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

Case No. AD J6659170
Regular
Mar 25, 2016

JOSE VIRAMONTES vs. MARBORG INDUSTRIES, NEW HAMPSHIRE INSURANCE

This case involves a lien claimant, ManagedMed Inc., seeking reconsideration of a decision that disallowed its $\$13,032.00$ lien. The original judge found the applicant sustained industrial orthopedic injuries but not a psychiatric injury. ManagedMed argued the psychiatric injury was a compensable consequence and the defendant did not properly deny it. The Appeals Board denied reconsideration, adopting the judge's report and reasoning that the lien claimant, standing in the applicant's shoes, failed to prove by a preponderance of evidence that industrial events predominantly caused the alleged psychiatric injury.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationIndustrial injuryPsychiatric injuryOrthopedic injuryCompensable consequenceLabor Code section 5402Burden of proofPreponderance of evidence
References
3
Case No. ADJ3908311
Regular
Jul 07, 2009

LUCILA MARTINEZ vs. MANPOWER OF SAN DIEGO, TRANSCONTINENTAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Lucila Martinez's petition for reconsideration, affirming the administrative law judge's decision. The applicant's claim for a psychiatric injury, whether as a consequence of her admitted orthopedic injury or a new injury, was barred by the six-month employment provision of Labor Code section 3208.3(d). The Board adopted the judge's report and reasoning, finding no error in the denial of the psychiatric claim or the exclusion of Dr. Ruiz's report. While the majority denied reconsideration entirely, one commissioner dissented, arguing that the applicant should receive medical treatment for her psychiatric injury if it's necessary to cure or relieve her from the effects of her industrial orthopedic injury.

Workers' Compensation Appeals BoardLucila MartinezManpower of San DiegoTranscontinental Insurance CompanyFindings and Awardindustrial injurypsyche injuryorthopedic injuryLabor Code section 3208.3(d)compensable consequence
References
2
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. ADJ1279352
Regular
Nov 18, 2010

WARREN BARNA vs. PACIFIC TUBE, ST. PAUL TRAVELERS, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of an award finding them liable for an applicant's psychiatric injury. The applicant had previously settled orthopedic claims and a cumulative trauma claim. The Appeals Board granted reconsideration to amend the original decision, adding specific findings required by Labor Code section 4751 regarding the applicant's pre-existing psychiatric disability and the compensable industrial psychiatric injury. The Board affirmed the original finding of liability against the SIBTF, while clarifying the applicant's eligibility for SIBTF benefits and addressing the issue of potential offsets.

Subsequent Injuries Benefits Trust Fundpsychiatric disabilitypre-existing disabilityindustrial injurypermanent partial disabilityLabor Code section 4751Workers' Compensation Appeals Boardreconsiderationcumulative traumaspecific injury
References
0
Case No. ADJ3135090 (SAC 0355157) ADJ6834808
Regular
Sep 12, 2019

GUY LEE vs. UOP/MCGEORGE SCHOOL OF LAW, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board affirmed the WCJ's decision denying benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF). Applicant's prior stipulation dismissing claims for sleep disturbance, sexual dysfunction, and psychiatric injury bound him from pursuing these for SIBTF benefits. Even without those dismissals, applicant's permanent disability rating for the subsequent injury, after adjustments, did not meet the 35% threshold required for SIBTF eligibility. The WCJ's finding that the industrial injury was not the predominant cause of the claimed psychiatric injury also contributed to the denial.

Subsequent Injuries Benefits Trust FundLabor Code section 4751permanent partial disabilitystipulated dismissalpredominant causepsychiatric injurybilateral carpal tunneldiminished future earning capacityWCJWorkers' Compensation Appeals Board
References
4
Case No. ADJ9041984 ADJ9040577
Regular
Dec 21, 2018

ISABEL VALENCIA vs. FIFTH AND PACIFIC COMPANIES, HARTFORD CASUALTY INSURANCE COMPANY, BROADSPIRE SERVICES, INC.

This case involves applicant Isabel Valencia's claim for psychiatric injury stemming from a previously stipulated orthopedic injury. The defendant contended the psychiatric injury was not work-related, arguing it was a consequence of the physical injury. The Appeals Board denied reconsideration, affirming that a "compensable consequence" injury, like a psychiatric condition resulting from an industrial orthopedic injury, is industrially related. The Board also found it appropriate to further develop the record regarding applicant's disability, as the current psychiatric condition prevents accurate assessment.

