wieseltier prepared the requested report and opined that applicant was precluded from "prolonged or repetitive neck movements and heavy lifting," but did not opine as to whether applicant should be restricted from work. (Id., p. 7.) Thereafter, defendant's attorney requested that Dr. Wieseltier prepare a supplemental report on whether or not the preclusions set forth in his April 6, 2017 report should result in restrictions. (Ex. X, Report of Dr. Wieseltier, August 2, 2017, p. 3.)

  The Board found that defendant deviated from its usual procedures by seeking a supplemental medical report from a non-treating physician and by imposing work restrictions without resolving conflicting medical reports, establishing a prima facie claim of discrimination under section 132a.

  Official decision · page 8 →

Also recorded as

The same claims administrator is printed several ways across the decisions, and all of them were counted as one. This is every spelling behind the figures above.

• ADMINSURE
• ADMINSURE, INC.
• Adminsure
• ADMINSURE ONTARIO
• ADMINSURE INC.
• Adminsure, Inc.
• Adminsure Inc.

Is this your company and something here is wrong? Tell us and we will fix it. Every figure on this page is a count of released decisions this claims administrator is named in, and the decisions themselves are listed above with the passage each turned on.