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

Case No. ADJ10335205
Regular
Feb 16, 2017

BARNARD VILLAR vs. STATE OF CALIFORNIA, CDCR, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board found the medical opinion of the panel Qualified Medical Examiner (PQME) to be substantial medical evidence, based on an adequate examination and supported by reasoning. This opinion was relied upon by the workers' compensation administrative law judge. Consequently, the applicant's petition was denied.

Petition for ReconsiderationDeniedWorkers' Compensation Appeals BoardWCJ ReportAdopted and IncorporatedSubstantial Medical EvidenceReasonable Medical ProbabilityPanel Qualified Medical ExaminerPQMEBarry Gwartz M.D.
References
Case No. ADJ2428736 (SJO 0217650)
Regular
Jan 26, 2017

PAMELA GRAHAM vs. MONTESSORI SCHOOL OF FREMONT; CIGA

This Workers' Compensation Appeals Board decision denies reconsideration, upholding the administrative law judge's finding that the defendant failed to meet their burden of proof on apportionment. The Board found the orthopedic agreed medical examiner's opinions on apportionment were not substantial evidence because they lacked detailed reasoning, failed to explain the causal connection between degenerative disc disease and permanent disability, and did not adequately address apportionment to non-industrial causes. Therefore, the defendant's petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedApportionmentBurden of ProofMedical OpinionReasonable Medical ProbabilitySpeculativePertinent FactsAdequate Examination
References
Case No. ADJ252083 (NOR 0166266) ADJ3827633 (LAO 0784953) ADJ3395707 (LAO 0784956) ADJ629194 (LAO 0849490) ADJ2985386 (LAO 0784955) ADJ2625573 (LAO 0784951)
Regular
Apr 12, 2011

CLAUDIA DYER vs. BOEING/McDONNELL DOUGLAS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHARTIS INSURANCE

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the WCJ's findings of industrial injuries to the applicant's knees, neck, back, shoulders, hips, hands, and ankle across multiple dates. The Board found the WCJ's decision was supported by substantial evidence, specifically Dr. Nelson's well-reasoned medical opinions on causation and apportionment. CIGA's petition was also found deficient for failing to comply with procedural requirements for referencing the record. Finally, CIGA was estopped from asserting the statute of limitations defense due to the employer's knowledge of the injury and failure to provide notice of rights.

CIGAFremont InsuranceliquidationPetition for ReconsiderationJoint Findings and Awardindustrial injuryaircraft mechanickneesneckback
References
Case No. ADJ9422751
Regular
May 02, 2017

ANGANYE CHOY vs. FRIENDLY FRANCHISEES CORPORATION DBA CARL'S JR, UNITED STATES FIRE INSURANCE COMPANY, administered by CRUM AND FORSTER

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The WCAB adopted the WCJ's report, finding the panel qualified medical examiner's opinion to be substantial evidence based on adequate examination and reasoning. The Board affirmed that one physician's relevant opinion can constitute substantial evidence, even if contradicted. Furthermore, no good cause was established for further discovery after the mandatory settlement conference.

Petition for ReconsiderationWCJ reportsubstantial evidencemedical opinionreasonable medical probabilityPQMEadequate examinationconsistent medical opinionsdiscoverymandatory settlement conference
References
Case No. SAL 0095713; SAL 0095714 SAL 0096384
Regular
Mar 03, 2008

NELLIE RUIZ vs. DOCTORS ON DUTY, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Workers' Compensation Appeals Board granted reconsideration to defer issues of permanent disability and apportionment due to a lack of substantial medical evidence. Neither the Agreed Medical Examiner nor the Qualified Medical Examiner adequately addressed the causation of the applicant's disability as required by Labor Code section 4663. The case is returned to the trial level for further proceedings to develop the record on apportionment.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryLeft KneeRight KneeCumulative TraumaApportionmentPermanent DisabilityAgreed Medical Examiner
References
Case No. ADJ6622799
Regular
Oct 18, 2013

TERRY A. WIRTH vs. STATE OF CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

This case concerns the denial of a Petition for Reconsideration filed by the defendant, the State of California Highway Patrol. The applicant, Terry A. Wirth, suffered a continuous trauma injury (prostate cancer) leading to urinary and erectile dysfunction. The Appeals Board adopted the Workers' Compensation Judge's report, finding that the date of injury was in 2008, determining the applicable permanent disability compensation rate based on that date. The Board also found ample evidence supporting the agreed medical examiner's impairment ratings for the applicant's post-surgical conditions, dismissing the defendant's objections.

