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

Case No. FRE 0197989, FRE 0200410
Regular
Feb 04, 2008

SANDRA LaPLANTE vs. WAL-MART, AMERICAN HOME ASSURANCE, AIG, FRANK GATES SERVICE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, finding that the WCJ erred by not applying the *Benson* doctrine on apportionment of permanent disability based on causation. The Board remanded the case for further proceedings to determine the percentage of permanent disability attributable to each industrial injury and pre-existing conditions, as required by Labor Code sections 4663 and 4664. The *Benson* doctrine dictates that the prior *Wilkinson* doctrine, allowing combined awards in successive injury cases, is no longer generally applicable due to the legislative intent for causation-based apportionment.

Wilkinson doctrineBenson v. The Permanente Groupapportionmentcausationsuccessive industrial injuriescumulative traumaspecific injurypermanent disability ratingmedical examiner reportcompensable consequence
References
9
Case No. MISSING
Regular Panel Decision
Nov 16, 2011

Claim of Wiess v. Mittal

Claimant, a steel worker from 1965 to 2008, filed an occupational hearing loss claim. His initial employer, Bethlehem Steel Corporation, was succeeded by Arcelor Mittal. A Workers' Compensation Law Judge apportioned the award based on the claimant's length of service with each employer. Bethlehem appealed, arguing Arcelor had not satisfied notice requirements and challenging the apportionment method. The Workers' Compensation Board determined Bethlehem had actual knowledge of the claimant's hearing loss through annual testing and credible testimony, and affirmed apportionment based on length of service. The appellate court affirmed the Board's decisions, finding no error in the Board's findings regarding actual knowledge or apportionment method.

Occupational hearing lossApportionmentActual knowledgeNotice requirementsEmployer liabilityWorkers' Compensation Law § 49-eeMedical evidenceBurden of proofAdverse inferenceIndustrial injury
References
8
Case No. MON 315604 MON 315605
Regular
Feb 15, 2008

KEVIN S. LACY vs. HOUSE OF BILLIARDS, ZENITH INSURANCE COMPANY c/o OCTAGON INSURANCE SERVICES, STATEC COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded a prior award and remanded the case to the trial level for further proceedings and a new decision. The rescission was based on the need to re-evaluate permanent disability and apportionment in light of the *Benson* decision, which changed the rules for apportionment from *Wilkinson* to a causation-based standard. The Board also found that further development of the record was required to clarify the apportionment percentages between the two industrial injuries.

Workers Compensation Appeals BoardReconsiderationPermanent DisabilityApportionmentWilkinsonBensonCausationIndustrial InjuryMedical ReportDeposition Testimony
References
2
Case No. ADJ4251836 (LAO 0830604) ADJ2226654 (LAO 0830603)
Regular
Dec 15, 2015

CALEB CHUA vs. DELIVERY SOLUTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to further develop the medical record regarding permanent disability apportionment for Caleb Chua. The original award found 30% permanent disability, apportioned by the WCJ based on Dr. Burstein's opinion. Applicant contended this apportionment was improperly based on pre-existing factors without substantial medical evidence, while his treating physician, Dr. Miller, supported a higher industrial causation. The Board found neither physician's apportionment opinion met the required legal standards for substantial evidence, necessitating further development of the record on this issue.

ApportionmentPermanent DisabilitySubstantial Medical EvidenceIndustrial InjuryCumulative TraumaStrokeHypertensionMedical CausationLabor Code Section 4662(a)(3)Findings and Award
References
6
Case No. ADJ3625409 (SAL 0119152)
Regular
Sep 21, 2009

GUADALUPE BENAVIDES vs. SALINAS VALLEY MEMORIAL HOSPITAL, Permissibly Self-Insured, Administered By ACCLAMATION INSURANCE MANAGEMENT SERVICES

The Appeals Board granted reconsideration, rescinding the prior award. The WCJ incorrectly ruled that surgical knee replacement precluded apportionment of permanent disability. The Board found that Labor Code § 4663 requires apportionment based on causation, even if the contributing pathology is surgically removed. Therefore, the matter was returned for a new rating based on the QME's opinion that 75% of the applicant's permanent disability was due to pre-existing conditions.

