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

Case No. ADJ4406096 (LAO 0784412)
Regular

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER

Defendant sought removal from a WCJ's order stipulating to two Agreed Medical Evaluators (AMEs), alleging the WCJ "forced" the agreement. Applicant's attorney and the WCJ countered that defense counsel had agreed to and proposed the AMEs, with the WCJ merely documenting the stipulation. The Appeals Board denied removal as defendant showed no prejudice, but initiated its own removal to address the attorney's alleged false statements and vexatious tactics. Consequently, the Board intends to impose sanctions of up to $2,500 on the defendant and its attorneys for filing a frivolous petition containing misrepresentations.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical EvaluatorsWCJSanctionsBad Faith TacticsFrivolousUnnecessary DelayStipulationMisrepresentation of Facts
References
Case No. ADJ14669607
Regular
Apr 10, 2023

DOUGLAS HERB vs. COUNTY OF LOS ANGELES, SEDGWICK CLAIMS MANAGEMENT SERVICES, INCORPORATED

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original finding that the applicant sustained industrial injuries to his internal system and head, causing 71% permanent disability. The defendant argued the Agreed Medical Evaluator's (AME) report regarding head injury and sleep issues lacked substantial medical evidence. The Board found the AME's report to be substantial, as it was not speculative, based on adequate examination, and explained its reasoning. Furthermore, the Board found the AME's method of analogizing the applicant's headaches to trigeminal neuralgia for impairment rating was permissible and accurately reflected the applicant's activities of daily living deficits.

GERDirritable bowel syndromehypertensionheadachessleep disturbancepermanent partial disabilityapportionmentmedical treatmentattorney's feeAgreed Medical Evaluator
References
Case No. STK 0204368
Regular
Jun 20, 2008

JUDITH KNOX vs. DOCTOR'S MEDICAL CENTER, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior finding that the applicant did not sustain a cumulative trauma injury. The Board found the Agreed Medical Evaluator's (AME) opinion lacked substantial evidence due to an incomplete medical history regarding the applicant's actual job duties and work schedule. The case is returned to the trial level for further development of the record, including a supplemental report from the AME.

Workers' Compensation Appeals BoardCumulative TraumaAgreed Medical EvaluatorSubstantial EvidenceMedical OpinionCausationReturn to Trial LevelFurther Development of RecordRescinded OrderSupplemental Report
References
Case No. SFO 0459441
Regular
Mar 11, 2008

FRANK DEOME vs. CALIFORNIA MEDICAL CENTER, INNOVATIVE CLAIMS SOLUTIONS, INC.

The Workers' Compensation Appeals Board rescinded the previous award and returned the case for further proceedings because the record was insufficient to determine permanent disability and apportionment. The Board found that the WCJ's analysis of apportionment, particularly regarding a prior 1993 injury, was based on insufficient medical evidence and did not align with current legal standards. The case is remanded for further development of the medical record, potentially through an Agreed Medical Evaluation, and the WCJ will revisit all contentions after new evidence is presented.

WORKERS' COMPENSATION APPEALS BOARDDEOMECALIFORNIA MEDICAL CENTERINNOVATIVE CLAIMS SOLUTIONSINDUSTRIAL INJURYBACK SURGERYPERMANENTLY DISABLEDCOMPLEX REGIONAL PAIN SYNDROMEVOCATIONAL REHABILITATIONPERMANENT AND STATIONARY
References
Case No. ADJ7436407, ADJ1895040 (FRE 0238028)
Regular
Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Colleen Newby's Petition for Removal, upholding the denial of her petition to quash a Qualified Medical Evaluator (QME) request. The Board found that the prior employer, Fresno Community Medical Center, was authorized to file an application for adjudication of claim for Newby's subsequent employment with St. Agnes Medical Center. Crucially, the Board determined that a claim form is not a prerequisite for St. Agnes to request a QME panel in this specific scenario, where a second injury is claimed by a prior employer. Newby's due process claim was rejected as she had an opportunity to present her arguments on removal.

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability
References
Case No. ADJ6674097
Regular
Jul 09, 2012

GLENDORA PARKS vs. ST. VINCENT MEDICAL CENTER, SEDGWICK CMS

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding the administrative law judge's decision to proceed to trial. The defendant sought to have the agreed medical evaluator reexamine the applicant due to allegedly "stale" medical reports and to file new applications for specific injuries. However, the Board found that the defendant had not demonstrated significant prejudice and that the trial judge could properly address the issues, including the impact of surveillance videos not shown to the AME. The Board concluded that the case should proceed to trial as scheduled.

Petition for RemovalAgreed Medical Evaluator (AME)stale reportsurveillance videospecific injurycontinuous traumatrial judgedevelop medical recordprejudicial errorirreparable harm
References
Case No. ADJ79 96674
Regular
Mar 24, 2016

ARLZENIA HASLEY vs. EL CENTRO REGIONAL MEDICAL CENTER

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Removal, which sought to invalidate the medical evidence of the Agreed Medical Examiner (AME), Dr. Luros. The WCAB found that removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. The defendant's arguments regarding flawed medical opinions and the AME's unavailability can be addressed through standard appeal procedures. Furthermore, the defendant filed a supplemental pleading without prior permission, which was disregarded by the Board.

Petition for RemovalArlzenia HasleyEl Centro Regional Medical CenterTriStar Risk ManagementWCABWCJsubstantial prejudiceirreparable harmreconsiderationsupplemental pleading
References
Case No. ADJ4494290 (SAL 0118345)
Regular
Apr 22, 2016

JEANETTE VAUGHN vs. CENTRAL COAST COMMUNITY HEALTHCARE, AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal, rescinding the WCJ's prior order allowing the Agreed Medical Evaluator (AME) to continue. This decision stemmed from the defendant's violation of Labor Code section 4062.3 and Rule 35 by providing the AME with a Consultative Rating without proper prior service on the applicant. Consequently, the applicant is entitled to select a new Qualified Medical Evaluator (QME) if a new AME cannot be agreed upon. Prior AME reports remain admissible if they predate the improper submission of information.

RemovalPetition for RemovalFindings and OrdersAgreed Medical EvaluatorAMEQualified Medical EvaluatorPQMELabor Code Section 4062.3Administrative Director Rule 35Consultative Rating
References
Case No. ADJ10356570
Regular
Oct 20, 2017

SYRUS YARBROUGH vs. SOUTHERN GLAZER'S WINE AND SPIRITS, TRUMBALL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Syrus Yarbrough's Petition for Removal, rescinding a previous order compelling him to attend an Agreed Medical Evaluator (AME) appointment. The WCAB found that Labor Code section 4067, relied upon by the judge, did not apply as applicant had not yet attended a formal AME evaluation. Furthermore, the WCAB clarified that Labor Code section 4062.2(f) only applies after an AME evaluation has occurred and does not preclude withdrawal from an AME agreement before such an evaluation. The WCAB noted that the applicant could still be ordered to see his regular physician or a Qualified Medical Evaluator.

Petition for RemovalAgreed Medical EvaluatorPetition to CompelMedical ExaminationSignificant PrejudiceIrreparable HarmLabor Code Section 4067Labor Code Section 4062.2(f)Withdraw from AMEWCAB
References
Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
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