WORKERS' COMPENSATION APPEALS BOARDFIFTH AND PACIFIC COMPANIESHARTFORD CASUALTY INSURANCE COMPANYBROADSPIRE SERVICESINC.ADJ9041984ADJ9040577Findings Award and Orderstipulationpsychiatric injury
References
1
Case No. ADJ2054018 (FRE 0219780) ADJ403978 (FRE 0219781)
Regular
Jul 09, 2014

Karen Clacher vs. The Call Center LLC, State Compensation Insurance

The Appeals Board granted the defendant's petition for reconsideration, rescinding the finding that the applicant sustained an industrial psychiatric injury. The Board found, based on the Agreed Medical Evaluator's opinion, that the applicant's psychiatric condition was predominantly due to a pre-existing, non-industrial mental illness. Consequently, the applicant's petition for reconsideration was denied, and the matter was returned for further proceedings regarding admitted injuries.

Workers' Compensation Appeals BoardIndustrial InjuryPsycheReconsiderationApportionmentSubstantial EvidenceAgreed Medical EvaluatorPredominant CauseViolent ActSubstantial Cause
References
0
Case No. ADJ107733 (SDO 0348759)
Regular
Mar 23, 2012

ALFREDO GUTIERREZ vs. VIKING COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award. The applicant sustained an admitted industrial back injury but sought compensation for a consequential psychiatric injury. The Board upheld the judge's denial of the psychiatric claim based on Labor Code section 3208.3(d), which requires at least six months of employment for psychiatric injury claims. The applicant did not meet this six-month requirement, and the Board found his arguments regarding modified work and employment status unpersuasive under existing precedent.

Workers' Compensation Appeals BoardViking CompanyState Compensation Insurance FundAlfredo Gutierrezindustrial injuryback injurypermanent disabilitypsychiatric injuryLabor Code section 3208.3(d)Wal-Mart Stores
References
1
Case No. ADJ2015796
Regular
Nov 24, 2010

Stella Cunningham vs. Addus Health Care, Department of Social Services, IHSS, State Compensation Insurance Fund

In this workers' compensation case, the applicant sustained an industrial injury in 2007. The administrative law judge (WCJ) previously denied a lien claim for $\$3,935.00$ from Industrial Psychiatric Network, finding no substantial medical evidence supported the necessity of their treatment for the admitted orthopedic injury. The lien claimant sought reconsideration, arguing their treatment was necessary for the industrial injury. However, the Appeals Board dismissed the petition for reconsideration as untimely, as it was filed more than 25 days after the WCJ's decision was served by mail. Therefore, the lien claimant's petition is dismissed due to jurisdictional untimeliness.

Industrial Psychiatric NetworkPetition for ReconsiderationFindings and OrderCompromise and Releaseburden of proofsubstantial medical evidencereasonable and necessary treatmentadmitted orthopedic injuryuntimelyjurisdictional
References
2
Case No. ADJ10275361
Regular
Jan 27, 2020

RUSSELL MCFADDEN (deceased); RENEE MCFADDEN, JAZMINE MCFADDEN, and RUSSELL MCFADDEN, II vs. KEOLIS TRANSIT AMERICA; LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a judge's decision denying a death benefit claim for Russell McFadden, who died by suicide. The applicant contended his death resulted from an industrial psychiatric injury due to occupational stress. Medical evidence indicated that industrial factors were only a 35% cause of the decedent's psychiatric disorder, with significant pre-existing conditions and drug use being the predominant causes. Furthermore, the Board found no evidence that the suicide was an irresistible impulse, distinguishing it from cases where an industrial injury directly causes a mental condition that prevents resistance to suicide. Therefore, the claim was denied based on the psychiatric injury not being predominantly industrially caused and the suicide not meeting the criteria for compensability.

Workers Compensation Appeals BoardRenee McFaddenKeolis Transit AmericaLiberty Mutual Insurance CompanyADJ10275361Opinion and Decision After ReconsiderationIndustrial Psychiatric InjuryOccupational Stress and StrainCompensable Death ClaimLabor Code Section 3600(a)(6)
References
6
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