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Case Law Database

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

Case No. ADJ9854290
Regular
Apr 10, 2017

MARY VIEIRA vs. PASO ROBLES TANK, INCORPORATED., OLD REPUBLIC GENERAL INSURANCE CORPORATION, GALLAGHER BASSETT SERVICES

This case involves defendant's petition for reconsideration of a finding of total permanent disability due to an admitted industrial right ankle injury complicated by Complex Regional Pain Syndrome (CRPS). Defendant argues the Qualified Medical Evaluator's (QME) report lacks substantial evidence due to failure to review prior injury records and for not using DRE ratings. The Appeals Board granted reconsideration to admit a supplemental QME report that reviewed the prior injury records and did not alter the QME's opinions. The Board intends to admit this supplemental report unless good cause is shown within 15 days.

Complex Regional Pain SyndromeCRPSQualified Medical EvaluatorQMEsubstantial evidenceDRE ratingsAMA Guidessupplemental reportPetition for ReconsiderationFindings and Award
References
0
Case No. MISSING
Regular Panel Decision

Claim of Thomasula v. Wilson Concrete & Masonry

Claimant sought workers' compensation benefits for a left shoulder injury sustained during employment. The Workers' Compensation Board denied the claim, finding claimant's testimony not credible due to a delay in seeking medical attention, failure to file an accident report, and admitting to misrepresenting the injury as non-work-related for private insurance. Claimant appealed, but the appellate court affirmed the Board's decision, upholding the Board's authority to resolve credibility issues. The court found substantial evidence supported the determination that the injury was not work-related. Claimant's remaining arguments were considered and rejected as lacking merit.

Workers' CompensationCredibility AssessmentAccidental InjuryEmployment InjuryMedical Attention DelayAccident ReportInsurance MisrepresentationAppellate ReviewSubstantial EvidenceBoard's Authority
References
3
Case No. ADJ3953602 (SRO 0133844) ADJ2646453 (SRO 0133845)
Regular
Dec 21, 2012

ROBERTO HERNANDEZ vs. MILL VALLEY SCHOOL DISTRICT, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board affirmed an earlier decision awarding applicant 100% permanent disability, less credits and fees, due to industrial injuries to his right knee, psyche, and lumbar spine. The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration, arguing the applicant's disability was solely from the latter injury and thus not eligible for SIBTF benefits. The Board accepted the applicant's late-filed answer to the SIBTF's petition and, agreeing with the original judge, denied the SIBTF's petition for reconsideration. The Board also admitted two exhibits previously marked for identification into evidence.

WORKERS' COMPENSATION APPEALS BOARDSUBSEQUENT INJURIES BENEFITS TRUST FUNDRECONSIDERATIONFINDINGS AND AWARDPERMANENT DISABILITYINDUSTRIAL INJURYPSYCHELUMBAR SPINEMAINTENANCE WORKERADMINISTRATIVE LAW JUDGE
References
2
Case No. ADJ3156337 (FRE 0209931) ADJ4199467 (FRE 0209932)
Regular
Nov 20, 2008

FRANK FLORES vs. NICKEL'S PAYLESS STORES, WAUSAU INSURANCE COMPANIES, EVEREST NATIONAL INSURANCE COMPANY, AMERICAN COMMERCIAL CLAIMS ADMINSITRATORS

The Workers' Compensation Appeals Board granted reconsideration of an award for a 1999 right foot and ankle injury, specifically addressing the defendant's claims of error in permanent disability calculation without apportionment and the exclusion of medical evidence. The Board intends to admit the Agreed Medical Evaluator's reports into evidence, which the WCJ had previously excluded. This decision will allow the Board to review all relevant medical evidence before making a final determination on apportionment and the applicant's claimed injuries.

Workers Compensation Appeals BoardIndustrial InjuryPermanent Partial DisabilityApportionmentAgreed Medical EvaluatorSubstantial Medical EvidenceAdmissibility of EvidencePetition for ReconsiderationAmended Findings Award and OrderMinutes of Hearing
References
0
Case No. ADJ3040080 (VEN 0121790) ADJ1943127 (VEN 0121791)
Regular
Jul 18, 2011

Sean Schiemann vs. Paradise Chevrolet, State Compensation Insurance Fund, Subsequent Injuries Benefits Trust Fund

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, remanding the case for further proceedings. Issues included the proper apportionment of permanent disability between the State Compensation Insurance Fund (SCIF) and the Subsequent Injuries Benefits Trust Fund (SIF), conflicting findings on permanent and temporary disability, and inconsistencies regarding attorney fees. The Board also noted missing medical reports and incorrect party designations. The trial judge must clarify the permanent disability award for each injury, determine benefit rates and dates, and ensure all relevant medical evidence is properly admitted.

