Innovative Claims Solutions, INC.

What they litigate

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

• AOE/COE2
• QME/AME process2
• Apportionment1
• Temporary disability1

Where they appear

• Sacramento 3
• Fresno 1
• Oakland 1
• Redding 1
• Salinas 1
• San Francisco 1
• San Jose 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.

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

Counted over 10 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.

• ADJ14902030 · 2025-01-24 · San Francisco District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.1Defendant seeks reconsideration of the Joint Findings of Fact, Award, and Order (F&A) issued by a workers' compensation administrative law judge (WCJ) on October 16, 2024. In that decision, the WCJ found in pertinent part in Case No ADJ14902030 that applicant, while employed during the period of November 15, 2004 through January 23, 2021 as a firefighter by defendant the City of Daly City, sustained injury arising out of and in the course of employment to the respiratory system and circulatory system/heart and that applicant's injury caused permanent disability of 79% in Case No ADJ14902030, and she awarded permanent disability, attorney's fees, and a life pension; and in Case No. ADJ19260558 that applicant, while employed during the period of January 1, 2005 through January 23, 2021 as a firefighter, by the City of Daly City, did not sustain injury arising out of and in the course of employment to the circulatory system/heart and ordered that applicant take nothing in Case No. ADJ19260558.

  The WCJ found that applicant's employment caused a single injury to the respiratory and circulatory system/heart, supported by medical evidence and employment history.

  Official decision · page 1 →
• ADJ14364236 · 2024-08-26 · Redding District OfficeQME/AME processdefendant prevailed

  Determinative passage · p.2On June 10, 2024, the WCJ issued her Findings of Fact, determining that Dr. Sonu was not disqualified as the QME, and that the QME was not unavailable for cross-examination. The WCJ's Opinion on Decision noted the QME's detailed physical findings in the February 7, 2023 report, as well as the attestations of the QME that he had personally accomplished a physical examination of the applicant. (Opinion on Decision, p. 3.) The WCJ further noted that applicant did not promptly raise the issue of the adequacy of the examination, waiting more than one year to offer any objection to the evaluation, as set forth in his April 1, 2024 DOR. With respect to the availability of the QME for deposition, the WCJ noted that applicant had the burden of proving unavailability of the QME but had offered no evidence in support of that contention. (Id. at p. 4.)

  The WCJ found the QME's physical examination credible based on detailed findings and attestations, and applicant failed to prove unavailability for deposition; removal standard not met.

  Official decision · page 2 →
• ADJ11248645 · 2023-08-31 · Fresno District OfficeTemporary disabilitydefendant prevailed

  Determinative passage · p.6Labor Code section 4853 provides, "Whenever such disability of any such officer or employee continues for a period beyond one year, such member shall thereafter be subject as to disability indemnity to the provisions of this division other than Section 4850 during the remainder of the period of said disability or until the effective date of his retirement under the Public Employees' Retirement Act, and the leave of absence shall continue."

  The applicant is not entitled to temporary disability benefits for the second injury because Labor Code section 4853 bars temporary disability payments after the effective date of CalPERS industrial disability retirement, even if the injuries are from different dates but with the same governmental entity employer.

  Official decision · page 6 →
• ADJ12524191 · 2022-08-30 · Oakland District OfficeAOE/COEremanded

  Determinative passage · p.3FINDINGS OF FACT (1) the applicant, while employed on February 13, 2019, in Livermore, California, as a firefighter, occupational group number 490, by the Livermore- Pleasanton Fire Department, permissibly self-insured for workers' compensation, its claims administered by Innovative Claims Solutions, Incorporated, claims to have sustained an injury arising out of and in the course of employment to his psyche. (2) The compensability of said injury cannot be determined by means of the available evidentiary record, and that record requires further development, consistent with the opinion on decision herein. (3) All other issues must be deferred.

