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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. ADJ8217279
Regular
May 05, 2017

PETER BOURASSA vs. DOLLAR TREE, SEDGWICK

The Appeals Board affirmed the WCJ's decision regarding applicant Peter Bourassa's workers' compensation claim. The lien claimant, Monrovia Memorial Hospital, sought payment exceeding $\$58,272.00$ for services rendered. The Board clarified that facility fees for long-term care hospitals exempt from the Official Medical Fee Schedule (OMFS) must be paid on a "reasonable cost basis." The lien claimant failed to meet its burden of proving the reasonableness of its charges under relevant case law.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderLien ClaimantReasonable Cost BasisOMFSKunz studyAffirmAffirmAffirm
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ7730913, ADJ8640698, ADJ8233287, ADJ7881756, ADJ8438104, ADJ7467140, ADJ7467243, ADJ9068351, ADJ9081983
Regular
Dec 02, 2016

HOLLIS COPELAND, JR. vs. DENVER NUGGETS, PINNACOL ASSURANCE

This case involved multiple consolidated workers' compensation claims where the Board initially denied reconsideration of an order dismissing Pinnacol Assurance for lack of personal jurisdiction. The Appeals Board is now granting reconsideration on its own motion to correct clerical errors in its prior opinion. Specifically, the Board failed to list all nine adjudication file numbers and did not serve all affected applicants. The decision after reconsideration affirms the original denial of reconsideration but amends the opinion to include all case numbers.

Appeals BoardGranting ReconsiderationOn MotionDecision After ReconsiderationClerical ErrorsPersonal JurisdictionPinnacol AssuranceConsolidated CasesAdjudication File NumbersAffirm Opinion
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ10715455
Regular
Mar 18, 2019

MICHAEL KAMM vs. COUNTY OF MONTEREY, P.S.I., administered by INTERCARE HOLDINGS INSURANCE SERVICES, INC.

In this case, the Appeals Board partially rescinded the WCJ's award for psychiatric injury due to inconsistencies in the medical opinion regarding predominant causation. While the Board affirmed the rejection of the good faith personnel action defense, it found Dr. Lopez's opinion lacked clarity on whether employment events were the predominant cause of the applicant's overall psychiatric disability. Therefore, the matter is returned to the WCJ for further development of the medical record to clarify predominant causation before a new decision can be issued.

Workers' Compensation Appeals BoardReconsiderationPsychiatric InjuryPredominant CausationLabor Code Section 3208.3(h)Good Faith Personnel Action DefensePanel Qualified Medical Evaluator (PQME)Dr. LopezAnxiety DisorderMajor Depression
References
Case No. ADJ3204688 (VNO 426728)
Regular
Sep 22, 2009

WESLEY HARVICK vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS, SCIF STATE CONTRACT SERVICES

The applicant, a former correctional officer, sought to reopen his workers' compensation claim for new and further disability, specifically to his psyche. The Workers' Compensation Appeals Board (WCAB) affirmed a prior ruling finding a $95\%$ permanent disability, combining a $91\%$ psychiatric rating with an internal disability rating. The applicant appealed, arguing for $100\%$ permanent disability based on an Agreed Medical Evaluator's opinion that the applicant was totally psychiatrically disabled due to the unavailability of adequate medical treatment in his area. The majority affirmed the WCAB's decision, adopting the reasoning of the trial judge, while a dissenting commissioner argued for $100\%$ permanent disability, emphasizing the applicant's inability to obtain treatment and the employer's failure to prove unreasonable refusal.

Workers' Compensation Appeals BoardReconsiderationSupplemental Findings and AwardNew and Further DisabilityPsyche DisabilityInternal DisabilityPermanent DisabilityCorrectional OfficerCumulative InjuryPetition to Reopen
References
Case No. ADJ7948651
Regular
May 09, 2016

Barbara Tom vs. CITY OF OAKLAND, JT2 INTEGRATED

This case involves a petition for reconsideration by the defendant, City of Oakland, following an award of permanent disability to applicant Barbara Tom. The defendant argued the Workers' Compensation Judge (WCJ) erred by not deferring to the Agreed Medical Evaluator's (AME) opinion and by not developing the record with the AME. The WCAB denied reconsideration, adopting the WCJ's report which found the AME's opinion deficient. The WCJ's report detailed how the primary treating physician's report was more persuasive and thoroughly reasoned, supporting the WCJ's findings over the AME's.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Primary Treating Physician (PTP)AMA GuidesPermanent Disability RatingCarpal Tunnel SyndromeSubstantial EvidenceWCJ OpinionMedical Opinion Deference
References
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