Illinois Midwest Insurance Agency, LLC

What they litigate

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

Where they appear

• Fresno 7
• Santa Rosa 5
• Van Nuys 5
• Oakland 4
• Sacramento 4
• Los Angeles 3
• Santa Barbara 3
• Anaheim 1
• Bakersfield 1
• Oxnard 1
• Redding 1
• Riverside 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.

• 21 for the defense
• 12 for the applicant
• 6 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.

• ADJ21458754 · 2026-03-03 · Oakland District OfficeJurisdiction / venuedefendant prevailed

  Determinative passage · p.6With these principles in mind, we observe that the process by which a party may seek the issuance of a panel of QMEs is addressed in Rule 30 (Cal. Code Regs., tit. 8, § 30). Rule 30 requires that represented parties submit a request for a panel of QMEs electronically to the DWC Medical Unit, and that they identify the following elements:

  The panel request was valid despite an incorrect date of injury because it contained the correct claim number, which is the primary identifier for a QME panel request under Rule 30. The Appeals Board emphasized substance over form and found no significant prejudice or irreparable harm from the date error.

  Official decision · page 6 →
• ADJ17943105 · 2026-01-12 · Santa Rosa District OfficeAOE/COEdefendant prevailed

  Determinative passage · p.6injuries, applicant was not forthcoming. On June 17, 2023, applicant sought emergency treatment and requested a spine MRI, however on physical examination applicant's back was normal. Eventually, applicant self-procured lumbar spine x-rays and an MRI which were reviewed by his primary treating physician but no further action was indicated by him. Applicant also complained of left side testicle pain, however, Dr. Alchemy referred him to his primary care physician for it and per applicant he treated for it non-industrially including surgical intervention. There is simply no evidence in the record of industrial navel pain/left testicle injury. Significantly, AME, Dr. Marino only found injury to applicant's left ankle, and we are bound to make our findings based on the medical evidence. Hence, applicant did not prove any industrial injury to his neck, back, chest, shoulders nor navel pain/left testicle.

  No substantial medical evidence supports industrial injury to body parts other than the left ankle; AME Dr. Marino found injury only to the left ankle.

  Official decision · page 6 →
• ADJ17939202 · 2026-01-12 · Santa Rosa District OfficeEarnings / average weekly earningsdeferred

  Determinative passage · p.7As stated in the Court's written opinion, "The court finds it appropriate to award indemnity based upon the applicant's actual lost wages during the period of her incapacity, as the wages earned during the year prior to her injury no longer reflect her true earning capacity. However, the current evidentiary record is insufficient to determine her exact earnings at that time. Applicant's reliance on the pay statement history at page 56 of Applicant's Exhibit 25, while noted, is not substantial as it is unclear as to what exact periods these payments covered. This sole issue is deferred upon further development of the record. The parties are encouraged to informally resolve this issue with jurisdiction reserved." (Opinion on Decision)

  The court found that the applicant's actual lost wages during incapacity should be used, but the record was insufficient to determine exact earnings. Determination of Average Weekly Wage was deferred with jurisdiction reserved.

  Official decision · page 7 →
• ADJ19310869 · 2025-12-15 · Fresno District OfficePsyche AOE/COEremanded

  Determinative passage · p.8In the instant case, the WCJ did not address whether the workplace incidents were actual events of employment. (Lab. Code § 3208.3(b)(1); Rolda v. Pitney Bowes, Inc., supra, 66 Cal. Comp. Cases at pp. 245-247.) Therefore, the WCJ must perform a proper analysis of the psych claim.

  The WCJ failed to properly analyze whether workplace incidents were actual events of employment and the medical opinion was insufficient as it did not break down causation percentages and ignored more credible employer witness testimony; further medical development was required.

  Official decision · page 8 →
• ADJ13806639 · 2025-10-06 · Fresno District OfficePenalties under Labor Code §5814defendant prevailed

  Determinative passage · p.5We first turn to lien claimant's argument that because the WCJ awarded the full amount of costs and interest, an award of penalties was mandatory under Labor Code section 4622(a). We reject this argument and clarify that application of Labor Code section 4622 with respect to this lien claimant in this case is improper.

