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Case Law Database

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

Case No. ADJ8550681
Regular
May 14, 2015

NANCY TOM vs. PARAMOUNT PICTURES

Applicant Nancy Tom sought reconsideration of a workers' compensation award, arguing her 9% permanent disability rating was too low. She contended for further medical evaluation regarding worsening symptoms and a claimed 40% grip loss in her right hand, plus additional impairment ratings for her thumb and knee. The Board denied reconsideration, adopting the WCJ's reasoning that Dr. Angerman's conclusory deposition testimony regarding increased impairment lacked substantial medical evidence and conflicted with AMA Guides to the Evaluation of Permanent Impairment. The Board found that Applicant failed to meet her burden of proof for a higher disability rating.

Workers' Compensation Appeals BoardParamount PicturesPermissibly Self-InsuredPetition for ReconsiderationFindings of Fact and AwardExecutive AssistantIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorOrthopedist
References
4
Case No. ADJ6757080
Regular
Jul 23, 2012

GRACE AOKI vs. CITY OF TORRANCE

This case concerns a library page's permanent disability rating for a right shoulder injury. The agreed medical evaluator combined ratings for loss of motion and weakness/grip strength, exceeding AMA Guides limitations for combining such impairments. The Appeals Board found the physician's report insufficient to rebut AMA Guide standards or explain the combined rating. Consequently, the permanent disability award was reduced from 46% to 20%.

Workers' Compensation Appeals BoardGrace AokiCity of TorrancePermissibly Self-InsuredReconsiderationJoint Findings and AwardPermanent DisabilityAgreed Medical EvaluatorSeymour L. AlbanPetition for Reconsideration
References
1
Case No. ADJ3525524 (LAO 0866019)
Regular
Jan 11, 2016

CECILE CONSTANTINO vs. QUEENSCARE, ALEA NORTH AMERICA

The Board granted reconsideration, finding the WCJ erred in both applying the Labor Code section 4658(d)(2) increase to a 2004 injury and in not properly apportioning disability to a prior 1993 injury. The Board determined the agreed medical evaluators' opinions regarding apportionment were substantial evidence and reversed the WCJ's finding that the AMA Guides impairment rating was successfully rebutted. Consequently, the permanent disability rating was recalculated using the scheduled AMA Guides rating and incorporating apportionment, resulting in a lower overall permanent disability percentage and award.

WCABPetition for ReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorAMA GuidesGuzmanApportionmentLabor Code section 4658(d)(2)
References
7
Case No. ADJ9311285
Regular
Jan 12, 2018

Herbert Schmitz vs. Westlands Water District, Liberty Mutual Insurance Company/Wausau

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision awarding 74% permanent disability. The defendant argued the Qualified Medical Evaluator (QME), Dr. Deshmukh, improperly used the hernia chapter of the AMA Guides for impairment rating, violating *Almaraz-Guzman* principles. The WCAB agreed that Dr. Deshmukh's rating lacked sufficient explanation for deviating from standard orthopedic evaluations. Consequently, the WCAB rescinded the permanent disability and attorney's fees findings, returning the case for further proceedings, potentially including a supplemental report or deposition from Dr. Deshmukh, to properly address impairment rating.

Workers Compensation Appeals BoardPermanent DisabilityQualified Medical EvaluatorWhole Person ImpairmentAMA GuidesAlmaraz-GuzmanIndustrial InjuryMedical TreatmentLabor CodeFindings and Award
References
6
Case No. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
1
Case No. ADJ9890148
Regular
Feb 02, 2017

Timothy Bedford vs. CITY OF LOS ANGELES

This Workers' Compensation Appeals Board case denies reconsideration of a permanent disability rating. The Board affirmed the use of Figure 15-19 of the AMA Guides, finding it permissible to use any chapter or method within the Guides that most accurately reflects impairment. The Agreed Medical Evaluator's opinion was deemed substantial, as he explained how Figure 15-19 was used to derive a more accurate rating based on the applicant's specific spinal condition. The decision also distinguished the current case from prior panel decisions regarding the application of the AMA Guides and work limitations.

AMA Guidespermanent disability ratingrebuttable presumptionwhole person impairmentAlmaraz/Guzman IIclinical judgmentagreed medical evaluator (AME)Figure 15-19functional losssurgical-grade disc herniations
References
7
Case No. ADJ480092 (SFO 0498380) ADJ2934310 (SFO 0498381)
Regular
Apr 26, 2009

TONI MORGAN vs. REDWOOD CREDIT UNION, ZENITH INSURANCE COMPANY, UNITED STATES FIRE INSURANCE CO.

This case concerns an applicant's petition for reconsideration of a workers' compensation judge's finding that the 2005 Permanent Disability Rating Schedule (PDRS) should apply to two cumulative trauma injuries. The applicant argued for the 1997 PDRS, asserting a defendant's termination of temporary disability payments triggered a Labor Code notice requirement. Alternatively, the applicant contended the $15\%$ permanent disability rating was too low, citing *Almaraz/Guzman* regarding disparities between AMA Guides impairment ratings and actual employability. The Appeals Board granted reconsideration, agreeing the medical record needed further development under *Almaraz/Guzman*, and deferred the permanent disability issue for trial level review. A dissenting opinion argued the applicant waived the AMA Guides impairment issue by not raising it earlier.

WCABRedwood Credit UnionZenith Insurance CompanyUnited States Fire Insurance Co.cumulative traumapermanent disability rating schedule2005 PDRS1997 PDRSLabor Code section 4061Labor Code section 4660
References
11
Case No. ADJ8762477
Regular
Nov 07, 2014

JAVIER RAMIREZ vs. SPACE LOK, INC.; REPUBLIC UNDERWRITERS INSURANCE, administered by SEDGWICK

The Workers' Compensation Appeals Board granted reconsideration, reversing the original finding of 36% permanent disability. The Board found the WCJ erred by not giving sufficient weight to the PQME's opinion, which suggested a higher impairment rating for the applicant's thumb injury based on factors not explicitly covered by the AMA Guides. Consequently, the applicant's permanent disability was increased to 51%, and their attorney's fee was adjusted accordingly. The decision highlights the principle that medical opinions may deviate from strict AMA Guides application when clinical judgment and comparable impairments are warranted.

Permanent Disability RatingReconsiderationPanel Qualified Medical Evaluator (PQME)Almaraz/GuzmanAMA GuidesWhole Person Impairment (WPI)Substantial EvidenceMedical Expert OpinionGrip StrengthThumb Deformity
References
11
Case No. ADJ12305682
Regular
Apr 14, 2023

DAVID REED vs. CSR MANAGEMENT SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves CSR Management Services and their insurer seeking reconsideration of a $71\%$ permanent disability award for David Reed. The defendants argued that the qualified medical evaluator, Dr. Brophy, did not sufficiently explain the applicant's scarring impairment. The Workers' Compensation Appeals Board denied the petition, finding Dr. Brophy adequately explained the scarring impairments as Class 1 under the AMA Guides. The Board noted that defendants could have sought further clarification from the evaluator.

CSR Management ServicesState Compensation Insurance FundADJ12305682Petition for ReconsiderationAmended Findings of FactAward and Orderconstruction laborerindustrial injuryupper extremitiesback
References
2
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
12
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