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Case Law Database

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

Case No. ADJ3416937 (SRO 0141443) ADJ4476347 (SRO 0118020)
Regular
Apr 25, 2011

TIMOTHY ROBINSON vs. COUNTY OF SONOMA, Permissibly Self-Insured

This case concerns apportionment of permanent disability for an injured correctional officer. The applicant sustained an admitted industrial injury to his neck, resulting in a 12% permanent disability after initial apportionment. The WCJ calculated a total permanent disability of 43%, then apportioned 20% to non-industrial factors under Labor Code section 4663. Further apportionment occurred for a prior low back injury under Labor Code section 4664, using a converted rating from the old schedule to the new AMA Guides. The Appeals Board affirmed the WCJ's decision, finding no prohibition against applying both section 4663 and section 4664 apportionment, and deeming the prior injury properly converted and subtracted. A dissenting opinion argued that the older rating schedule's "overlap" concept is incompatible with the current AMA Guides method, and that the defendant failed to prove overlap for the prior injury.

Workers' Compensation Appeals BoardCounty of SonomaTimothy RobinsonCorrectional OfficerIndustrial InjuryNeck InjuryPermanent DisabilityApportionmentLabor Code Section 4663Labor Code Section 4664
References
6
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. 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. 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. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
Significant
Feb 03, 2009

Mario Almaraz, Joyce Guzman vs. Environmental Recovery Services (a.k.a. ENVIROSERVE), State Compensation Insurance Fund, Milpitas Unified School District, Permissibly Self-Insured, Keenan & Associates, Adjusting Agent

The Appeals Board held that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable by showing that an impairment rating based on the AMA Guides would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability.

AMA Guidesrebuttable presumptionpermanent disability rating2005 Scheduleimpairment determinationmedical opinionevidentiary standardequitable awardvocational specialistsactivities of daily living
References
61
Case No. ADJ1932557 (SJO 0267873)
Regular
Mar 20, 2009

JOHN VLCEK vs. THE HOME DEPOT, permissibly self-insured

This case involves an admitted industrial knee injury where the applicant disputed the awarded 4% permanent disability. The Appeals Board granted reconsideration to address how diminished future earning capacity (DFEC) and AMA Guides impairments are rebutted under the 2005 Schedule. The Board is returning the case to the trial level to allow the judge and parties to apply recent en banc decisions in *Ogilvie* and *Almaraz*. These decisions clarify the methods for rebutting the DFEC and AMA Guides portions of the permanent disability rating schedule.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityDiminished Future Earning CapacityDFECAMA Guides2005 ScheduleOgilvieAlmarazPanel Qualified Medical Evaluator
References
3
Case No. ADJ5668010
Regular
Jan 29, 2016

RAGHBIR MAHIL vs. FOSTER FARMS

This case concerns applicant Raghbir Mahil's appeal of a WCJ's decision regarding his 2002 industrial injury. The WCJ found injury to the neck and psyche, awarding 42% permanent disability based on the AMA Guides and denying injury to the right upper extremity and headaches. Applicant argued for total permanent disability, no psychiatric apportionment, and the application of the 1997 rating schedule. The Appeals Board rescinded the WCJ's decision, returning the matter for re-rating permanent disability under the 1997 Schedule due to the timing of temporary disability payments. The Board otherwise affirmed the WCJ's findings, including no injury to the right upper extremity or headaches, and the need for neck treatment only.

Workers' Compensation Appeals BoardRaghbir MahilFoster FarmsOpinion Decision After ReconsiderationFindings and Awardadmitted industrial injuryneck injurypsyche injurypermanent disabilityAMA Guides
References
2
Case No. ADJ425881 (MON 0349358) ADJ1664800 (MON 0330278)
Regular
Feb 23, 2009

Jerry Salmeron vs. COCA COLA ENTERPRISES

This case concerns an applicant's admitted industrial injuries to his low back, psyche, and hernias, and his subsequent permanent disability ratings. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes regarding the proper application of the 2005 Schedule for Rating Permanent Disabilities, particularly concerning diminished future earning capacity (DFEC). The WCAB rescinded the prior awards and remanded the cases to the trial level to allow the judge and parties to apply recent en banc decisions clarifying how the DFEC and AMA Guides portions of the schedule can be rebutted. The decision emphasizes that rebuttal must be consistent with Labor Code section 4660 and specific en banc rulings on evidence and methodology.

WCABSalmeronCoca Cola EnterprisesDecision After ReconsiderationFindings and Awardpermanent disabilityrebutted2005 Schedulediminished future earning capacityDFEC
References
3
Case No. ADJ100201 (GRO 0034542) ADJ2946755 (GRO 0034543)
Regular
Mar 08, 2010

Bradley Lorenz vs. STOWASSER PONTIAC, INTERCARE ROSEVILLE

This case concerns an applicant's claim for workers' compensation benefits due to back injuries. The applicant sought reconsideration of a prior award, arguing the permanent disability rating was too low, as he believed he had successfully rebutted the rating based on the AMA Guides. The Appeals Board affirmed the WCJ's decision, finding that the applicant failed to provide substantial medical evidence to rebut the scheduled rating. The Board clarified that the burden of proof for rebuttal rests with the applicant and that a conclusory statement of "loss of function" is insufficient.

Workers' Compensation Appeals BoardPermanent DisabilityAMA GuidesReconsiderationJoint Findings and AwardIndustrial InjuryRebuttalWhole Person ImpairmentMedical OpinionAgreed Medical Evaluator
References
9
Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
4
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