Oak River Insurance Company

What they litigate

Disputed issues across the decisions this insurance carrier is named in. Every row opens the decisions it counts.

Where they appear

• Anaheim 8
• Los Angeles 5
• Van Nuys 4
• Long Beach 3
• Pomona 3
• Oxnard 2
• San Diego 2
• Santa Ana 2
• Santa Rosa 2
• Lodi 1
• Marina del Rey 1
• Oakland 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 insurance carrier does its work. It describes how a set of appealed disputes came out.

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

Counted over 33 appealed decisions. Not this insurance carrier’s book of work.

Decisions

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

• ADJ9787530 · 2026-03-03 · Oxnard District OfficeMedical treatment / UR / IMRdefendant prevailed

  Determinative passage · p.6However, as the WCJ's Report observes, following the March 28, 2014 injury date, applicant sought and received treatment from within defendant's MPN including evaluation and diagnosis by Eileen Lee, D.O. (Ex. A, Report of Eileen Lee, D.O., various dates), surgical intervention performed by Clarence Petrie, M.D. (Ex. D, Reports of Clarence Petrie, M.D., various dates), and later, follow-up consultation with Raye Bellinger, M.D. (Ex. E, Reports of Raye Bellinger, M.D., various dates). The evidence thus supports defendant's timely provision of medical treatment in response to applicant's March 28, 2014 injury. Moreover, lien claimant identifies no request for medical treatment submitted by applicant which defendant neglected or refused. (See Knight v. United Parcel Service (2006) 71 Cal.Comp.Cases 1423 (Appeals Board en banc).)

  The evidence showed that defendant provided timely and necessary medical treatment within its MPN for the admitted injury, and there was no denial of care or evidence supporting the need for self-procured treatment at employer expense.

  Official decision · page 6 →
• ADJ11008738 · 2025-10-20 · Long Beach District OfficeSanctions under Labor Code §5813applicant prevailed

  Determinative passage · p.5the MOH from the April 28, 2025 lien conference until July 11, 2025, a review of the record does not show defendant's conduct rose to the level of bad faith that is needed to impose sanctions under section 5813. Specifically, defendant contends "on May 5, 2025, the day the Minutes were received via email, the inbox experienced a high volume of message over 250 emails. The relevant

  Defendant's failure to timely serve and file proof of service was found to be inadvertent and not in bad faith, thus sanctions were not warranted.

  Official decision · page 5 →
• ADJ16834660 · 2025-08-21 · Anaheim District OfficeLiensmixed

  Determinative passage · p.1Lien claimant Medland Medical (lien claimant) petitioned for reconsideration of the Findings and Orders issued by the workers' compensation administrative law judge (WCJ) in this matter on December 31, 2024. In that decision, the WCJ found that applicant, while employed as a landscaper from April 17, 2021 to April 17, 2022, sustained industrial injury to his bilateral upper extremities. The WCJ also found, in relevant part, that lien claimant is not entitled to reimbursement of medical treatment and medical-legal reporting costs for services rendered prior to the denial of the claim on January 13, 2023, and that lien claimant is entitled to payment for medical treatment services rendered after the claim denial, but that the evidentiary record was inadequate to determine the value of medical treatment services rendered after the claim denial.

  The WCAB found the evidentiary record inadequate to determine the value of medical treatment services rendered after the claim denial but approved the settlement stipulation for lien reimbursement.

  Official decision · page 1 →
• ADJ13119319 · 2025-07-07 · Lodi District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of the March 25, 2025, Findings of Fact and Orders (F&O) wherein the workers' compensation administrative law judge (WCJ) found, in relevant part, that the applicant was an employee of Portuguese Fraternal Society of America and SES Hall on March 29, 2018 when he sustained injury arising out of and in the course of employment to the left wrist. All other issues were deferred.

  Applicant's credible and unrebutted testimony showed defendant's control and supervision over work, and defendant failed to rebut presumption of employment under Labor Code section 2750.5 and Borello factors.

  Official decision · page 1 →
• ADJ10809542 · 2025-04-01 · Oakland District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.3Turning to the merits, since "date of injury" was specifically placed at issue at trial (Minutes of Hearing and Summary of Evidence of December 17, 2024 trial at p. 2) and the WCJ explained in the Opinion on Decision that "the date of injury is August 2, 2017...." (Opinion on Decision at p. 8), we will amend the WCJ's decision to include an express finding that the Labor Code section 5412 date of injury is August 2, 2017. We will otherwise affirm the WCJ's decision for the reasons stated by the WCJ in the Report, which we adopt, incorporate and quote below.

  The date of injury was found to be August 2, 2017, based on the finding that compensable temporary disability began on that date and the condition became permanent and stationary later, supported by substantial evidence including medical opinions and applicant's testimony.

  Official decision · page 3 →
• ADJ15359587 · 2025-03-03 · Santa Ana District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.8Next, we disagree with the WCJ's overly technical reliance on stipulated occupation numbers in order to justify making the determination that applicant's job description in the medical reporting was somehow not credible. Dr. Bolling provided a detailed list of applicant's job duties, and Dr. Bolling was aware that applicant was the manager. Even if applicant was a manager, when she performed the more physical duties, she would have been entitled to a higher occupational variant. Thus, we conclude that the medical reporting by the QME Dr. Bolling is substantial medical evidence and sufficient to find AOE/COE.

  The WCAB found that the QME Dr. Bolling's medical opinion was substantial evidence supporting injury AOE/COE, rejecting the WCJ's prior finding that the QME's opinion was not substantial due to occupational history discrepancies, and granted reconsideration to find injury AOE/COE.

