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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. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ3374876 (SJO 0268303)
Regular
Feb 25, 2010

SUSAN MOYERS vs. COUNCIL ON AGING, STATE COMPENSATION INSURANCE FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

In this case, the Subsequent Injuries Benefits Trust Fund (SIBTF) sought to compel the applicant to use the same Agreed Medical Examiner (AME) from her original workers' compensation claim for her SIBTF claim. The Workers' Compensation Appeals Board affirmed the WCJ's order allowing the applicant to obtain new medical-legal evaluations for her SIBTF claim with a different physician, independent of the original AME. The Board determined that the discovery procedures for workers' compensation claims, as outlined in Labor Code section 4062.2, do not apply to SIBTF claims due to their distinct legal issues. Therefore, SIBTF is responsible for reasonable costs of these independent evaluations, ensuring due process for developing evidence specific to the SIBTF claim.

Subsequent Injuries Benefits Trust FundSIBTFMedical-Legal DiscoveryAgreed Medical ExaminerAMEQualified Medical ExaminerQMELabor Code Section 4062.2Workers' Compensation ClaimMedical Evaluations
References
Case No. ADJ3388749 (VNO 0561016)
Regular
Nov 26, 2018

ROBERTA MOORE vs. CITY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration to address conflicting medical opinions from the Agreed Medical Examiner (AME) regarding the apportionment of applicant Roberta Moore's fibromyalgia disability. The AME's report initially apportioned 70% of the disability to the industrial injury, but later changed to 100% to the industrial component, citing remission of her non-industrial condition. The Board found this sudden change unexplained and is remanding the case for further clarification from the AME or a new medical examination. Additionally, the Board will allow parties to address permanent total disability findings in light of the *Fitzpatrick* decision.

Agreed Medical ExaminerFibromyalgiaCumulative TraumaApportionmentUndifferentiated Connective Tissue DiseasePermanent Total DisabilityVocational FeasibilityLabor MarketAgreed Medical Examiner (AME)Medical-Legal Expense
References
Case No. ADJ6622799
Regular
Oct 18, 2013

TERRY A. WIRTH vs. STATE OF CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

This case concerns the denial of a Petition for Reconsideration filed by the defendant, the State of California Highway Patrol. The applicant, Terry A. Wirth, suffered a continuous trauma injury (prostate cancer) leading to urinary and erectile dysfunction. The Appeals Board adopted the Workers' Compensation Judge's report, finding that the date of injury was in 2008, determining the applicable permanent disability compensation rate based on that date. The Board also found ample evidence supporting the agreed medical examiner's impairment ratings for the applicant's post-surgical conditions, dismissing the defendant's objections.

Workers' Compensation Appeals BoardState of California Highway PatrolState Compensation Insurance FundPetition for ReconsiderationPermanent disability compensation rateLabor Code section 5412Urinary incontinenceErectile dysfunctionCommon postprostatectomy symptomsWhole person impairment ratings
References
Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
Case No. ADJ984347 (FRE 0202559)
Regular
Apr 01, 2014

ENRICA TORRES vs. CLOVIS UNIFIED SCHOOL DISTRICT

This Workers' Compensation Appeals Board case involves an applicant who sustained a psyche injury due to cumulative trauma from workplace sexual harassment. The defendant, Clovis Unified School District, sought reconsideration of an award for further medical treatment. The Agreed Medical Examiner's (AME) opinions on the applicant's need for ongoing treatment were contradictory, leading to ambiguity. Therefore, the Board amended the award to defer the determination of further medical treatment pending clarification, requiring a supplemental AME report or stipulation.

Enrica TorresClovis Unified School DistrictYORK RISK SERVICES GROUPINC.ADJ984347ADJ4520728WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONPERMANENT DISABILITYFURTHER MEDICAL TREATMENT
References
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