What this form is for
Petition to reopen Note: A declaration of readiness to proceed must also be filed with this form. See I&A guide 11 for more detailed
Official file
Published by the Division of Workers' Compensation. This page does not replace the form — it points at the state's PDF and, where the form is what a panel actually ruled on, quotes that ruling.
How to fill a DWC form →Source: dir.ca.gov/dwc/forms.html. Unofficial guide — the PDF on that site is the form.
What the Appeals Board did with this
Decisions of the Workers' Compensation Appeals Board that turned on this kind of filing. Each quotes the passage it turned on and links to the official PDF.
- ADJ3719477 · 2026-06-15 · Bakersfield District OfficeReopening / new and further disabilityapplicant prevailed
Determinative passage · p.1The WCJ found, in relevant part, that in case ADJ3719477, from March 28, 1986 to May 5, 2005, while employed by defendant as a sheriff's deputy, applicant sustained injury arising out of and in the course of employment (AOE/COE) to his low back and claims to have sustained injury to his neck, bilateral knees, and circulatory system-heart. The WCJ further found Dr. Donald Webb to be the Agreed Medical Evaluator (AME) who provided services in this case and the Petition to Reopen dated January 20, 2010 was timely filed on January 25, 2010. The WCJ also found good cause to reopen the April 18, 2007 Award and further development of the medical- record to be necessary to determine the nature and extent of the new and further disability. The WCJ ordered parties to coordinate discovery efforts to have applicant reevaluated by the AME, Dr. Donald Webb, to determine the nature and extent of the new and further disability. All other issues were deferred and reserved.
The WCJ found good cause to reopen based on evidence of new and further disability, including new periods of temporary disability, despite AME Dr. Webb's opinion that permanent impairment had not changed. The WCAB affirmed this finding and ordered reevaluation by a new AME.
Official decision · page 1 → - ADJ11754124 · 2026-05-26 · Pomona District OfficeReopening / new and further disabilityapplicant prevailed
Determinative passage · p.1Applicant seeks reconsideration of the "Findings and Order" (F&O) issued on February 20, 2026, by the workers' compensation administrative law judge (WCJ). The WCJ found, in pertinent part, that applicant's internal injury complaints are barred by Labor Code1 section 5410 because applicant failed to obtain substantial medical evidence establishing internal injury within five years from his date of injury.
The WCJ's finding that applicant's internal injury complaints were barred by Labor Code section 5410 was unsupported due to lack of substantial medical evidence; applicant timely filed petition to reopen; record development needed; thus, reconsideration granted and matter remanded for further proceedings.
Official decision · page 1 → - ADJ18796354 · 2026-04-14 · Oakland District OfficeReopening / new and further disabilityapplicant prevailed
Determinative passage · p.1Defendant seeks reconsideration, and in the alternative removal of the Amended Findings and Orders (F&O) issued by a workers' compensation administrative law judge (WCJ) on December 2, 2025. In the F&O, the WCJ rescinded his October 22, 2025 decision in ADJ18796354 and ADJ18797375 and found in ADJ18796354 that applicant, while employed during the period ending December 1, 2023, as a tool and die specialist by defendant claims to have sustained injury arising out of and in the course of employment (AOE/COE) to various body parts; and that the record requires further development in the form of further reporting or deposition testimony by the qualified medical evaluator (QME) Ryan Derby, M.D., "as to whether the bilateral upper extremities are part of the single cumulative injury he finds." With respect to both cases, the WCJ ordered further discovery with the QME Dr. Derby "with respect to whether the single cumulative injury he finds includes the bilateral upper extremities, including carpal tunnel syndrome, and if so, how and why he believes that to be the case" and he suggested "a QME re-exam to determine if the applicant's other injuries, as found by the QME are currently P&S and ratable." Finally, he ordered that all other issues were deferred.
The WCJ found the record needed further development regarding the cumulative injury claim, deferring all other issues pending this development, and the Board denied reconsideration of this order as it did not irreparably harm the defendant.
Official decision · page 1 → - ADJ12302753 · 2026-01-23 · Lodi District OfficeReopening / new and further disabilityapplicant prevailed
Determinative passage · p.12Internal medicine PQME Dr. Mahmoudi also provides a substantial opinion regarding the worsening of applicant's hypertension. As noted in the WCJ's Report, Dr. Mahmoudi opined that applicant has industrial hypertension due to deconditioning and the cumulative effects of his injury. (See Applicant's Exhibit 4, Deposition of Dr. Mahmoudi, p. 8, lines 3-12). He felt that applicant had an increase in hypertension from stage 1 to stage 2 and that increase is industrial, especially given applicant's use of NSAIDs. (Id. at p. 9, lines 17-25). He confirmed that all the prior blood pressure measurements that he is using to find causations for the hypertension predate the stipulated award of October 31, 2022. (Id. at p. 16, lines 21-25). He also testified that applicant's first class 2 diagnosis for hypertension was on April 14, 2021. (Id. at p. 35, lines 6-16). The QME reaffirmed that he felt this was industrial due to the NSAIDs, weight gain, and total knee replacement, especially since NSAIDs can increase blood pressure. (Id. at pp.
The WCJ found new and further disability of the left knee and hypertension based on substantial medical evidence, including unrebutted opinions of PQME Dr. Mahmoudi and Dr. Sclafani, and concluded the stipulated award was properly reopened under section 5410 and 5803.
Official decision · page 12 →