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

Case No. ADJ10443669
Regular
Oct 04, 2017

Donna Carter vs. Rose International Group, OneBeacon Insurance Group

The Appeals Board affirmed the Workers' Compensation Judge's finding that Donna Carter sustained an industrial injury to her right knee and left wrist on May 18, 2016. Despite inconsistencies in the applicant's testimony regarding a slip and fall incident, her account was corroborated by a witness who found her on the floor. Medical records from the day of the incident also supported the applicant's claim, establishing a clear mechanism of injury. The Board found that the common sense nature of a slip and fall does not require expert medical opinion to establish industrial causation for the incident itself.

ADJ10443669Rose International GroupOneBeacon Insurance GroupDonna CarterWorkers' Compensation Appeals BoardOpinion and Decision After Reconsiderationslip and fallindustrial injuryright kneeleft wrist
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ8223018
Regular
Sep 30, 2014

GERARDO VARGAS vs. ACCOUNTABILITY INCORPORATED, administered by LUMBERMEN'S UNDERWRITING ALLIANCE

The Workers' Compensation Appeals Board (WCAB) dismissed a petition for removal filed by Accountability Incorporated. The dismissal was primarily due to a lack of proper verification on the petition. Even if it had been verified, the WCAB indicated it would have denied the petition on its merits, adopting the reasoning of the workers' compensation administrative law judge. Therefore, the petition for removal was officially dismissed.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ ReportLack of VerificationDismissalCal Code Regs tit 8 § 10843(b)Deny on the MeritsAdministrative Law JudgeAccountability IncorporatedLumbermen's Underwriting Alliance
References
Case No. ADJ4245808
Regular
Jan 13, 2013

PATRICIA ANNE DYKES vs. CITY OF SAN DIEGO

This case involves an applicant claiming a psyche injury due to sexual harassment and assault by a supervisor. The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The judge found the applicant not credible due to inconsistent testimony and conflicting accounts of events. Medical opinions suggested pre-existing psychopathology and significant non-industrial stressors as the predominant causes of any alleged psychological issues. Ultimately, the applicant failed to meet her burden of proof regarding injury arising out of and in the course of employment.

Workers' Compensation Appeals BoardReconsideration DeniedPsyche InjuryAOE/COECredibility FindingSexual HarassmentSexual AssaultSupervisor MisconductWitness TestimonyMedical Records
References
Case No. ADJ599176 (SAC 0333692) ADJ2396484 (RDG 0122019) ADJ7950339
Regular
Mar 21, 2017

Fernando Muniz Villalpando vs. Doherty Brothers, Martin Dusters, State Compensation Insurance Fund

This case involves an applicant seeking to self-administer his Medical Set-Aside Account (MSA) after previously agreeing to third-party administration by Bridge Pointe/NuQuest. The Appeals Board granted reconsideration, rescinded the prior order, and returned the matter to the trial level. The Board found that the trial judge needs to review the original agreement to determine if it allows for a change of administration or if applicant has contractual rights to pursue this. Further proceedings will assess applicant's competency for self-administration and any opposition from the defendant.

Medical Set-Aside AccountMSAPetition for ReconsiderationJoint Findings and OrderMedical Set-Aside Account administrationself-administrationBridge PointeNuQuestState Compensation Insurance FundCompromise and Release Agreement
References
Case No. ADJ3057068
Regular
Nov 01, 2010

Cecilio Torres vs. Holbrook Construction, Inc., Lincoln General Insurance Company, American Claims Management, State Compensation Insurance Fund

The Workers' Compensation Appeals Board granted reconsideration, rescinded a prior decision, and returned the case for further proceedings. The applicant claimed a back and other injuries, alleging he notified his supervisor of the incident and subsequent pain before termination. The Board found the applicant met his burden to prove he provided sufficient notice of injury to his supervisor prior to termination, fulfilling the notice requirement of Labor Code section 3600(a)(10). Defendants failed to rebut the applicant's evidence that he reported the injury and requested medical treatment from his supervisor.

Workers' Compensation Appeals BoardReconsiderationLabor Code Section 3600(a)(10)Notice of InjuryTerminationPreponderance of EvidenceSupervisor NoticeActual NoticeEmployer KnowledgeWCJ Decision
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ7500739
Regular
May 25, 2012

SAMIRA HASAN vs. AMERICAN SHIELD PRIVATE SECURITY, GALLAGHER BASSETT

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior finding, ruling that Samira Hasan, a security guard, sustained an industrial injury. Hasan was struck by a car while crossing the street for coffee shortly before her shift began, having signed in and received implied approval from her supervisor. The Board found this to be a compensated coffee break exception to the "going and coming" rule, thus arising out of and in the course of employment. One Board member dissented, giving greater weight to the administrative law judge's credibility findings regarding the supervisor's testimony.

Workers' Compensation Appeals Boardindustrial injurycourse of employmentarising out of employmentgoing and coming rulecompensated lunch breaksign-in sheetsupervisor approvalcredibility findingsdissenting opinion
References
Case No. ADJ176329 (VNO 0542064)
Regular
Jun 15, 2009

Jesse W. Pratt vs. Lancaster Healthcare Center, Zurich America Insurance Company

This case involved a maintenance supervisor who claimed industrial injury to his psyche and various physical ailments due to alleged stress and harassment by his supervisor. The Appeals Board granted reconsideration, reversing the initial award. The Board found that the applicant's psychiatric injury was substantially caused by lawful, nondiscriminatory, good-faith personnel actions, specifically workplace critiques and job modifications by management. Consequently, compensability for the psychiatric injury was barred under Labor Code section 3208.3(h). The issue of whether the applicant's non-psychiatric conditions were industrially caused was deferred for further development of the record at the trial level.

Workers' Compensation Appeals BoardLabor Code section 3208.3(h)good faith personnel actionpsychiatric injuryindustrial injurycompensabilitymaintenance supervisorreconsiderationFindings and Awardactual events of employment
References
Case No. ADJ6603653
Regular
Mar 29, 2010

PEGGY MILLER vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, Legally Uninsured, STATE COMPENSATION INSURANCE FUND

This case concerns applicant Peggy Miller's claim for a psychiatric injury allegedly arising from a verbal dispute with her supervisor over medication administration. The Workers' Compensation Appeals Board (WCAB) denied her petition for reconsideration of a prior finding that her injury was not compensable. The WCAB majority adopted the judge's report concluding the incident was a lawful, non-discriminatory, good faith personnel action and not a compensable industrial injury. However, one commissioner dissented, arguing the supervisor's directive to administer medication contrary to physician's orders was unlawful, thus not a "lawful, nondiscriminatory, good faith personnel action" under Labor Code section 3208.3(h).

Workers' Compensation Appeals BoardPsychiatric injuryVerbal exchange24 hour clockMedication administrationShift supervisorPersonnel actionLawfulNondiscriminatoryBad faith
References
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