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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ2241828
Regular
Dec 05, 2008

LISA MANZO vs. WHITE MEMORIAL MEDICAL CENTER

The Workers' Compensation Appeals Board dismissed the employer's petition for reconsideration as it was not a final order but granted removal to rescind the WCJ's disapproval of the Stipulations. The Board found the Stipulations might be adequate despite the WCJ's concerns and ordered the matter returned to the trial level with missing documents to be filed. The employer must provide Dr. Knight's December 2006 report, its investigator's report, and the proposed Stipulations for a new decision on their adequacy.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalStipulations with Request for AwardWCJ disapprovalinadequate Stipulationsunsigned Stipulationsindustrial injuryright wristright elbow
References
Case No. ADJ2375135 (MON 0350920) ADJ3115402 (MON 0350919)
Regular
Nov 09, 2011

ISAIAS H. AYALA vs. D & D MOVE IT TREES COMPANY, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the WCJ's award of home care to the applicant, ordering the case returned for further proceedings and a new decision. This action stems from disputed stipulations regarding the admissibility of a PQME report and the reliability of a secondary treating physician's recommendations. Key issues to be clarified include the exact stipulations made, the admissibility of medical reports, and the reasonableness and necessity of the proposed 24/7 home care, along with its specific parameters. The WCJ must address these foundational issues before making a new determination on home care.

Workers' Compensation Appeals BoardReconsiderationHome CarePrimary Treating PhysicianSecondary Treating PhysicianPanel Qualified Medical Evaluator (PQME)AdmissibilityStipulationMedical TreatmentPsychiatric Injury
References
Case No. ADJ1292068 (STK 0203177)
Regular
Apr 26, 2010

Kenneth Bryant vs. STAFF MARK INVESTMENT LLC, AMERICAN HOME ASSURANCE COMPANY, CHARTIS

The defendant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision awarding permanent disability and asserting estoppel regarding earnings. The WCAB granted reconsideration, finding the judge erred by treating an initial answer's earnings admission as a final stipulation. The Appeals Board determined that the issue of earnings was actively disputed and evidence was presented, thus the prior admission was withdrawn. Consequently, the WCAB rescinded the decision and returned the matter for further proceedings to determine average weekly wages and other related issues.

WCABReconsiderationOpinion and OrderFindings Award and OrderPermanent DisabilityTemporary DisabilityEarningsOverpaymentCreditAdmission
References
Case No. ADJ9371315
Regular
Sep 08, 2014

JOHN STEPHEN CHACON vs. SACRAMENTO MUNICIPAL UTITILITY DISTRICT, INTERCARE HOLDINGS INSURANCE SERVICES

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration and denied their petition for removal. This action was taken because the underlying stipulated award was void as the unrepresented applicant never reviewed or signed the amended stipulations. The WCAB found this procedural defect rendered the award invalid, and therefore, the judge's order vacating it was appropriate and the defendant's subsequent appeals were moot. The case will return to the trial level for a status conference and further proceedings to ensure due process.

Order Vacating AwardStipulationsRemovalReconsiderationVoid StipulationsUnrepresented ApplicantInformation and Assistance OfficerDue ProcessEx Parte CommunicationSupplemental Pleading
References
Case No. ADJ8211594
Regular
Jan 17, 2014

ERROL GRIFFIN vs. COUNTY OF LOS ANGELES DEPARTMENT OF HEALTH, Permissibly Self-Insured, Administered By TRISTAR RISK MANAGEMENT

This case involves a dispute over the applicant's average weekly wage (AWW) for temporary disability benefits. Initially, the parties stipulated to an AWW of $1,676.04, but the defendant sought reconsideration based on mutual mistake, claiming the correct AWW was $859.16. Subsequently, both parties filed an amended stipulation agreeing to an AWW of $800.07. The Appeals Board granted reconsideration to defer the issue of temporary disability indemnity and returned the matter to the WCJ to consider the amended stipulation and determine the correct benefits.

Petition for ReconsiderationFindings and AwardTemporary Disability IndemnityStipulated FactsMutual MistakeAverage Weekly WageAmended StipulationWorkers' Compensation Appeals BoardWCJMutual Mistake
References
Case No. ADJ8189699
Regular
Mar 27, 2013

VERONICA TREJO vs. COUNTY OF LOS ANGELES

This case involves a dispute over a workers' compensation award based on stipulations approved at a mandatory settlement conference where the applicant was not present. The defendant sought to set aside the award, alleging issues with signatures and a "mutual mistake" regarding permanent disability. The Appeals Board denied the applicant's petition for removal, upholding the judge's authority to set aside the award pending further investigation. The Board highlighted serious ethical concerns regarding potential misconduct by both parties in the filing of the stipulations. The case was remanded for a status conference to address signature validity and potential sanctions.

Petition for RemovalOrder Setting Aside AwardStipulations with Request for AwardMandatory Settlement ConferenceAgreed Medical EvaluatorPetition to Set Aside StipulationMutual MistakeFraudDue ProcessEthical Misconduct
References
Case No. STK 183882
Regular
Feb 24, 2009

ROBERTO REYES vs. NEW IMAGE FOAM PRODUCTS INC., EVEREST NATIONAL INSURANCE COMPANY

This case concerns whether the 1997 or 2005 Permanent Disability Rating Schedule should apply to an applicant's back injury. The majority affirmed the administrative law judge's use of the 2005 schedule, finding no basis to deviate. However, a dissenting commissioner argued the 1997 schedule should have been used, citing the employer's May 2004 admission that the treating physician indicated permanent disability. This admission, the dissent argued, falls under an exception to the 2005 schedule's applicability, as interpreted by relevant case law.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability Rating Schedule1997 PDRS2005 PDRSLabor Code section 4660(d)Treating Physician ReportPermanent and Stationary StatusVocational RehabilitationAdmission
References
Case No. ADJ6820997
Regular
Feb 08, 2012

RODOLFO VILLALOVOS vs. ACE BEVERAGE COMPANY, TOPA INSURANCE COMPANY

This case involves a dispute over the admissibility of medical reports from a physician outside the defendant's Medical Provider Network (MPN) and the subsequent award of temporary and permanent disability benefits. The Appeals Board rescinded the original decision due to unresolved issues regarding the proper establishment and notice of the MPN. The case is returned to the trial level for further proceedings to determine the validity of the MPN and the admissibility of the medical evidence. The WCJ must also clarify whether certain QME reports were admitted into evidence, as reliance on unadmitted evidence is improper.

MPNValdezPrimary Treating PhysicianReconsiderationMedical Provider NetworkInadmissible ReportsStipulationTemporary DisabilityPermanent DisabilityMedical Treatment
References
Case No. ADJ282433 (LAO 0880367)
Regular
Jun 08, 2015

MICHAEL DUFFEY vs. CMH RECORDS, STATE FARM INSURANCE COMPANY

The Appeals Board granted reconsideration to admit previously excluded defendant exhibits, specifically the depositions and report of Drs. Miller and Saint Martin. Despite ruling the exhibits admissible, the Board affirmed the original finding that defendant failed to present substantial evidence to terminate applicant's continuing home health care. Dr. Miller's change of opinion was deemed unsubstantiated, and Dr. Saint Martin's opinion was deemed irrelevant to the specific terms of the prior stipulation. The Board emphasized that admitting the evidence ensures due process and reinforces the integrity of its decision.

Petition for ReconsiderationFindings and AwardHome Health CareSubstantial EvidenceAdmissible ExhibitsDepositionMedical ReportAgreed Medical EvaluatorPrimary Treating PhysicianDue Process
References
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