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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ8469531, ADJ9267403
Regular
May 02, 2019

KAREN DOUGLAS vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that barred the applicant's psychiatric claim under Labor Code section 4660.1(c)(1). The WCAB rescinded the original Findings and Award for both consolidated cases. The matters are returned to the trial level for further proceedings and a new decision, guided by a subsequent WCAB en banc opinion addressing section 4660.1(c). The WCAB did not address other issues raised in the applicant's petition.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPsychiatric claimLabor Code section 4660.1(c)(1)Permanent total disabilityInjury to body partsReport and RecommendationPetition for ReconsiderationSupplemental pleading
References
Case No. ADJ9914916
Regular
Feb 22, 2017

RUSSELL MADSON vs. MICHAEL J. CAVALETTO RANCHES, ZENITH INSURANCE COMPANY

This case concerns an applicant who sustained a psychological injury after a severe truck rollover accident. The Workers' Compensation Appeals Board (WCAB) overturned a prior ruling that denied permanent disability for the psychological injury. The WCAB found that Labor Code section 4660.1(c), which limits psychiatric disability awards arising from physical injuries, did not apply because the psychiatric injury was directly caused by the traumatic events of employment. Furthermore, the Board determined the accident itself constituted a "violent act," qualifying for an exception to section 4660.1(c) and entitling the applicant to compensation for his psychiatric impairment, ultimately awarding 60% permanent disability.

AOE/COELabor Code section 4660.1(c)violent actreconsiderationpsychiatric permanent disabilitymotor vehicle accidentcatastrophic injuryPTSDGAF scoreQME
References
Case No. ADJ11197293
Regular
Dec 18, 2020

KEVIN TORRES vs. ARCTIC MECHANICAL, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns an applicant's entitlement to an increased impairment rating for sleep dysfunction. The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board affirmed the Administrative Law Judge's finding that Labor Code Section 4660.1(c)(1) does not preclude an increased impairment rating for sleep dysfunction if it is directly caused by the industrial injury, rather than a consequence of it. Medical evidence from Dr. Jonathan Wang established a direct causal link between the applicant's sleep dysfunction and the industrial injury. The Board found Dr. Wang's report and deposition testimony constituted substantial medical evidence supporting this conclusion and rejected the defendant's arguments.

Labor Code 4660.1(c)(1)sleep dysfunctiondirect causationincreased impairment ratingcompensable consequencepsychiatric disordersubstantial medical evidenceQME reportdeposition testimonyAMA Guides
References
Case No. ADJ9777475
Regular
Feb 14, 2017

MOSES CASTILLO vs. CITY OF LOS ANGELES

The WCAB granted reconsideration regarding a prior award of $73\%$ permanent disability for an applicant's industrial injuries. The Board found the WCJ erred by including a $2\%$ rating for sleep apnea, as Labor Code section 4660.1(c)(1) prohibits increases for sleep dysfunction arising from a compensable physical injury. Furthermore, the Board remanded for clarification on the $10\%$ right hand and wrist impairment rating, as the agreed medical evaluator may have improperly combined impairment components under the AMA Guides. Jurisdiction was deferred for a re-rating of permanent disability after these issues are resolved.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityLabor Code section 4660.1(c)(1)AMA GuidesAgreed Medical EvaluatorCarpal Tunnel SyndromeCumulative InjuryDate of Injury
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. SFO 0492831
Regular
Jan 23, 2008

ELIAS MONTOYA vs. ASTON BARNES, INC., STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration to clarify the application of Labor Code section 4656 regarding temporary disability indemnity limits. The Board held that "new and further" disability does not extend the 104-week limit under section 4656(c)(1), nor do spinal disc excisions and bone grafts qualify as "amputations" under section 4656(c)(2)(C). Consequently, the applicant is entitled to temporary disability indemnity only up to two years from the date of the first payment.

Workers' Compensation Appeals BoardElias MontoyaAston Barnes Inc.State Compensation Insurance FundSFO 0492831Opinion and Decision After ReconsiderationTemporary Disability IndemnityIndustrial InjuryThoracic SpineChest Injury
References
Case No. ADJ9474687
Regular
Jun 14, 2019

GUSTAVO NIEVES UGALDE vs. ROCKWELL DRYWALL, INC., STARR INDEMNITY, adjusted by YORK RISK MANAGEMENT GROUP

The Workers' Compensation Appeals Board (WCAB) rescinded the prior award and remanded the case for further proceedings, finding the applicant's psychiatric injury was a consequence of his physical injury, not directly from a violent act. The Board determined the applicant's fall from stilts, while accepted as industrial, did not meet the legal definition of a "violent act" required for an increased psychiatric impairment rating under Labor Code § 4660.1(c)(2)(A). Therefore, the case must be returned to allow the WCJ to first determine if the injury qualifies as "catastrophic" under § 4660.1(c)(2)(B) for potential increased psychiatric rating. The WCAB acknowledged the applicant's credible testimony regarding the use of stilts and the psychiatric QME's opinion on causation but found the issue of a "violent act" was not sufficiently established.

AOE/COEViolent ActCompensable ConsequencePsychiatric InjuryPermanent DisabilityReconsiderationFindings and AwardMedical EvaluatorVocational ExpertLabor Code Section 4660.1
References
Case No. ADJ10116932
En Banc
May 10, 2019

Kris Wilson vs. STATE OF CA CAL FIRE, STATE COMPENSATION INSURANCE FUND

The Appeals Board held that a firefighter's injury, which resulted in a near-death experience and significant physical impairments, qualifies as a 'catastrophic injury' under Labor Code section 4660.1(c)(2)(B), thus allowing an increased permanent disability rating for the consequential psychiatric injury.

en bancreconsiderationpermanent disabilitypsychiatric injurysection 4660.1(c)catastrophic injuryviolent actcompensable consequenceproximate causepre-existing condition
References
Case No. ADJ9365173
Regular
Jun 19, 2017

MARIA LOPEZ vs. GENERAL WAX CO. INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Board denied the defendant's petition for reconsideration, affirming the finding of permanent total disability for the applicant. The applicant sustained admitted industrial injuries including a partial finger amputation, hypertension, gastrointestinal issues, and a psychiatric injury. The Board found that the finger amputation constituted a "violent act" under Labor Code section 4660.1(c), making the applicant's psychiatric impairment compensable. The defendant's arguments regarding stale medical records and insufficient vocational expert analysis were rejected due to lack of proper citation and contradictory evidence in the record.

AOE/COEPermanent Total DisabilityPsychiatric InjuryLabor Code 4660.1(c)Violent ActCatastrophic InjuryVocational ExpertApportionmentSubstantial Medical EvidencePetition for Reconsideration
References
Case No. ADJ10116932
Significant
May 10, 2019

Kris Wilson, Applicant vs. STATE OF CA CAL FIRE; legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Appeals Board held that a firefighter's severe, life-threatening physical injuries from smoke inhalation constituted a 'catastrophic injury' under Labor Code section 4660.1(c)(2)(B), thus allowing an increased permanent disability rating for his resulting psychiatric injury.

En Banc DecisionLabor Code Section 4660.1(c)Catastrophic InjuryPsychiatric InjuryCompensable ConsequenceMedical TreatmentPermanent DisabilityImpairment RatingFirefighterWildfire Exposure
References
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