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

Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ4431752 (ANA 0387918) ADJ771024 (ANA 0387917)
Regular
May 14, 2009

CYNTHIA WILSON vs. ALBERTSONS, INC., permissibly self-insured, administered by SPECIALTY RISK SERVICES

This case involves an applicant seeking reconsideration of a prior finding of no ratable permanent disability for a left knee injury. The applicant argues the Agreed Medical Evaluator's report may not adequately capture her disability under the new *Almaraz/Guzman* precedent, which allows consideration of factors beyond the AMA Guides. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further medical record development. This is to allow the Agreed Medical Evaluator to specifically address whether the AMA Guides adequately describe the applicant's disability and, if not, to outline other relevant factors.

WCABAlbertson's Inc.Specialty Risk ServicesADJ4431752ADJ771024Opinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of Fact Award and OrderRatable Permanent DisabilityAlmaraz/Guzman
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. ADJ6808453
Regular
Dec 14, 2012

JOSEFINA PARRA vs. CHULA VISTA ELEMENTARY SCHOOL DISTRICT, TRISTAR RISK MANAGEMENT

The Appeals Board dismissed the defendant's petition for reconsideration and denied their petition for removal. The Board found the WCJ's order to develop the medical record was not a final order, making reconsideration improper. Furthermore, the Board agreed that the defendant failed to demonstrate sufficient grounds for removal and found the PQME's opinions lacking substantial evidence due to insufficient rationale. The Board affirmed the need to further develop the medical record, specifically by re-evaluating the applicant with her treating physician.

WCABPetition for ReconsiderationPetition for RemovalFindings and OrdersPanel Qualified Medical EvaluatorPQMEsubstantial evidencedevelop the medical recordtreating physicianorthopedic surgeon
References
Case No. ADJ3721868 (VNO 0540149), ADJ855172 (VNO 0540146), ADJ671254 (VNO 0540148)
Regular
Sep 05, 2018

AGUSTIN ZENDEJAS vs. CALABASAS GOLF & COUNTRY CLUB, EMPLOYERS COMPENSATION INSURANCE COMPANY, VIRGINIA SURETY COMPANY INC., FIRSTCOMP division of MARKEL SERVICE INC, dba MARKEL INSURANCE SERVICE

This case concerns appeals by defendants challenging an award of temporary disability benefits. The Appeals Board granted reconsideration, finding the award inconsistent with stipulated facts and medical evidence, particularly Dr. Alonso's report. The Board amended the findings to state the applicant is not owed temporary disability benefits after July 12, 2007. The issue of an overpayment credit was deferred to a WCJ for further proceedings.

Workers Compensation Appeals BoardAgustin ZendejasCalabasas Golf & Country ClubEmployers Compensation Insurance CompanyVirginia Surety CompanyFirstCompMarkel Service IncPetition for ReconsiderationFindings and AwardTemporary Disability Indemnity
References
Case No. ADJ1796224
Regular
Sep 09, 2008

JOSE BONILLA vs. PRO-COMM PLASTERING

Reconsideration granted due to insufficient evidence regarding applicant's employment at the time of injury. Case returned to trial level for further development of the record.

ReconsiderationIndustrial injuryEmployment disputeWall DesignPro-Comm PlasteringWCJEvidence developmentDeposition transcriptsSubstantial justiceLabor Code § 5906
References
Case No. ADJ1818278 (SFO 0495048) ADJ3997974 (SFO 0495050)
Regular
Oct 10, 2008

Dana Large vs. KLEIN PLASTERING, REDLANDS INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the original award because the judge's findings on permanent disability were not supported by substantial medical evidence. Specifically, the Agreed Medical Evaluator's impairment ratings for knee injury and unrelated left thigh atrophy lacked clear explanation and proper methodology according to the AMA Guides. The case is returned to the trial level for further development of the medical record and reconsideration of the permanent disability rating.

WCABReconsiderationFindings and AwardIndustrial InjuryRight KneePermanent DisabilityAMA GuidesAgreed Medical EvaluatorWhole Person ImpairmentLeft Thigh Atrophy
References
Case No. ADJ1750055 (SDO0289470); ADJ184723 (SDO0289471)
Regular
Apr 24, 2023

BEDFORD PALMER vs. SAN DIEGO GAS & ELECTRIC/SEMPRA ENERGY

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award and remanded the case for further proceedings. The WCAB found that the applicant's hypertension claim, which was key to his temporary disability claim, had not been formally accepted or denied. Furthermore, the WCAB noted ambiguity regarding whether the applicant retired voluntarily or due to his industrial injuries, impacting his entitlement to temporary disability benefits. The case is returned to the WCJ to develop the record on these crucial issues and issue a new decision.

Workers' Compensation Appeals BoardTemporary Total DisabilityVocational Rehabilitation Temporary DisabilityPetition for ReconsiderationJoint Findings Award and OrderAdministrative Law JudgeInternal System InjuryHypertensionAgreed Medical ExaminerStipulation
References
Case No. ADJ8883423; ADJ11327965
Regular
Feb 21, 2023

MICKEY THORNTON vs. NORTHWEST LINEMAN COLLEGE/GRID TRAINING CORPORATION, ALASKA NATIONAL INSURANCE COMPANY, LASSEN MUNICIPAL UTILITY DISTRICT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to review the finding of "new and further disability" to the applicant's low back stemming from a 2013 cervical spine injury. The Board found the current medical evidence insufficient to establish a causal link between the 2013 injury and the low back condition. Therefore, the issue of new and further low back disability is deferred for further development of the record with substantial medical evidence. The Board stressed its duty to ensure substantial justice by not leaving undeveloped matters.

New and further disabilityReconsiderationStipulated awardAgreed medical evaluatorSubstantial evidenceMedical opinionRecord developmentCervical spineLow back injuryApportionment
References
Case No. ADJ460837 (VNO 0490198)
Regular
Nov 17, 2008

ROSARIO TRUJILLO, vs. ADECCO STAFFING; CSSC,

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of an Order Approving Compromise and Release, which settled applicant Rosario Trujillo's claims for $\$30,000$. The defendant sought to set aside the settlement, arguing a Medicare set-aside analysis used for the settlement was no longer valid at the time of approval. The Board found the defendant made an insufficient showing to set aside the settlement, noting no changed condition had been demonstrated to invalidate the analysis, and that the defendant failed to establish fraud, mutual mistake, duress, or undue influence.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationCompromise and ReleaseOrder Approving Compromise and ReleaseWCJMedicare Set-Aside AnalysisCoventry Workers' Compensation Servicesgood causefraudmutual mistake of fact
References
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