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

Case No. ADJ8718778
Regular
Jul 06, 2015

BETOEL GOMEZ vs. UNITED PALLET SERVICES, CIGA

This case concerns applicant Betoel Gomez's claim for permanent disability due to a right hand and bilateral wrist injury. The defendant, United Pallet Services, sought reconsideration of a $21\%$ permanent disability award, arguing the Qualified Medical Evaluator (QME) improperly used an analogical rating rather than AMA Guides' scheduled ratings. The Appeals Board granted reconsideration, agreeing the QME failed to adequately justify the analogical rating in his supplemental report. Ultimately, the Board amended the award to $10\%$ permanent disability, based on the QME's initial report which applied the AMA Guides to grip strength loss.

Workers' Compensation Appeals BoardCIGAUllico Casualty Companyliquidationpermanent disabilityWhole Person ImpairmentWPIAMA GuidesAlmaraz/GuzmanQualified Medical Evaluator
References
2
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. 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
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. ADJ1679104 (LBO 0387820)
Regular
Aug 26, 2010

GUADALUPE FREGOSO vs. INTEGRAL DESIGN CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a permanent disability rating for an applicant injured on August 1, 2006. The defendant argued the rating was erroneous because the administrative law judge (WCJ) instructed the disability evaluator to rate the treating physician's report without referencing the AMA Guides. The Appeals Board denied the petition, finding that the WCJ's instructions were based on the physician's opinion, which complied with the AMA Guides, and the evaluator's rating followed those instructions. The Board also corrected a clerical error regarding the attorney fee calculation.

WORKERS' COMPENSATION APPEALS BOARDReconsiderationFindings and Awardtemporary disabilitypermanent disabilityapportionmentnon-industrial causesindustrial injurynecklow back
References
1
Case No. ADJ4299001 (SAL 0110239)
Regular
Mar 10, 2009

JOAQUIN CORTEZ (MARTINEZ) vs. FRU-CON CONSTRUCTION CORPORATION, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior award and returned the case for further proceedings. The Board found that the workers' compensation judge (WCJ) improperly disregarded the AMA Guides and relevant case law when determining permanent disability. Specifically, the WCJ's reliance on vocational expert opinions for diminished future earning capacity (DFEC) was inconsistent with established precedent. The matter is remanded for the WCJ to re-evaluate permanent disability consistent with recent en banc decisions addressing rebuttal of the AMA Guides and DFEC portions of the rating schedule.

Workers' Compensation Appeals BoardJoaquin CortezFru-Con Construction CorporationZurich American Insurance CompanyIndustrial InjuryTemporary Total DisabilityPermanent DisabilityDisability Evaluation UnitRebuttalAmerican Medical Association Guides
References
3
Case No. ADJ8738819
Regular
Jun 10, 2015

Stephanie MOTEN vs. CITY OF LOS ANGELES

This case involves a dispute over Stephanie Moten's permanent disability rating following a work injury. Both the applicant and defendant sought reconsideration of an award of 19% permanent disability. The Appeals Board found the Agreed Medical Evaluator's (AME) permanent disability ratings were not substantial evidence due to improper application of the AMA Guides and failure to properly analyze nerve impairment. Consequently, the Board deferred the issues of permanent disability and attorney's fees, returning the case to the trial level for further proceedings.

Workers' Compensation Appeals BoardStephanie MotenCity of Los AngelesTristar Risk ManagementOpinion and Decision After ReconsiderationPermanent DisabilityAmerican Medical Association GuidesAMA GuidesAgreed Medical EvaluatorAME
References
5
Case No. ADJ2628303
Regular
Apr 01, 2014

GLORIA CAIRES vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE

The Appeals Board rescinded the original award and returned the case for further proceedings due to insufficient medical evidence on apportionment. Specifically, the Board found that the opinions of the orthopedic and psychiatric medical evaluators regarding the apportionment of permanent disability lacked substantial medical evidence. The orthopedic evaluator's apportionment methodology, referencing an AMA Guides example, was deemed improper under current Labor Code sections 4663 and 4664. The psychiatric evaluator's apportionment was also found insufficient as it did not adequately explain how psychiatric permanent disability should be apportioned separately from injury causation.

Workers' Compensation Appeals BoardPermanent Disability ApportionmentQualified Medical Evaluator (PQME)Agreed Medical Evaluator (AME)American Medical Association Guides to the Evaluation of Permanent ImpairmentRange of Motion MethodDiagnosis-Related Estimate (DRE) MethodCompensable ConsequenceCausation of Permanent DisabilitySubstantial Medical Evidence
References
12
Case No. ADJ7056401
Regular
Dec 02, 2020

BENITO HUERTA vs. MANPOWER, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration of a prior award, finding insufficient medical evidence to support an industrial injury to the applicant's left leg. The Board also determined that temporary disability was not a litigated issue at trial and thus deleted any prior findings on that matter. The issue of permanent disability was deferred due to the inadequacy of the medical evaluator's report, which failed to properly explain deviations from the AMA Guides. The case is returned to the trial level for further development of the record and a new decision on the left leg injury and permanent disability, with a new medical evaluator to be selected.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuryLow BackRight ShoulderLeft LegTemporary DisabilityPermanent DisabilityAgreed Medical EvaluatorAMA Guides
References
0
Case No. ADJ8242073
Regular
May 06, 2014

JOSE GUIJOSA vs. PECK ROAD GRAVEL PIT/STEVE BUBALO CONSTRUCTION COMPANY, SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior award due to deficiencies in the medical evidence regarding permanent disability. While the Board affirmed the finding of injury AOE/COE, they found the opinions of both treating physician Dr. Capen and Agreed Medical Evaluator Dr. Tooke insufficient to determine permanent disability due to inconsistencies and failure to adhere to AMA Guides. The case is returned to the trial level for further development of the record on permanent disability, with a corrected permanent and stationary date of March 23, 2013.

AOE/COEPermanent DisabilityPetition for ReconsiderationFindings and AwardHeavy Equipment OperatorLumbar SpineThoracic SpineAMA GuidesDr. Daniel CapenDr. Michael Tooke
References
0
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