ApportionmentPermanent DisabilityQualified Medical EvaluatorIndustrial InjuryNon-IndustrialPrevious InjuriesDegenerative ArthritisTotal Knee ReplacementLabor Code § 4663Causation
References
4
Case No. VNO 497801; VNO 497802 VNO 497803; VNO 497804
Regular
Feb 14, 2008

ANDREW LAVIGNE vs. COUNTY OF LOS ANGELES

The Appeals Board rescinded the prior award and returned the case for further proceedings, requiring a new WCJ to reconsider permanent disability and apportionment based on *Benson v. The Permanente Medical Group*. The WCJ must determine which Permanent Disability Rating Schedule applies to each injury and may need to further develop the medical record to ensure substantial evidence supports any findings. The decision emphasizes that *Benson*'s rule on apportionment based on causation is now binding.

Appeals BoardReconsiderationJoint Findings and AwardPermanent DisabilityApportionmentWilkinsonBensonPDRSAldiPendergrass
References
16
Case No. ADJ971186 (VNO 0527686)
Regular
Dec 13, 2013

FERNANDO PEREZ vs. SHERWOOD MANAGEMENT, dba DANIEL'S JEWELERS, CIGA administered by BROADSPIRE, CLARENDON INSURANCE COMPANY administered by NORTH AMERICAN RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration and reduced the applicant's permanent disability award from 60% to 49%. This reduction was based on apportioning 30% of the applicant's psychiatric permanent disability to non-industrial factors, specifically a pre-existing personality disorder, as opined by Dr. Cooper. The Board found Dr. Cooper's apportionment medically substantial evidence, consistent with current legal standards requiring apportionment based on causation. The award and attorney's fees were subsequently amended to reflect the reduced permanent disability percentage.

ApportionmentPsychiatric injuryPermanent disabilityNon-industrial factorsMedical opinionCausationLabor Code section 4663(a)E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten)Brodie v. Workers' Comp. Appeals Bd.Escobedo v. Marshalls
References
4
Case No. ADJ805875 (NOR 0205656)
Regular
May 26, 2010

JOSE GONZALEZ vs. UNIFORM RENTAL SERVICES and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, in liquidation, Administered by BROADSPIRE CLAIMS SERVICES

This case involves Jose Gonzalez seeking reconsideration of a Workers' Compensation Appeals Board decision that apportioned 10% of his permanent disability to a prior injury. The Board denied reconsideration, affirming the Administrative Law Judge's finding that the Agreed Medical Examiner's report on apportionment was substantial evidence. The applicant's argument that the AME's report was based on an incorrect history and that a new physician's report showed full recovery from the prior injury was rejected. The Board found that apportionment is based on causation, not solely on prior work restrictions, and that the applicant's new medical report was untimely.

ApportionmentAgreed Medical Examiner (AME)Petition for ReconsiderationPermanent DisabilityIndustrial InjuryPrior InjuryCausationLabor Code Section 4663Labor Code Section 4664Substantial Evidence
References
3
Case No. ADJ1817589 (POM 0209340)
Regular
Feb 22, 2011

MARIAM HASAN vs. GUADALUPE HOMES, SEDGWICK CIGA GLENDALE

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding 100% permanent disability due to industrial injuries sustained in 1991. The defendant sought apportionment based on pre-existing degenerative spinal conditions. While the Agreed Medical Evaluator opined some apportionment was warranted, their report lacked sufficient detail to meet legal standards for causation and apportionment. Consequently, the case is returned to the trial level for further development of the medical record regarding permanent disability and apportionment.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderPermanent DisabilityApportionmentAgreed Medical EvaluatorWCJLabor Code Section 4663EscobedoGatten
References
4
Case No. WCK 0064705
Regular
Aug 14, 2008

PATRICIA BRADY vs. NORTH BAY MEDICAL CENTER, GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings. The Board found the previous decision ambiguous regarding liability apportionment between defendants and inconsistent with current apportionment law, specifically citing the need to apply *Benson v. The Permanente Medical Group*. The WCJ must now reconsider apportionment of permanent and temporary disability based on causation, address the administration of the award, and clarify CIGA's liability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryCervical SpineUpper ExtremitiesAverage Weekly EarningsTemporary Disability IndemnityPermanent DisabilityApportionment
References
5
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