American Claims Management

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 6
• San Diego 4
• Fresno 2
• Marina del Rey 2
• Riverside 2
• Sacramento 2
• San Francisco 2
• Stockton 2
• Long Beach 1
• Los Angeles 1
• Oakland 1
• Oxnard 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 defense
• 13 for the applicant
• 4 returned for more record

Counted over 31 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.

• ADJ8558358 · 2025-09-22 · Fresno District OfficePenalties under Labor Code §5814applicant prevailed

  Determinative passage · p.10The length of the delay is considerable since the award became final upon denial of review by the California Supreme Court on October 2, 2024, and remains unpaid. (Exh. 7, Supreme Court Order petition for review denied, EAMS 78475965, 10/2/24.) The delay was an intentional, solitary incident unrelated to any claims processing or legitimate business needs. The delayed payment was following a judicial award that would generally allow for payment to be made within 30 days of the decision becoming final. (Report, at p. 11.) We agree with the WCJ's weighing of the considerations appurtenant to the question of unreasonable delay under section 5814 and attorney's fees under section 5814.5.

  The defendant unreasonably delayed payment of a final award, justifying penalties and attorney fees under Labor Code sections 5814 and 5814.5.

  Official decision · page 10 →
• ADJ6840627 · 2025-03-17 · Sacramento District OfficeMedical treatment / UR / IMRremanded

  Determinative passage · p.6Turning to defendant's argument that the WCJ erroneously found that applicant was entitled to reimbursement for self-procured chiropractic treatment because the treatment was not authorized under Utilization Review, we note that the parties raised the issue of "[l]iability for self-procured medical treatment" without reference to Utilization Review and without submitting Utilization Review documents for admission in evidence. It is thus unclear whether a Request for Authorization (RFA) was submitted and, if so, whether defendant reserved its right to retrospective Utilization Review by issuing a written decision complying with AD Rule 9792.9(b)(1). (Cal. Code Regs., tit. 8, § 9792.9(b)(1).) Hence, we will order that a final decision after reconsideration is deferred pending further review of the merits of this issue.

  The Appeals Board found unclear whether Utilization Review was properly followed and deferred final decision for further review.

  Official decision · page 6 →
• ADJ14328080 · 2024-10-16 · San Diego District OfficeJurisdiction / venueapplicant prevailed

  Determinative passage · p.3In the instant case, defendant failed to serve applicant with a copy of the letter indicating defendant's intention to seek dismissal of the claim in contravention to WCAB Rule 10550(b). Defendant served only applicant's attorney and American Claims Management. As indicated by the WCJ, failure to serve notice to applicant not only makes defendant's Petition to Dismiss defective, but "violates applicant's right to due process." (Report, p. 3.)

  Defendant failed to serve applicant with the required notice under WCAB Rule 10550(b), making the Petition to Dismiss defective and violating applicant's due process rights. Additionally, the cases were reactivated for hearing, restarting the one-year period for dismissal under Rule 10550(a), rendering the issue moot.

  Official decision · page 3 →
• ADJ15225348 · 2023-12-12 · Oakland District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.1For the reasons stated in the WCJ's report, we agree that the opinions of panel qualified medical examiner (PQME) Rommel Hindocha is substantial medical evidence upon which the WCJ properly relied. To be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416§ 17, 419 [33 Cal.Comp.Cases 660].) A physician's report must also be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and

  The WCJ properly relied on Dr. Hindocha's Almaraz/Guzman rating as substantial medical evidence because it was based on reasonable medical probability, supported by specific findings including significant limitations in 7/8 ADL categories, unsuccessful surgeries, and muscle atrophy, and was consistent with applicant's testimony and medical records.

  Official decision · page 1 →
• ADJ8558358 · 2023-11-09 · Fresno District OfficePermanent total disabilityapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of the March 16, 2023 Findings of Fact, Award & Opinion on Decision (F&A), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as a semi-truck driver/laborer on August 4, 2010, sustained industrial injury to the cervical spine, thoracic spine, lumbar spine, headaches, hearing loss, psyche, hypertension, high blood pressure, heart-left ventricular hypertrophy, chest pain, medication effects, sleep, [dysphagia], failed spine surgery, and adjacent segment disease. The WCJ found that as a result of his injuries, applicant sustained permanent and total disability without apportionment.

  The WCJ's finding of permanent and total disability without apportionment was supported by the aggregate medical-legal record, including psychiatric, internal medicine, neurological injuries, the primary treating physician's opinions, vocational expert's report, and credible trial testimony, outweighing the orthopedic AME's apportionment opinion.

  Official decision · page 1 →
• ADJ16048168 · 2023-02-13 · Stockton District OfficeTemporary disabilityapplicant prevailed

  Determinative passage · p.4Expedited Hearing was held October 19, 2022, with issues of, inter alia, temporary disability from the day of PQME evaluation on August 8, 2022, need for further medical treatment, and applicant's request to change treating physician.