Workers' Compensation Appeals BoardState of California Highway PatrolState Compensation Insurance FundPetition for ReconsiderationPermanent disability compensation rateLabor Code section 5412Urinary incontinenceErectile dysfunctionCommon postprostatectomy symptomsWhole person impairment ratings
References
Case No. ADJ8657415
Regular
Oct 06, 2017

Oliver Boutte IV (Deceased) vs. U.S. XPRESS ENTERPRISES, LIBERTY MUTUAL INSURANCE COMPANY

This Workers' Compensation Appeals Board case involved a petition for reconsideration filed by U.S. Xpress Enterprises and Liberty Mutual Insurance Company. The defendants argued that the medical report relied upon by the Workers' Compensation Judge (WCJ) was not substantial evidence, specifically regarding the timing of the employee's death from a pulmonary embolus. The Board denied the petition, adopting the WCJ's report which found the physician's opinion to be substantial medical evidence based on adequate examination and reasoning. The Board concluded the WCJ properly found this opinion more persuasive than the opposing medical opinion.

Oliver Boutte IVU.S. Xpress EnterprisesLiberty Mutual Insurance CompanyADJ8657415Petition for ReconsiderationWorkers' Compensation Appeals Boardsubstantial evidencemedical opinionpulmonary embolusreasonable medical probability
References
Case No. ADJ3355286 (SAC 0369062)
Regular
Jun 24, 2010

Dale E. Hansen vs. EL DORADO TRUSS COMPANY, INC., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration, finding no final order existed subject to review. The Board also denied the applicant's petition for removal, as no significant prejudice or irreparable harm was demonstrated. The applicant had sought to disqualify a psychiatric QME and argued the WCJ erred on multiple procedural and evidentiary grounds. The WCJ's order for the parties to confer on an Agreed Medical Examiner was found not to be a final determination.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Examiner (QME)Agreed Medical Examiner (AME)Reporting RequirementsFinal OrderSubstantive RightsPrejudiceIrreparable Harm
References
Case No. ADJ8368816
Regular
Feb 25, 2015

DOUGLAS PINK vs. CAMPORA PROPANE SERVICE, CRUM & FOSTER INSURANCE

The Workers' Compensation Appeals Board denied applicant Douglas Pink's Petition for Removal. Removal is an extraordinary remedy granted only upon a showing of substantial prejudice or irreparable harm. The Board found that Pink failed to demonstrate such harm, nor did he prove that reconsideration would be an inadequate remedy. Additional deficiencies in the petition included lack of evidence for a requested evidentiary hearing and the applicant's attorney's apparent failure to adequately notify the applicant of a medical examination.

Petition for RemovalExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationAdequate RemedyWCJ ReportMinutes of HearingEvidentiary HearingQualified Medical Examiner
References
Case No. ADJ4707980 (VNO 0543260) ADJ3907003 (VNO 0543258) ADJ7500629
Regular
Apr 05, 2012

RAMON SALAZAR vs. CONSOLIDATED DISPOSAL SERVICE, ACE USA Administered By CANNON COCHRAN MANAGEMENT SERVICES INC.

The Appeals Board granted removal, rescinding the WCJ's order for a sanctions hearing and the appearance of the defendant's claims examiner. While acknowledging the duty to disclose evidence before a trial, the Board found no authority requiring pre-expedited hearing disclosure of sub rosa films, thus negating grounds for sanctions. The Board also determined an affidavit from the claims examiner would suffice, making her live appearance unnecessary. The order for the sub rosa films to be sent to the Agreed Medical Examiner was affirmed.

sub rosa filmsexpedited hearingsanctionsPetition for RemovalAgreed Medical Examinertemporary disability indemnitymedical treatmentclaims examineraffidavitLabor Code section 5813
References
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