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Case Law Database

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

Case No. ADJ823138 (OXN 0142604)
Regular
Oct 25, 2010

CHERYL PEET vs. COUNTY OF VENTURA, Permissibly SelfInsured, Administered By CORVEL CORPORATION

The Workers' Compensation Appeals Board is reconsidering a prior decision that found a deputy probation officer sustained industrial injuries resulting in 78% permanent disability. The defendant sought reconsideration, arguing the Qualified Medical Examiner's (QME) opinion, which formed the basis of the award, was ambiguous and unsubstantiated. The Board agrees that the QME's assessment of 60% whole person impairment is not adequately supported by the record, particularly in light of the applicant's own testimony regarding her daily activities. Therefore, the case is returned to the trial level for further evidence development and a new decision, with consideration for cost of living adjustments if a life pension is awarded.

Workers Compensation Appeals BoardCheryl PeetCounty of VenturaCORVEL CORPORATIONADJ823138OXN 0142604Opinion and Decision After Reconsiderationdeputy probation officerindustrial injuryright upper extremity
References
Case No. FRE 229989
Regular
Feb 04, 2008

MARTIN GAMBOA vs. FRESNO VALVES & CASTINGS, INC., STATE COMPENSATION INSURANCE FUND

The applicant, Martin Gamboa, is seeking reconsideration of a previous Workers' Compensation Appeals Board decision that awarded him 9% permanent disability for a left knee injury, based on an Agreed Medical Examiner's report. Gamboa argues the report is insufficient under the AMA Guides and requires further development of the record. The Board denied reconsideration, finding that Gamboa is bound by his prior stipulation at trial that the AME report rated to 9% permanent disability under the applicable schedule. The court emphasized that issues not raised at trial cannot be introduced for the first time on reconsideration.

Workers' Compensation Appeals BoardAgreed Medical EvaluatorPermanent Disability Rating Schedule2005 ScheduleAMA Guides5th EditionStipulationSubstantial EvidenceFurther DevelopmentReconsideration Denied
References
Case No. OAK 0321116
Regular
Jun 25, 2008

RANDALL MINVIELLE vs. COUNTY OF CONTRA COSTA / CONTRA COSTA FIRE

The Workers' Compensation Appeals Board rescinded the prior award because the defendant failed to prove overlap between the applicant's 2004 and 1992 back injuries. Apportionment under Labor Code section 4664 was improper as the permanent disability from each injury was rated under different standards (1950 schedule vs. AMA Guides). The case was returned to the trial level to determine if both injuries could be rated under the same standard for proper apportionment.

Workers' Compensation Appeals BoardRandall MinvielleCounty of Contra CostaContra Costa Firelegally uninsuredOAK 0321116Opinion and Decision After Reconsiderationindustrial injuryfirefighterback injury
References
Case No. ADJ11088696
Regular
Oct 27, 2020

ARCEL R. MANNING vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted the applicant's Petition for Reconsideration because the original Findings and Award lacked a summary of the evidence relied upon by the judge, preventing evaluation of the applicant's contentions. Specifically, the judge failed to properly document the method of combining orthopedic and internal impairment ratings or the application of the AMA Guides for hypertension and kidney disease. The case is returned to the trial level for further proceedings to develop the record and address these rating issues.

Petition for ReconsiderationFindings and AwardPermanent DisabilityLife PensionAMA Guides 5th EditionOrthopedic ImpairmentInternal ImpairmentHypertensionKidney DiseaseMedical Treatment
References
Case No. ADJ6998138
Regular
Feb 13, 2012

WAI CHIU LI vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the County of Los Angeles' Petition for Reconsideration. The Board upheld its prior decision to increase applicant Wai Chiu Li's permanent disability rating from 15% to 36% for a left forearm injury. This increase was based on the agreed medical examiner's use of clinical judgment to incorporate grip strength loss, consistent with the AMA Guides. The Board emphasized that physician judgment is crucial in accurately assessing impairment according to the Guides.

