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

Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
5
Case No. MISSING
Regular Panel Decision

Claim of Neal v. Blue Circle Cement

The claimant, a laborer, suffered a compensable back injury in November 1998 and returned to work after eight months. In January 2002, he sustained another back injury. A Workers’ Compensation Law Judge determined that the January 2002 injury was an aggravation of the prior 1998 injury, assigned disability levels from January 2002 to April 2003, and found no compensable lost time thereafter. The Workers’ Compensation Board affirmed this decision. The Appellate Division found substantial evidence, including medical testimony and MRI comparisons, to support the Board’s determination regarding the aggravation of the injury and the disability levels. The court also upheld the Board's prerogative to resolve conflicting medical evidence and make credibility determinations, particularly in light of evidence that the claimant exaggerated his symptoms.

Workers' CompensationBack InjuryAggravation of InjuryDisability LevelsMedical EvidenceCredibility AssessmentEmployer LiabilityJudicial ReviewAppellate DivisionAdministrative Law
References
4
Case No. ADJ9543550
Regular
Aug 06, 2018

JESUS CASTELLANOS VALENTE vs. KASO ENTERPRISES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the petition for reconsideration in this case, affirming the Administrative Law Judge's (WCJ) findings. The WCJ found the applicant sustained a cumulative trauma injury, resulting in aggravation of pre-existing diabetes and hypertension and development of a sleep disorder. The Board gave great weight to the WCJ's credibility determination, finding no substantial evidence to reject it. The Board also affirmed that the physical consequences of the cumulative trauma, such as the aggravated medical conditions and sleep disorder, were compensable despite the non-compensability of a separate psychiatric injury claim.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationGarza v. Workmen's Comp. Appeals Bd.specific injurycontinuing traumacumulative injuryorthopedic injurypsychiatric injuryLabor Code section 3208.3(d)
References
8
Case No. MISSING
Regular Panel Decision

Claim Eccles v. Truck-Lite, Inc.

The claimant sustained a head injury after falling from a chair at work and sought workers' compensation benefits. The employer and its carrier disputed the claim, attributing the fall to a non-work-related medical condition. The Workers' Compensation Board ruled that the accident and injuries were not caused by the claimant's preexisting diabetic condition and awarded benefits. The employer and carrier appealed. The court affirmed the Board's decision, noting the Board's authority to assess witness credibility and medical expert opinions, and found the presumption of compensability under Workers’ Compensation Law § 21 had not been rebutted. The court also upheld the Board's rejection of the argument that the claim should be denied due to a violation of Workers’ Compensation Law § 114-a.

Workers' CompensationFall from ChairHead InjuryDiabetic ConditionHypoglycemiaPresumption of CompensabilityCredibility AssessmentMedical Expert OpinionAppellate ReviewSection 21 WCL
References
4
Case No. ADJ7521436
Regular
Jun 24, 2013

ABEL RAMIREZ vs. CROWN WIRE COMMUNICATIONS, INC., TOWER SELECT INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because it was filed against a non-final discovery order. The Board then removed the case to itself and amended the original order. The amended order allows the parties 15 days to agree on an Agreed Medical Evaluator (AME) for the issue of diabetes aggravation, and if they cannot agree, they must request a Qualified Medical Evaluator (QME) panel. The Board found the WCJ's original appointment of a "regular physician" was premature.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code Section 5701Labor Code Section 4062.2Industrial InjuryAggravation of DiabetesInternal Medicine
References
8
Case No. MISSING
Regular Panel Decision
Dec 02, 1986

Firestein v. Kingsbrook Jewish Medical Center

Helene Firestein, an employee of Kingsbrook Jewish Medical Center, suffered a work-related hip injury. While hospitalized at Kingsbrook, she sustained an aggravation of her injury due to alleged negligence by a coemployee, Scott. Firestein received workers' compensation benefits for both the initial injury and its aggravation. She then commenced a common-law action against Kingsbrook and Scott for damages from the aggravation. The court determined that her application for and acceptance of workers' compensation benefits do not preclude her from bringing a separate common-law action, as the aggravation of the injury did not arise out of and in the course of her employment, and any recovery would be subject to a workers’ compensation lien. The court affirmed the lower court's denial of motions to dismiss based on the exclusivity of workers' compensation.

