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

Case No. ADJ2709955 (MON 0356320)
Regular
Jun 21, 2017

Mario Cocola vs. California Hospital Medical Center

The Workers' Compensation Appeals Board denied Mario Cocola's petition for reconsideration, upholding the finding that he sustained $69\%$ permanent disability from industrial injuries. Cocola argued the administrative judge erred by disregarding the Agreed Medical Examiner's opinion that he was totally disabled from the open labor market due to orthopedic injuries. The Board agreed with the judge's report that the physician's opinion lacked sufficient objective basis for the change in work restrictions. A dissenting opinion argued the medical and vocational evidence supported a $100\%$ permanent disability finding and requested clarification from the medical examiner.

Petition for ReconsiderationFindings of Fact and Awardpermanent disabilitycumulative traumalumbar spinecervical spinepsychecervicogenic headachesEmergency Unit CoordinatorAgreed Medical Examiner
References
1
Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
Case No. ADJ3079482 (STK 0190821)
Regular
Apr 15, 2010

STEVEN JONES vs. BEN'S DRY WALL, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of a finding that the applicant sustained an industrial injury to his neck, arms, shoulders, and back. The defendant argued the claim was time-barred, challenged the admissibility of certain medical reports, and disputed the status of a medical examiner. The Board denied reconsideration, finding the applicant's credible testimony and the qualified medical examiner's opinion supported the injury finding. Furthermore, the defendant waived statute of limitations arguments by failing to present supporting facts or law. The Board affirmed the WCJ's decision, including the admission of Dr. Lipton's report and the determination that Dr. Abeliuk was not an agreed medical examiner.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderWCJindustrial injurycumulative traumastatute of limitationsLabor Code section 5405agreed medical examiner (AME)qualified medical examiner (QME)
References
3
Case No. MISSING
Regular Panel Decision

Mazella v. Beals

This dissenting opinion, authored by J.E. Smith, challenges the majority's finding that defendant William Beals, M.D.'s negligence was a proximate cause of Joseph Mazella's suicide. The dissent highlights Beals' admitted negligence in treating Mazella for depression over many years without personal consultations. However, it emphasizes that Mazella received extensive subsequent medical treatment from other providers, including hospitalizations and significant medication changes, after his last contact with Beals. The dissenting judge argues that these intervening acts by other medical professionals constitute a superseding cause, severing any causal link between Beals' prior negligence and Mazella's death. Furthermore, the dissent contends that an evidentiary error regarding the admission of a consent agreement between defendant and the Office of Professional Medical Conduct unfairly prejudiced the defendant, contributing to the jury's erroneous determination of liability.

Medical malpracticeProximate causeSuicideIntervening causeSuperseding causeDissenting opinionPsychiatric treatmentNegligenceEvidentiary errorProfessional Medical Conduct
References
16
Case No. ADJ9709726
Regular
Jun 25, 2015

LAURA NUNEZ vs. SUTTER PACIFIC MEDICAL FOUNDATION, SUTTER HEALTH

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the finding of industrial injury AOE/COE for thoracic outlet syndrome, arguing it wasn't an issue for trial and the medical evidence was insufficient. The Board found that thoracic spine injury was an issue and that Dr. Avery's opinion provided substantial medical evidence to support the thoracic outlet syndrome finding. Any potential defects in the original WCJ opinion were cured by the WCJ's subsequent report.

Thoracic outlet syndromeAOE/COEPetition for Reconsiderationsubstantial medical evidenceG. James Avery M.D.Steven Bratman M.D.industrial injuryapportionmentWCJlabor code 5313
References
1
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
0
Case No. ADJ79 96674
Regular
Mar 24, 2016

ARLZENIA HASLEY vs. EL CENTRO REGIONAL MEDICAL CENTER

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Removal, which sought to invalidate the medical evidence of the Agreed Medical Examiner (AME), Dr. Luros. The WCAB found that removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. The defendant's arguments regarding flawed medical opinions and the AME's unavailability can be addressed through standard appeal procedures. Furthermore, the defendant filed a supplemental pleading without prior permission, which was disregarded by the Board.

Petition for RemovalArlzenia HasleyEl Centro Regional Medical CenterTriStar Risk ManagementWCABWCJsubstantial prejudiceirreparable harmreconsiderationsupplemental pleading
References
2
Case No. ADJ4269674 (STK 0156078) ADJ4476682 (STK 02102241)
Regular
Jan 26, 2012

MANUEL GOMES vs. EDWIN H. SMITH AND SONS, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, affirming the WCJ's finding that the applicant did not sustain a cumulative trauma injury to his right knee by June 2005. While acknowledging both medical opinions were admissible, the Board found Dr. Mandell's reports lacked substantial medical evidence for a 2005 injury. Conversely, Dr. Miller's opinion, which attributed the applicant's disability and need for treatment to the prior 1998 industrial injury, was deemed persuasive and supported by relevant facts. Therefore, CIGA failed to meet its burden of proof to establish a cumulative trauma injury in 2005.

CIGAPetition for ReconsiderationFindings of Fact and Orderscumulative traumaindustrial injuryright kneesubstantial medical evidenceAgreed Medical Evaluator (AME)Panel Qualified Medical Evaluator (PQME)stipulated award
References
7
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. ADJ6635537
Regular
May 06, 2011

EDDIE ESPINOZA vs. BARRETT BUSINESS SERVICES, INC.

This case involves a dispute over medical treatment network (MPN) compliance for an industrial back injury. The WCAB granted reconsideration to address whether the defendant's inadequate MPN notices led to a neglect or refusal to provide reasonable medical treatment, impacting the admissibility of outside medical reports. The Board will require the WCJ to re-evaluate MPN compliance and the propriety of further medical development. The case is returned to the trial level for further proceedings and a new decision consistent with the Board's opinion.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)ReconsiderationFindings Award and OrderIndustrial InjuryMedical TreatmentTemporary DisabilityPermanent DisabilityApportionmentMedical Legal Process
References
4
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