  The WCJ properly deferred the determination of penalties and interest because the lien claimant was not the medical-legal provider and due process requires an evidentiary hearing for penalties; interest was also premature to award.

  Official decision · page 5 →
• ADJ10361114 · 2024-12-31 · Oakland District OfficePermanent disability ratingdeferred

  Determinative passage · p.1Defendant seeks reconsideration of the "Amended Findings, Award, and Orders with Opinion on Decision" (F&A) issued on August 20, 2024, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that applicant was 100% permanently totally disabled.

  The Appeals Board found that the medical evidence on Combined Values Chart rebuttal was not substantial and that vocational expert opinions improperly included medical conclusions. The Board deferred the permanent disability issue for further development of the medical and vocational record.

  Official decision · page 1 →
• ADJ17674030 · 2024-12-30 · Riverside District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.7Here, lien claimant clearly met the burden of proving applicant's injury was industrial. Dr. Haghighinia's reporting constitutes substantial medical evidence by taking an accurate and adequate history of injury and explaining how and why the industrial work exposure caused applicant's complaints. The WCJ faulted the doctor for using an incorrect pronoun in one portion of the report, however this is a common error seen across many medical reports and does not, by itself, warrant rejecting the entirety of the report. The WCJ further noted that the doctor found that applicant had no flexion or extension range of motion measurements of the lumbar spine. This appears to be a misreading as the doctor placed an asterisk in these sections and noted that applicant was having pain in these areas. Again, this is a relatively minor issue that does not warrant rejecting the doctor's finding of industrial injury. Finally, the WCJ noted that the primary treater did not review applicant's prior medical records; however, there is no allegation that any such records exist, or were otherwise obtained and not reviewed.

  Dr. Haghighinia's reporting constituted substantial medical evidence, taking an accurate and adequate history and explaining how and why the industrial work exposure caused applicant's complaints. Minor report errors did not warrant rejection.

  Official decision · page 7 →
• ADJ10085720 · 2024-11-19 · Fresno District OfficeSerious and willful misconductremanded

  Determinative passage · p.11Here, the WCJ's conclusion that defendant engaged in serious and willful misconduct appears to be premised upon the violation of a safety order, namely the failure to properly secure the skylights such that they could support 400 pounds of weight pursuant to Code of California Regulations, Title 8, section 1632. That applicant was able to fall through the skylight in the manner he did supports the conclusion that it was unable to support 400 pounds of weight. However, the WCJ's decision fails to address defendant's argument raised in the post-trial brief as well as the Petition that the safety order in question explicitly references a different safety order, Code of California Regulations, Title 8, section 3212, which authorizes the provision of fall protection equipment as an alternative method of securing workers from injury when working around preexisting skylights.

  The WCJ's original decision did not adequately address defendant's argument about compliance with alternative safety measures and failed to resolve factual disputes about the provision and use of fall protection harnesses, which are critical to determining whether the safety order was violated and whether the violation was reckless or intentional. The Appeals Board granted reconsideration and remanded for a new decision to resolve these factual disputes and apply the correct legal standards.

  Official decision · page 11 →
• ADJ16740659 · 2024-10-22 · Oakland District OfficeAOE/COEremanded

  Determinative passage · p.11Next, the parties dispute whether applicant's injury to the low back was industrial. No doctor has provided a clear opinion explaining causation to the low back. At one point, the QME concludes that there is no way to answer that question. The QME failed to adequately explain how and why he was incapable of answering the question. It further appears that the QME failed to consider the proper legal standard of causation in workers' compensation, which is contributory causation. The September 13, 2022 injury need not be the sole cause of injury to the low back. It is sufficient if the September 13, 2022 injury aggravated or exacerbated prior injury to the low back.

