PSI

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 4
• Sacramento 2
• Santa Barbara 2
• Anaheim 1
• Bakersfield 1
• Long Beach 1
• Los Angeles 1
• Marina del Rey 1
• Oakland 1
• Pomona 1
• Riverside 1
• Santa Rosa 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.

• 10 for the defense
• 7 for the applicant
• 1 returned for more record

Counted over 16 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.

• ADJ12963083 · 2026-03-06 · Stockton District OfficeStatute of limitationsremanded

  Determinative passage · p.12Accordingly, given that the WCJ's decision in this case (ADJ12963083) to bar applicant's claim based on the statute of limitations is not based on admitted evidence or substantial evidence, it must be our decision after reconsideration to rescind the F&O and return this matter to the trial level for further development of the record consistent with this decision. We affirm the WCJ's decision to dismiss applicant's claim in ADJ13167130 pursuant to the parties' stipulation.

  The WCAB found that the WCJ's decision barring the claim based on statute of limitations was not supported by substantial evidence and rescinded it, returning the matter for further proceedings. The WCJ had found the claim barred because applicant knew or should have known of the injury earlier, but the WCAB found the date of injury to be the QME report date, making the claim timely.

  Official decision · page 12 →
• ADJ9198656 · 2025-07-07 · Santa Barbara District OfficeStatute of limitationsapplicant prevailed

  Determinative passage · p.4To the extent that Zurich also now raises the running of the statute of limitations of section 5405 for the first time, we agree with the PWCJ's observation that the affirmative defense is not timely raised. (Lab. Code, § 5409 ["The running of the period of limitations prescribed by this chapter is an affirmative defense and operates to bar the remedy and not to extinguish the right of the employee. Such defense may be waived. Failure to present such defense prior to the submission of the cause for decision is a sufficient waiver."]; see also Memorial Hospital Assoc. v. Workers' Comp. Appeals Bd. (Caldwell) (1995) 60 Cal.Comp.Cases 779 (writ denied) [statute of limitations waived by failing to raise the defense at mandatory settlement conference]; Griffith v. Workers' Comp. Appeals Bd. (1989) 209 Cal.App.3d 1260, 1265 [54 Cal.Comp.Cases 145, 148]) [issue not raised at trial level is waived].) Even were this not the case, we observe that applicant continued to receive authorized medical treatment and indemnity through 2013 when she filed the instant applications. (See, e.g., Ex. 11, report of AME Chester Hasday, M.D., dated November 11, 2019, at pp. 4, 57.) As such, we find Zurich's arguments regarding the applicability of the statute of limitations to be unpersuasive. (See Lab. Code, § 5405(b)-(c).)

  The statute of limitations defense was not timely raised and was waived; the claim is not barred as the applicant continued to receive authorized medical treatment and indemnity through 2013.

  Official decision · page 4 →
• ADJ14244361 · 2024-09-16 · Sacramento District OfficeQME/AME processmixed

  Determinative passage · p.1Applicant seeks reconsideration of the July 3, 2024 Findings of Fact, Award, and Order (F&O), wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as a firefighter during the period ending August 5, 2019, sustained industrial injury to her psyche. The WCJ found, in relevant part, that the reporting of Qualified Medical Evaluator (QME) Joseph R. Nevotti, Ph.D., did not constitute substantial medical evidence and that the deficiencies in the QME reporting could not be rehabilitated. Accordingly, the WCJ ordered Dr. Nevotti stricken as the QME and ordered the parties to consider the use of an Agreed Medical Evaluator or to obtain a new panel of QMEs.

  The WCJ found the QME's reporting was not substantial evidence and that the QME could not be rehabilitated due to unprofessional conduct and failure to apply correct apportionment law; the WCAB granted reconsideration and ordered a replacement panel of QMEs in psychology to resolve disputed issues.

  Official decision · page 1 →
• ADJ9464655 · 2024-08-22 · Anaheim District OfficeApportionmentmixed

  Determinative passage · p.1We issued an Opinion and Order Granting Petition for Reconsideration on Board Motion in this matter on February 18, 2021 (February Order) to study further the legal and factual issues raised by the Petition for Reconsideration. (Lab. Code, § 5900(b).) This is our Opinion and Decision after Reconsideration.

  The board corrected the prior decision to accurately reflect the comparative negligence percentages of the parties involved, including the applicant, third-party truck driver, and defendant employer, and clarified the method for calculating third-party credit based on total damages rather than settlement amount, leading to a mixed outcome with deferred credit determination.