  The compensability of the psychiatric injury could not be determined on the available record and requires further development; the matter is returned to the trial level for further proceedings.

  Official decision · page 3 →
• ADJ10939613 · 2021-04-21 · Sacramento District OfficeQME/AME processapplicant prevailed

  Determinative passage · p.2Both parties submitted briefs per the Minute Order and attached exhibits to their briefs. The WCJ then issued the disputed Order as outlined above. To date, no evidence has been admitted into the record regarding the QME dispute.

  The WCJ issued the QME Order without an evidentiary record, which is required for substantial evidence review; the Appeals Board cannot address the merits without a complete record and thus grants removal and remands for further proceedings.

  Official decision · page 2 →
• ADJ18173191 · 2024-03-28 · San Jose District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.1The Petition for Removal of the decision issued on February 28, 2024, has been withdrawn by petitioner. Therefore, it will be dismissed.

  Petitioner withdrew the Petition for Removal, leading to dismissal.

  Official decision · page 1 →
• ADJ11365948 · 2024-03-14 · Salinas District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.1The Petition for Removal of the decision issued on August 8, 2023 has been withdrawn by petitioner. Therefore, it will be dismissed.

  Petition for Removal was withdrawn by petitioner, leading to dismissal of the petition.

  Official decision · page 1 →
• ADJ13370650 · 2022-04-29 · Sacramento District OfficeReconsideration / removaldefendant prevailed

  Determinative passage · p.1Removal is an extraordinary remedy rarely exercised by the Appeals Board. (Cortez v. Workers' Comp. Appeals Bd. (2006) 136 Cal.App.4th 596, 599, fn. 5 [71 Cal.Comp.Cases 155]; Kleemann v. Workers' Comp. Appeals Bd. (2005) 127 Cal.App.4th 274, 280, fn. 2 [70 Cal.Comp.Cases 133].) The Appeals Board will grant removal only if the petitioner shows that substantial prejudice or irreparable harm will result if removal is not granted. (Cal. Code Regs., tit. 8, § 10955(a); see also Cortez, supra; Kleemann, supra.) Also, the petitioner must demonstrate that reconsideration will not be an adequate remedy if a final decision adverse to the petitioner ultimately issues. (Cal. Code Regs., tit. 8, § 10955(a).) Here, based upon the WCJ's analysis of the merits of petitioner's arguments, we are not persuaded that substantial prejudice or irreparable harm will result if removal is denied and/or that reconsideration will not be an adequate remedy if the matter ultimately proceeds to a final decision adverse to petitioner.

  Petitioner did not demonstrate substantial prejudice or irreparable harm, nor that reconsideration would be inadequate.

  Official decision · page 1 →
• ADJ13508500 · 2021-06-18 · Sacramento District OfficeReconsideration / removalapplicant prevailed

  Determinative passage · p.1We have considered the allegations of the Petition for Reconsideration 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 for the reasons stated in the WCJ's report, which we adopt and incorporate, and for the reasons stated below, we will deny reconsideration.

  The WCAB panel adopted the WCJ's report and denied the petition for reconsideration because the defendant failed to comply with its duty to conduct a reasonable and good faith investigation and improperly rejected the medical evidence without clarification attempts.

  Official decision · page 1 →
• ADJ number not stated · 2015-12-16Other disputed issuedefendant prevailed

  Determinative passage · p.111 NOTICE IS HEREBY GIVEN that the Appeals Board intends to suspend the privilege of Javier

  Repeated sanctions for bad-faith actions and frivolous tactics by Javier the applicant justified suspension of his privilege to appear before the WCAB.

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.

• INNOVATIVE CLAIMS SOLUTIONS
• INNOVATIVE CLAIM SOLUTIONS SAN RAMON
• Innovative Claims Solutions, Inc.
• Innovative Medical Management
• INNOVATIVE CLAIMS SAN RAMON
• Innovative Claim Solutions
• Innovative Risk Management

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.