Workers' Compensation Appeals BoardSubsequent Injuries Benefits Trust FundSCIFCumulative Trauma InjurySpecific InjuryPermanent DisabilityApportionment of LiabilityLife PensionTemporary DisabilityAttorney Fees
References
3
Case No. ADJ3552048 (LAO 0795520)
Regular
Feb 28, 2011

JAVIER GALINDO vs. MEAT EXPORTE CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant's appeal challenging the disallowance of psychiatric treatment costs. The Workers' Compensation Appeals Board (WCAB) affirmed the original decision, finding the applicant did not meet the six-month actual work requirement under Labor Code section 3208.3(d) for psychiatric injury claims. The applicant's extensive absences due to an admitted orthopedic injury meant he did not perform six months of actual service. The WCAB clarified that this six-month threshold applies even to psychiatric injuries stemming from admitted physical injuries. The lien claimant's arguments regarding detrimental reliance and the necessity of treatment for the orthopedic injury were also rejected.

Labor Code Section 3208.3(d)psychiatric injurysix months actual worklien claimantindustrial orthopedic injurydetrimentally reliedimplied authorizationWorkers' Compensation Appeals BoardFindings and OrderPetition for Reconsideration
References
6
Case No. MISSING
Regular Panel Decision
Dec 03, 2004

Claim of Scally v. Ravena Coeymans Selkirk Central School District

In this case, a claimant appealed a Workers’ Compensation Board decision regarding apportionment of her workers' compensation award. The claimant, who suffered a work-related left knee injury in 2002, had a pre-existing non-work-related injury to the same knee from 1986. While a WCLJ initially denied apportionment, the Board reversed, directing a 50/50 apportionment based on the premise that the prior injury would have resulted in a schedule loss of use award had it been work-related. The appellate court upheld the Board's determination, deferring to its interpretation that a non-work-related injury leading to a schedule loss of use constitutes a "disability in a compensation sense" for apportionment purposes. This decision was supported by medical expert testimony indicating a schedule loss of use from the prior surgery.

Workers' CompensationApportionmentKnee InjuryNon-work-related InjurySchedule Loss of UsePreexisting ConditionMedical Expert TestimonyBoard InterpretationJudicial ReviewAppellate Decision
References
13
Case No. ADJ1737177 (SAC 0359710)
Regular
Aug 11, 2014

Melinda Peterson vs. ALTIM HARMONY, ATHENS ADMINISTRATORS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a decision that denied an industrial injury to the applicant's left eye, despite admitting a cervical spine and psyche injury. The applicant contends that her vision loss is a result of her cervical surgery, as supported by an Agreed Medical Examiner's opinion. The Board found the medical record inadequately developed regarding the cause and industrial causation of the eye injury. Consequently, the case is returned to the trial level for further medical evaluations to establish a causal connection to the admitted injury.

Workers' Compensation Appeals BoardMelinda PetersonAltim HarmonyAthens Administrators Insurance CompanyADJ1737177SAC 0359710Petition for ReconsiderationFindings of Fact and AwardAdministrative Law JudgePermanent Disability
References
1
Case No. ADJ7185839, ADJ6907013
Regular
Nov 04, 2011

TIFFANY OCHOA vs. CROSSROADS STAFFING; COMMERCE & INDUSTRY INSURANCE COMPANY

The Appeals Board granted reconsideration and amended the prior decision, clarifying that the applicant did not sustain a cumulative trauma injury to her right wrist and upper extremity. The Board also rescinded the prior reservation of jurisdiction on future medical care for the admitted July 11, 2009 wrist injury. Applicant failed to meet her burden of proof for future medical treatment, as the available medical evidence did not support a need for it. The Board found no entitlement to temporary disability for the admitted injury and affirmed the dismissal of a separate specific injury claim due to lack of timely challenge.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and OrderCumulative TraumaSpecific InjuryRight WristTemporary DisabilityFuture Medical CareDismissal of ClaimDue Process
References
8
Case No. ADJ2859198 (MON 0336989) ADJ6864257 ADJ6864244
Regular
Dec 22, 2016

MICHAEL CHANEY vs. WARNER BROTHERS STUDIO FACILITIES

This Workers' Compensation Appeals Board decision addresses Defendant Warner Brothers' petition for reconsideration of a prior finding of injury AOE/COE to the applicant's neck, back, hands, and psyche. The Board admits a disputed medical report from Dr. Friedman into evidence, finding Defendant failed to meet its burden to exclude it. The Board affirms the WCJ's findings, concluding that substantial evidence supports injury to the applicant's hands and that the neck injury claim is not time-barred based on AME Dr. Harris's opinion. The Board also finds sufficient evidence for the psychiatric injury claim, relying on the admitted report and acknowledging Defendant's arguments regarding causation were factually inaccurate.

AOE/COEdate of injurystatute of limitationspsychiatric injurycausation thresholdLabor Code section 3208.3medical reportsAgreed Medical EvaluatorQualified Medical Examinercumulative trauma
References
11
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