Workers' Compensation LawCoemployee NegligenceAggravated InjuryDual Capacity DoctrineExclusivity ProvisionCommon Law ActionMedical MalpracticeEmployer LiabilityThird-Party TortfeasorWorkers' Compensation Lien
References
12
Case No. LBO 0370243
Regular
May 19, 2008

JOEL GRIMALDO vs. ABBEY EVENT SERVICES / STELLAR EVENT \& PRESENTATION, AMERICAN HOME INSURANCE, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration and reversed a previous finding, ruling that the applicant's diabetes was not industrially caused. While the applicant sustained an admitted industrial injury to his left foot, the Board found substantial medical evidence indicating his diabetes was a pre-existing condition that complicated the foot injury rather than being caused by it. Consequently, the decision was amended to exclude diabetes as an industrial injury.

Workers' Compensation Appeals Boardindustrial injurydiabetesfoot injuryosteomyelitisamputationcausationmedical evidencereconsiderationapportionment
References
8
Case No. ADJ671568 (VNO 0519723)
Regular
Jun 05, 2009

KAREN REFF vs. UNION OF AMERICAN HEBREW CONGREGATION, MEADOWBROOK INSURANCE COMPANY, GALLAGHER BASSETT

This case involves an applicant claiming her industrial pneumonia aggravated a pre-existing common variable immunodeficiency (CVID), necessitating ongoing immunoglobulin treatment. The defendant disputes that the pneumonia aggravated the CVID or that the treatment is causally related to the industrial injury. The Agreed Medical Evaluator could not definitively opine on CVID aggravation without reviewing later medical records. Consequently, the Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further medical development and a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryPneumoniaCommon Variable Immunodeficiency (CVID)Immunoglobulin Replacement TreatmentsAggravationAgreed Medical Evaluator (AME)Further Development of Record
References
10
Case No. ADJ3588877 (SAC 0332526)
Regular
Jul 19, 2011

Laurie Shreffler vs. Electronic Data System, Hewlett Packard, Travelers Insurance Company

In this Workers' Compensation Appeals Board decision, the Appeals Board reversed the finding that the applicant sustained an industrial injury related to diabetes. The Board adopted the WCJ's report, which favored Dr. Nishimura's medical opinion over Dr. Nacouzi's regarding the diabetes. While the award for temporary and permanent disability remains, the applicant is no longer entitled to industrial medical treatment for her diabetes. The decision otherwise affirmed the original award for injuries to the neck, low back, psyche, and irritable bowel syndrome.

Workers' Compensation Appeals BoardElectronic Data SystemHewlett PackardTravelers Insurance Companyindustrial injurylow backneckpsycheirritable bowel syndromediabetes
References
1
Case No. ADJ2590975 (STK 0190237)
Regular
Sep 12, 2011

RAFAEL DELEON vs. STATE OF CALIFORNIA, CDCR, MULE CREEK PRISON, adjusted by STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the Appeals Board affirmed a prior award granting medical treatment for applicant's diabetes. Despite the defendant's argument that diabetes treatment was for a non-industrial condition, the Board found it necessary to prevent worsening of the applicant's industrially caused heart disease. Medical evaluators concluded that controlling diabetes is an essential component of treating industrial heart conditions, making the treatment compensable. The decision hinges on the principle that treatment for non-industrial conditions is covered when essential to cure or relieve the effects of an industrial injury.

Workers' Compensation Appeals BoardIndustrial InjuryHeart ConditionDiabetesGastrointestinal DifficultiesAgreed Medical EvaluatorTreating PhysicianCardiologistMedical TreatmentLabor Code Section 4600
References
9
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