Workers' Compensation Appeals BoardDeputy SheriffIndustrial InjuryPermanent DisabilityReconsiderationAmerican Medical Association GuidesAMA GuidesAgreed Medical ExaminerAMEGrip Strength
References
Case No. ADJ9376675
Regular
Oct 20, 2015

JESSICA FIELD vs. INGLEWOOD POLICE DEPARTMENT, ADMINSURE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the permanent disability rating, arguing the DRE method, rather than the ROM method, was improperly applied by the QME. The Board adopted the WCJ's report, which found the QME's reliance on the DRE method, specifically Category IV, was supported by substantial medical evidence and properly applied under the AMA Guides, Fifth Edition. The defendant's contention that the rating was invalid under *Blackledge* was also rejected, as the QME report met legal and regulatory requirements.

Workers' Compensation Appeals BoardPetition for ReconsiderationDENIEDINGLEWOOD POLICE DEPARTMENTADMINSUREPermanent DisabilityAMA Guides Fifth EditionDRE MethodLumbar Spine Category IVwhole person impairment
References
Case No. ADJ10187704, ADJ10924724
Regular
May 17, 2018

STEVEN CASE vs. GOLDEN GATE BRIDGE HIGHWAY AND TRANSPORTATION DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to increase applicant's permanent disability rating for bilateral shoulder injury from 9% to 38%. The Board found the Agreed Medical Evaluator's (AME) alternative rating, based on strength loss, was substantial medical evidence and properly considered within the AMA Guides. The WCJ erred in applying an overly restrictive interpretation of "complex or extraordinary" cases for deviating from strict AMA Guides ratings. The AME's use of strength loss data from the AMA Guides, even for an age outside the specified range, was permissible under the *Almaraz-Guzman* line of cases when justified by clinical judgment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationAgreed Medical Evaluator (AME)permanent disability ratingbilateral shouldersorthopedic AMEAMA GuidesAlmaraz-Guzmanstrength loss index
References
Case No. ADJ9097334
Regular
Apr 25, 2016

CHARLES GELETKO vs. CALIFORNIA HIGHWAY PATROL, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of an award granting applicant benefits, arguing the administrative law judge (WCJ) improperly calculated the applicant's permanent disability. The SIBTF contended the WCJ erred by applying a 1.4 adjustment factor and by adding individual impairments rather than combining them. The Appeals Board granted reconsideration, agreeing with the WCJ's report to affirm the award while correcting a mathematical error, ultimately awarding applicant 82% permanent disability. The Board found the 1.4 modifier applicable under the relevant statute, but upheld the prohibition against using the Combined Values Chart when assessing SIBTF eligibility due to statutory exclusions for age and occupation adjustments.

Subsequent Injuries Benefits Trust FundLabor Code section 4751permanent disability thresholdwhole-person impairmentsection 4660.11.4 modifierCombined Values ChartCalifornia Highway Patrolcumulative trauma injurycardiovascular system
References
Case No. ADJ3849676 (AHM 0147658) ADJ1948081 (AHM 0147721)
Regular
Feb 14, 2011

ROBERT LEON vs. RF DEVELOPMENT & BUSCH CORPORATION, LINCOLN GENERAL INSURANCE

In this workers' compensation case, the defendant sought reconsideration of a $37\%$ permanent disability award, arguing the physician's impairment rating improperly deviated from the AMA Guides. The Appeals Board granted reconsideration, finding the physician's justification for not strictly applying the Guides was insufficient and not based on substantial medical evidence. Specifically, the physician's reliance on subjective complaints and analogies to amputation were not adequately supported. The Board rescinded the award and remanded the case for a new rating strictly following the AMA Guides.

Workers' Compensation Appeals BoardRF Development & Busch CorporationLincoln General InsuranceAmerican Claims ManagementRobert LeonADJ3849676ADJ1948081ReconsiderationFindings and AwardIndustrial Injuries
References
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
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