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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ2073428 (VNO 0465400) ADJ1610465 (VNO 0540972) ADJ3247765 (VNO 00384869)
Regular
Apr 04, 2011

JAY ZAVERI vs. STATE COMPENSATION INSURANCE FUND; Legally Uninsured

The applicant sought reconsideration of a workers' compensation award, arguing for a 100% permanent disability rating and challenging the permanent disability start date used for attorney fee commutation. The Appeals Board denied the petition, finding insufficient evidence to establish total permanent disability, as the applicant was currently employed and medical opinions did not definitively support such a rating. The Board also ruled that the applicant waived arguments regarding the rating of specific injuries by failing to properly object, and that even if considered, separate ratings for back, knee, and plantar fasciitis conditions would not result in a higher award due to fibromyalgia being the primary cause and rating higher. Finally, the Board clarified that the July 2, 2000 date was only relevant to the attorney fee commutation calculation and not to the determination of permanent disability indemnity payments.

WCABPetition for ReconsiderationJoint Findings and AwardWorkers' Compensation Judge (WCJ)Industrial InjuryBack InjuryHip InjuryBilateral Knee InjuryBilateral Foot InjuryBilateral Plantar Fasciitis
References
Case No. ADJ10192587
Regular
Dec 27, 2017

TIMOTHY WILCOX vs. CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION, STATE COMPENSATION INSURANCE FUND

This case involved a workers' compensation claim where the applicant, Timothy Wilcox, sought benefits for an abdominal injury sustained while lifting. The defendant contested the 50-pound lifting restriction recommended by the applicant's Qualified Medical Examiner (PQME), Dr. Fearer. The Appeals Board upheld the WCJ's decision, finding Dr. Fearer's medical opinion to be substantial evidence, even though it changed significantly. The Board adopted Dr. Fearer's reasoning that the 50-pound restriction, supported by applicant's credible testimony and affecting his ability to perform his firefighter duties, justified an increased permanent disability rating.

workers' compensationPetition for ReconsiderationQualified Medical ExaminerPQMEwhole person impairmentWPIlifting restrictioninternal herniasmall bowel resectionAlmaraz/Guzman
References
Case No. ADJ3843514
Regular
Sep 15, 2008

Ramona J. Ornelas vs. COUNTY OF SACRAMENTO

Reconsideration granted to address errors in permanent disability rating and apportionment. Matter returned for new rating considering walker use and clarifying apportionment.

RAMONA J. ORNELASCOUNTY OF SACRAMENTOADJ3843514SAC 0274104OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONLEFT MINOR SHOULDERLEFT MINOR WRISTBILATERAL KNEESPSYCHE
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ1834869
Regular
Feb 10, 2014

GREGORY CLEVELAND vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration regarding permanent disability (PD) awarded to the applicant. The Board adopted the findings of the administrative law judge, noting the defendant's failure to cross-examine the rater on the calculation of PD, which included instructions to consider overlap of heavy lifting. Furthermore, the Board admonished the defendant for attaching documents to its petition in violation of board rules. The applicant was awarded PD based on restrictions from heavy lifting for his cervical spine and right shoulder.

WORKERS' COMPENSATION APPEALS BOARDCITY OF LOS ANGELESPERMISSIBLY SELF-INSUREDPETITION FOR RECONSIDERATIONDENIEDRATING INSTRUCTIONSOVERLAPVERY HEAVY LIFTINGAPPORTIONMENTLABOR CODE §4664
References
Case No. ADJ9787852
Regular
Oct 18, 2016

CAROLINE NJOKI vs. 24 HOUR FITNESS, ACE AMERICAN INSURANCE COMPANY

This case affirms an award of temporary total disability benefits to an applicant injured while working for 24 Hour Fitness. The Workers' Compensation Appeals Board found that the employer failed to provide modified work within the applicant's medical restrictions. The employer's assertion that they offered modified work was contradicted by the applicant's credible testimony, which the Board credited. Therefore, the applicant's wage loss was deemed total, entitling her to ongoing temporary total disability benefits.

Temporary total disabilityModified workMedical restrictionsDriving restrictionCommuteGood faith offerWCJ credibilityHearsay evidenceLabor CodeRebuttal evidence
References
Case No. ADJ10610485
Regular
Mar 30, 2018

FRANCISCO REYNOSO vs. LUSAMERICA FOODS, BERKSHIRE HATHAWAY HOMESTATE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend the award, changing the start date of temporary disability benefits. Originally awarded from August 25, 2016, the Board revised this to February 16, 2017, as this was the first date medical evidence indicated work restrictions. The Board found insufficient proof that the applicant was terminated for cause, which would have barred benefits, due to contradictory employer testimony and the absence of key witnesses. However, the Board affirmed the original award regarding the continuation of temporary disability benefits.

Petition for ReconsiderationTemporary DisabilityPerformance Correction NoticeTermination for CauseModified WorkMedical RestrictionsPanel Qualified Medical EvaluatorWage LossAt-Will EmployeeProbationary Period
References
Case No. ADJ9908298
Regular
Jul 25, 2016

ELIZABETH SOTO vs. MOLEX, INC. dba AFFINITY MEDICAL, OLD REPUBLIC INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to clarify a previous order, rescinding the original Findings and Order. The defendant argued the claim was barred by the post-termination defense, but the WCAB found exceptions applied under Labor Code sections 3600(a)(10)(A) and 3600(a)(10)(D). The WCAB determined the date of injury was March 5, 2015, subsequent to the termination notice, and returned the case for further proceedings to develop the medical record regarding the extent of the applicant's injuries.

post-termination defenseLabor Code section 3600(a)(10)Labor Code section 3600(a)(10)(D)Labor Code section 5412cumulative traumacompensable disabilityknowledge of industrial causationdate of injurynotice of terminationU.S. HealthWorks
References
Case No. ADJ12705097
Regular
Sep 21, 2022

FRED BROYLES vs. ATLAS VAN LINES, ARCH INSURANCE, GALLAGHER BASSETT SERVICES

In Broyles v. Atlas Van Lines, the WCAB denied the defendant's petition for reconsideration, affirming the finding of 29% permanent disability. The Administrative Law Judge and the Board found that the Qualified Medical Evaluator (QME) properly utilized the Almaraz/Guzman principles to deviate from a strict AMA Guides rating. The QME's analogy to a hernia condition was deemed substantial evidence for assessing the applicant's impairment due to limitations on lifting and its impact on daily living activities. The Board concluded the QME adequately explained the departure from the standard rating and provided sufficient reasoning for the alternative assessment.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 4660.1(d)scheduled ratingprima facie evidencerebuttableMilpitas Unified School Dist. v. Workers' Comp. Appeals Bd.Almaraz-Guzman IIIwhole person impairment (WPI)AMA Guides
References
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