  Official decision · page 8 →
• ADJ12055950 · 2025-01-21 · Los Angeles District OfficeAOE/COEmixed

  Determinative passage · p.1Lien Claimant Dental Trauma Center (DTC) seeks reconsideration of the Findings of Fact and Order issued by the workers' compensation administrative law judge (WCJ) in this matter on October 10, 2024. In that decision, the WCJ found that DTC did not prove that an industrial injury occurred in this case, and that they did not establish that they provided valid medical-legal services.

  The WCJ found no industrial injury based on the medical evidence, but the Appeals Board found the record incomplete and granted reconsideration to allow further review of the injury AOE/COE issue.

  Official decision · page 1 →
• ADJ12730898 · 2024-08-08 · Santa Rosa District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.5Defendant produced insufficient evidence to meet its burden of proof as to the initial

  Defendant failed to prove applicant was the initial physical aggressor; coworker did not testify and witness testimony was limited and uncertain; injury is industrial and presumptively accepted due to untimely denial by defendant.

  Official decision · page 5 →
• ADJ16925192 · 2024-05-10 · Van Nuys District OfficeDeath benefitsdeferred

  Determinative passage · p.7In this regard, the record shows that the WCJ determined that Melanie the applicant is not entitled to Labor Code section 4703.5(a) death benefits based solely upon the finding that she was not a total dependent of the applicant and is otherwise undeveloped as to that issue. (Report, p. 7.) But since we have determined that Melanie the applicant was a total dependent, the record is without grounds to support the finding that she is not entitled to Labor Code section 4703.5(a) death benefits. Accordingly, we will substitute a finding that defers the issue of whether Melanie the applicant is entitled to Labor Code 4703.5(a) death benefits.

  Since Melanie the applicant was found to be a total dependent, the issue of her entitlement to death benefits under Labor Code section 4703.5(a) was deferred for further proceedings.

  Official decision · page 7 →
• ADJ11796055 · 2024-02-12 · Santa Rosa District OfficeQME/AME processdefendant prevailed

  Determinative passage · p.2Additionally, the F&O determines that there is insufficient evidence to establish that the reporting of the QME violates section 4628. (Finding of Fact No. 4.) Pursuant to Labor Code section 4628(e), a judicial determination that a medical-legal report "[failed] to comply with the requirements of this section shall make the report inadmissible as evidence and shall eliminate any liability for payment of any medical-legal expense incurred in connection with the report." (Lab. Code, § 4628(e).) A judicial determination with respect to an alleged violation of section 4628 necessarily implicates the reporting physician's rights to reimbursement for the preparation of the report as well as the defendant's concomitant right to resist such reimbursement in collateral proceedings. Consequently, the WCJ's determination regarding section 4628 compliance is a final order.

  The QME Dr. Lee complied with Labor Code section 4628 by personally reviewing and verifying the medical records and history, and the court found insufficient evidence to establish a violation.

  Official decision · page 2 →
• ADJ13080332 · 2024-02-08 · Marina del Rey District OfficeAOE/COEdeferred

  Determinative passage · p.5It appears that Dr. Mirzaians is awaiting additional diagnostics and a re-evaluation of applicant before he addresses the issues of permanent disability and apportionment. However, it also must be noted that in his November 1, 2021 supplemental report Dr. Mirzaians discussed various inconsistencies in the record as to whether applicant sustained injury to his right shoulder, left shoulder, or both shoulders. (Joint Exh. 4, pp. 6 § 7.) To be substantial evidence, a medical opinion must be based on pertinent facts, on an adequate examination and on an accurate history. (Escobedo v. Marshalls, supra.) The inconsistencies in the medical record, as discussed by Dr. Mirzaians, render his earlier opinions not substantial evidence as to applicant's shoulder injury. Review of the record also indicates that Dr. Mirzaians did not review any medical records pertaining to, and did not provide an opinion as to, the claimed "fingers" injury.4 Therefore, the record does not contain substantial evidence regarding that issue.

  Inconsistencies in the medical record and lack of substantial evidence regarding shoulder and fingers injuries; issues deferred for further development of the record.

  Official decision · page 5 →
• ADJ16344618 · 2023-12-04 · Anaheim District OfficeLiensremanded

  Determinative passage · p.1Lien claimant Medland Medical Group seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Order of September 12, 2023, wherein it was found that, while employed as a machine operator during a cumulative period ending May 27, 2022, applicant sustained industrial injury to the elbow and back, but not to the arm, wrist, or other body parts. As relevant to the instant Petition, it was found that lien claimant was not entitled to reimbursement for its lien. The basis behind the disallowance was the purported fact that applicant had been discharged from care by his primary treating physician, and that any further care from a new treating physician was only available after going through the qualified medical evaluator or agreed medical evaluator process. (Cal. Code Regs., tit. 8, § 9785; Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing) (2000) 80 Cal.App.4th 1041 [65 Cal.Comp.Cases 477.)

  The WCJ disallowed the lien claim based on the discharge of care by the primary treating physician and the requirement to go through the QME or AME process for further care; the WCAB granted reconsideration to analyze the applicability of the discharge and designation of a new primary treating physician.

  Official decision · page 1 →

Also recorded as

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

• OAK RIVER INSURANCE COMPANY
• Oak River Insurance Company
• OAK RIVER INSURANCE
• Oak River Ins. Co.

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 insurance carrier is named in, and the decisions themselves are listed above with the passage each turned on.