  PQME Sclafani's report was found to be substantial evidence supporting temporary partial disability beginning August 8, 2022, and there was no evidence of a subsequent injury being the sole cause of disability.

  Official decision · page 4 →
• ADJ14200347 · 2022-10-10 · Santa Ana District OfficeAOE/COEdefendant prevailed

  Determinative passage · p.5There was evidence to support Applicant's claim that he was diagnosed with Covid, namely a reference in records reviewed by the ortho QME, Dr. Elias, from James A. Sharkoff, M.D. / Pueblo Medical Center, indicating that on July 31, 2020 Applicant was seen for and diagnosed with Covid 19 pneumonia [Ex Y, P5]. However, as the Court noted, factual evidence of exposure to Covid at work was non-existent. In addition, there was an absence of medical opinion on the issue of causation.

  The court found insufficient medical evidence to establish causation of Covid-19 injury by a reasonable medical probability, requiring further development with a QME panel.

  Official decision · page 5 →
• ADJ10123051 · 2022-05-20 · San Diego District OfficeApportionmentdefendant prevailed

  Determinative passage · p.8It appears that Dr. Wieseltier speculated that the disability from applicant's pre-existing knee condition would have "manifested" without the June 20, 2015 injury. He did not explain how and why the pre-existing condition was causing permanent disability at the time of the evaluation, nor did he explain how and why those factors are responsible for 40% of applicant's right knee disability. Nor did he explain how he could apportion disability when he had not yet determined applicant's disability. Thus, Dr. Wieseltier's conclusion regarding apportionment, as stated in the December 12, 2019 report and quoted in the June 23, 2020 report, does not constitute substantial evidence.

  Dr. Wieseltier's apportionment opinion lacked explanation on how preexisting conditions caused permanent disability and was thus not substantial evidence; issue deferred for further development.

  Official decision · page 8 →
• ADJ2193346 · 2022-02-11 · Marina Del Rey District OfficeLiensdefendant prevailed

  Determinative passage · p.3subdivision (c)(1). As a result, lien claimant's lien was dismissed with prejudice by operation of law as of Monday, July 3, 2017 at 5:01 p.m.4

  The lien claimant failed to file the required declaration by the July 3, 2017 deadline, resulting in dismissal of the lien with prejudice by operation of law. The Appeals Board upheld this dismissal and denied the Petition for Reconsideration as untimely.

  Official decision · page 3 →
• ADJ11905041 · 2021-12-30 · Marina del Rey District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.8Based on the credible and unrebutted testimony of the Applicant, the testimony of Laura Richardson, the Panel QME reports and deposition of Dr. Isaac Schmidt and the entire record, Applicant has met her burden of proving that she sustained injury arising out of and in the course of employment to her low back on 11/25/2018. Applicant testified that on 11/25/2018 while she was assisting a CNA in lifting a patient she felt a pull in her back but she did not report the injury on that date because she was not in pain. The next day she noticed soreness but did not report the injury because she thought it would resolve on its own. The Applicant continued to work her usual and customary duties as a registered nurse with the same level of soreness until the end of December when she noticed the pain had increased and began radiating down one leg. At that time she decided to make an appointment with a primary care physician in January 2019 when her insurance "kicked in".

  Applicant's credible and unrebutted testimony and corroborating evidence established injury AOE/COE to low back on 11/25/2018.

  Official decision · page 8 →
• ADJ12562949 · 2021-09-27 · Van Nuys District OfficeCumulative traumaremanded

  Determinative passage · p.1Defendant seeks reconsideration of the July 14, 2021 Findings of Fact wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as a Certified Nursing Assistant at Encino Hospital Medical Center, sustained injury arising out of and in the course of employment to her cervical spine, bilateral shoulders, wrists, hands, and lumbar spine.

  The WCAB found that the record lacked substantial medical evidence on causation and that a medical evaluation under Labor Code sections 4060 and 4062.2 was necessary before a proper finding could be made.

  Official decision · page 1 →
• ADJ10807065 · 2021-09-21 · Los Angeles District OfficeSerious and willful misconductdefendant prevailed

  Determinative passage · p.3applicant (deceased), through the Law Offices of Fred Fong, who represents several of the applicant's dependents, has filed a timely, verified and properly served reconsideration petition. This petition asserts that the WCJ erred in determining that decedent the applicant's fatal accident due to a fall from a carport roof was not attributable to the defendant employer's serious and willful misconduct within the meaning of Labor Code section 4453. Petitioner makes this contention on the following grounds:

  The petitioners failed to prove that the employer or a designated representative had knowledge of or recklessly disregarded safety order violations causing the applicant's death, as required by Labor Code section 4453.1. The evidence showed the applicant had autonomy over the unsafe acts and the employer had safety programs in place. The OSHA fines and settlement did not establish employer misconduct under the statute.

  Official decision · page 3 →

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.

• AMERICAN CLAIMS MANAGEMENT
• American Claims Management
• American Claims Management, Inc.
• AMERICAN CLAIMS MANAGEMENT, INC.
• AMERICAN CLAIMS

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.