  Official decision · page 1 →
• 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 →
• ADJ11946779 · 2022-04-11 · Santa Rosa District OfficePsyche AOE/COEapplicant prevailed

  Determinative passage · p.8Here, and contrary to the WCJ's conclusions, we find no evidence in the record from either Dr. Mosby or Dr. Staehle that applicant sustained two, separate injuries. Rather, the concurring opinions of both doctors is that applicant sustained one, cumulative trauma injury resulting from various job stressors over a period of years. (See Western Growers Ins. Co. v. Workers' Comp.Appeals Bd. (Austin) (1993) 16 Cal.App.4th 227, 236-237 [58 Cal.Comp.Cases 323].) There is no statement in any of the reports from Dr. Mosby that the February 6, 2017 meeting caused a separate, specific injury, or that any of his diagnoses were separately caused just by that meeting. Dr. Mosby agrees with Dr. Staehle that the meeting was simply the "final straw" that broke applicant not a new or distinct injury but the culmination of a cumulative trauma stress injury.

  Both Dr. Mosby and Dr. Staehle opined that applicant sustained one cumulative trauma injury to his psyche from various workplace stressors, not two separate injuries.

  Official decision · page 8 →
• ADJ11310844 · 2021-03-26 · Sacramento District OfficePermanent disability ratingapplicant prevailed

  Determinative passage · p.36. Petitioner alleges: Applicant's level of permanent is incorrect due to the age adjustment.

  The permanent disability rating was amended from 9% to 15% based on the correct age adjustment for the applicant who was 32 years old at the time of injury.

  Official decision · page 3 →
• ADJ18360589 · 2024-09-16 · Riverside District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.5We concur with the WCJ that there is no risk of irreparable harm or substantial prejudice to the applicant in having this matter set for trial given that the trial judge has been tasked by the trial setting order with hearing the issue of employment and determining whether the record requires further development on that issue pursuant to the trial judge's power and duty to do so (see eg., McDuffie v. Los Angeles County Metropolitan Transit Authority (2002) 67 Cal.Comp.Cases 138 (Appeals Bd. en banc). (Report, p. 4.) Thus, there is no reason why reconsideration would not be an adequate remedy after a final order, decision, or award issues after hearing.

  Applicant failed to show substantial prejudice, irreparable harm, or that reconsideration would not be an adequate remedy after a final decision; thus, removal is denied.

  Official decision · page 5 →
• ADJ15467076 · 2024-04-29 · Van Nuys District OfficeReconsideration / removalapplicant prevailed

  Determinative passage · p.4The undersigned issued Findings and Orders and an Opinion on Decision on February 7, 2023, in favor of the Applicant on all issues, namely that (1) The defendant has failed to comply with the Stipulation & Order dated June 8, 2023 and (duplicate) Order dated June 9, 2023, (2) The applicant is entitled to penalties, interest, attorney's fees, and costs because the Stipulation and Order was not complied with, and (3) The defendant is not entitled to credit for TD payments allegedly made per County Code Section 6.20.070 and allegedly made prior to the dates of the Orders of June 8, 2023 and June 9, 2023. Thereafter, Defendants filed the instant Petition for Reconsideration on March 1, 2024.

  The defendant failed to comply with the stipulation and order, did not prove good cause for delay, and improperly claimed credit after the order became final, justifying denial of reconsideration and imposition of penalties.

  Official decision · page 4 →
• ADJ16527694 · 2024-04-29 · Oakland District OfficeReconsideration / removalapplicant prevailed

  Determinative passage · p.7Here, it is unclear from our preliminary review of the evidence and the existing record as to whether the offer of modified work made by defendant was a bona fide offer. Taking into account the statutory time constraints for acting on the petitions, and based upon our initial review of the record, we believe reconsideration must be granted to allow sufficient opportunity to further study the factual and legal issues in this case.

  The Appeals Board found that the offer of modified work was unclear as to whether it was bona fide and granted reconsideration to further study the factual and legal issues.

  Official decision · page 7 →
• ADJ10773229 · 2024-03-14 · Santa Barbara District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.1We have considered the allegations of the Petition for Removal and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record and based upon the WCJ's analysis of the merits of petitioner's arguments in the WCJ's report, we will deny removal.1

  The Appeals Board denied the petition because the petitioner did not demonstrate substantial prejudice or irreparable harm if removal was denied, nor that reconsideration would be inadequate if the matter proceeded to a final adverse decision.

  Official decision · page 1 →
• ADJ10960461 · 2023-06-21 · Bakersfield District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.1We have considered the allegations of the Petition for Removal and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record and based upon the WCJ's analysis of the merits of petitioner's arguments in the WCJ's report, we will deny removal.

  The Appeals Board denied the petition because the petitioner did not show substantial prejudice or irreparable harm if removal was denied, nor that reconsideration would be inadequate if the matter proceeded to a final decision adverse to petitioner.

  Official decision · page 1 →

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.