  No doctor provided a clear causation opinion for lumbar spine injury. The QME's equivocal testimony requires further development for credibility determinations. The record is insufficient to determine industrial injury to lumbar spine.

  Official decision · page 11 →
• ADJ16740659 · 2024-08-13 · Oakland District OfficeAOE/COEremanded

  Determinative passage · p.6Next, the parties dispute whether applicant's injury to the low back was industrial. No doctor has provided a clear opinion explaining causation to the low back. At one point, the QME concludes that there is no way to answer that question. The QME failed to adequately explain how and why he was incapable of answering the question. It further appears that the QME failed to consider the proper legal standard of causation in workers' compensation, which is contributory causation. The September 13, 2022 injury need not be the sole cause of injury to the low back. It is sufficient if the September 13, 2022 injury aggravated or exacerbated prior injury to the low back.

  No doctor provided a clear opinion explaining causation to the low back; QME equivocated and failed to apply proper legal standard; record development required.

  Official decision · page 6 →
• ADJ9042484 · 2024-07-30 · Van Nuys District OfficeAOE/COEapplicant prevailed

  Determinative passage · p.3Defendant admits industrial injury to the applicant's left foot and ankle. Applicant also alleges injury to her back, internal in the form of diabetes, gait derangement and RSD. Based upon applicant's credible testimony and the medical report(s) of Dr. Tye Ouzounian M.D., dated September 25, 2022 and his deposition of September 13, 2021, and the reports of Dr. Jan Merman, primary 'care physician, it is found that applicant also sustained injury in the form of gait derangement, resulting in lumbar injury as a compensable consequence, arising out of and occurring in the course of employment.

  Substantial evidence, including applicant's credible testimony and the medical reports and deposition of Dr. Tye Ouzounian, supports finding industrial injury to the lumbar spine and in the form of RSD as compensable consequences of the accepted lower extremity injury.

  Official decision · page 3 →
• ADJ10884845 · 2024-06-21 · Bakersfield District OfficeMedical treatment / UR / IMRdefendant prevailed

  Determinative passage · p.6II. Applicant also claims that the April 20, 2023 discovery order as to a new QME panel in psychiatry was vague. The order instructs applicant's attorney to provide the discovery order to the Administrative Director' Medical Unit within thirty days of its finality. (4/20/23 FA&O, p. 9.) Applicant did not request a QME panel in psychiatry within the time limit specified in the order. When applicant thereafter requested the panel, defendant objected to the request and filed a DOR requesting an Expedited Hearing to obtain a finding that the panel request was invalid. The disputed issue of the validity of the QME panel was heard at the trial on March 14, 2024. On April 2, 2024, the WCJ ordered the QME panel #3397632 invalidated; denied defendant's petition for a stay of an examination with Dr. Michael Hoffman; and allowed applicant and defendant thirty days from the date of these Orders to discuss the potential use of an AME in the field of psychiatry, or, in the absence of agreement, permit either party to request the Administrative Director's Medical Unit issue a QME panel in the field of psychiatry. (4/2/24 F&O, pp.

  The petition was denied because the applicant failed to timely comply with the discovery order to request a QME panel in psychiatry, rendering the panel invalid.

  Official decision · page 6 →

Also recorded as

The same claims administrator is printed several ways across the decisions, and all of them were counted as one. These are the twelve commonest of 15.

• ILLINOIS MIDWEST INSURANCE AGENCY, LLC
• ILLINOIS MIDWEST INSURANCE AGENCY
• ILLINOIS MIDWEST
• ILLINOIS MIDWEST SPRINGFIELD
• ILLINOIS MIDWEST INSURANCE
• Illinois Midwest Insurance Agency, LLC
• ILLINOIS MIDWEST INSURANCE AGENCY LLC
• ILLINOIS MIDWEST INSURANCE COMPANY
• Illinois Midwest Insurance Agency
• Illinois Midwest
• LP/ ILLINOIS MIDWEST INSURANCE AGENCY, LLC
• Illinois Midwest Insurance Company, LLC

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.