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

Case No. ADJ1939549
Regular
Dec 14, 2009

MATTHEW KELLEHER vs. STATE COMPENSATION INSURANCE FUND

The WCAB denied defendant's petition for reconsideration of the September 15, 2009 Findings and Award. The WCAB found that the AME's report complied with *Almaraz/Guzman II*, and that the AME did not go outside the four corners of the AMA Guides.

WCABPetition for ReconsiderationFindings and Awardindustrial injurypermanent disabilityAgreed Medical Evaluator (AME)American Medical Association Guides (AMA Guides)Whole Person Impairment (WPI)Almaraz/Guzman IAlmaraz/Guzman II
References
Case No. ADJ10934545
Regular
Aug 23, 2019

Richard Rodriguez vs. CPG FOODS, LLC/GALA FOOD, Cannon Cochran Management Services Inc.

The Appeals Board granted reconsideration and modified the original award, finding that the Qualified Medical Examiner's (QME) apportionment opinion lacked substantial evidence. The Board reversed the original 12% permanent disability finding, awarding 16% based on the QME's impairment rating after reviewing surveillance video evidence. The Board also clarified that treating physician reports from Dr. Mahboubian and Dr. Ahmed are admitted into evidence and may be relied upon. Finally, the Board affirmed the original findings regarding the injured body parts and the permanent and stationary date.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardApplicantDefendantsInjury AOE/COEUpper BackHipsKneesTemporary Total Disability
References
Case No. ADJ8599111
Regular
May 24, 2018

PAUL CHIN vs. EVEREST COLLEGE, AMERICAN ZURICH INSURANCE COMPANY

This Workers' Compensation Appeals Board decision grants reconsideration and affirms the applicant's award of 53% permanent disability, with adjustments for benefits paid and attorney fees. The Board rejected the defendant's attempt to challenge the *Almaraz/Guzman III* analysis, finding it was raised too late. The Board also refused to consider the defendant's supplemental pleading. The award is finalized with jurisdiction reserved for any disputes regarding benefit adjustments.

Petition for ReconsiderationAlmaraz/Guzman III analysisPanel Qualified Medical ExaminerPQMEPermanent DisabilityApportionmentAttorney FeeAppeals Board Rule 10848Supplemental PleadingTimely Manner
References
Case No. ADJ1078163, ADJ3341185
En Banc
Sep 03, 2009

MARIO ALMARAZ, JOYCE GUZMAN vs. ENVIRONMENTAL RECOVERY SERVICES, STATE COMPENSATION INSURANCE FUND, MILPITAS UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

This en banc decision clarifies that a permanent disability rating established by the Schedule is rebuttable, but any evidence to rebut the Whole Person Impairment (WPI) component must be based within the four corners of the AMA Guides.

AlmarazGuzmanWorkers' Compensation Appeals Boarden bancprecedentAMA Guides2005 Schedulepermanent disabilityrebuttableprima facie evidence
References
Case No. ADJ7558401
Regular
May 28, 2013

ROBERT RICE vs. PROCUT, LLC, ZENITH INSURANCE COMPANY

The WCAB granted reconsideration to address the defendant's challenge to the 45% permanent disability award. The defendant argued the Qualified Medical Evaluator's (PQME) opinion was unsubstantiated, particularly regarding the lumbar spine rating and the inclusion of pain impairment. The WCAB found the PQME's reports lacked sufficient rationale and explanation, failing to adequately justify the Almaraz-Guzman rating. Consequently, the WCAB rescinded the award and returned the case for further medical record development.

Workers' Compensation Appeals BoardProCut LLCZenith Insurance CompanyRobert Ricepermanent disabilityqualified medical evaluatorPQMEDr. Sanjay Chauhanwhole person impairmentAMA Guides
References
Case No. ADJ9385114
Regular
Feb 03, 2023

MICHELLE RICHMOND vs. SANTA ROSA TILE SUPPLY, PROCENTURY INSURANCE, ILLINOIS MIDWEST

The Workers' Compensation Appeals Board denied Santa Rosa Tile Supply's petition for reconsideration. The defendant argued the Administrative Law Judge erred in awarding 77% permanent disability and in not applying apportionment for a prior 1991 award. The Board adopted the WCJ's report, affirming that the physician properly rebutted the AMA Guides rating using Almaraz/Guzman principles by considering the applicant's limitations in activities of daily living. The Board also upheld the WCJ's decision to apply apportionment solely under Labor Code section 4663, as the defendant failed to demonstrate overlap with the prior award under section 4664.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityAMA GuidesMilpitas Unified School District v. Workers' Comp. Appeals Bd. (Guzman)Labor Code section 4663Labor Code section 4664Almaraz/GuzmanPQME
References
Case No. ADJ3311649 (LAO 0871212)
Regular
Apr 20, 2009

MILTON JEOVANY LOPEZ vs. LAZAR TRUCK LINES, NOVAPRO RISK SOLUTIONS FOR CTSA

The Workers' Compensation Appeals Board granted reconsideration of a decision that awarded the applicant 2% permanent disability for a knee injury. The applicant argued the rating was inaccurate based on the AMA Guides and sought recalculation under *Almaraz/Guzman*. The Board found the permanent disability issue was properly raised and that the medical record needed further development. Therefore, the matter was returned to the trial level to re-evaluate permanent disability consistent with the *Almaraz/Guzman* ruling.

Workers' Compensation Appeals BoardMilton Jeovany LopezLazar Truck LinesNovapro Risk SolutionsADJ3311649LAO 0871212ReconsiderationFindings and AwardPermanent DisabilityAMA Guides
References
Case No. ADJ480092 (SFO 0498380) ADJ2934310 (SFO 0498381)
Regular
Apr 26, 2009

TONI MORGAN vs. REDWOOD CREDIT UNION, ZENITH INSURANCE COMPANY, UNITED STATES FIRE INSURANCE CO.

This case concerns an applicant's petition for reconsideration of a workers' compensation judge's finding that the 2005 Permanent Disability Rating Schedule (PDRS) should apply to two cumulative trauma injuries. The applicant argued for the 1997 PDRS, asserting a defendant's termination of temporary disability payments triggered a Labor Code notice requirement. Alternatively, the applicant contended the $15\%$ permanent disability rating was too low, citing *Almaraz/Guzman* regarding disparities between AMA Guides impairment ratings and actual employability. The Appeals Board granted reconsideration, agreeing the medical record needed further development under *Almaraz/Guzman*, and deferred the permanent disability issue for trial level review. A dissenting opinion argued the applicant waived the AMA Guides impairment issue by not raising it earlier.

WCABRedwood Credit UnionZenith Insurance CompanyUnited States Fire Insurance Co.cumulative traumapermanent disability rating schedule2005 PDRS1997 PDRSLabor Code section 4061Labor Code section 4660
References
Case No. ADJ12705097
Regular
Sep 21, 2022

FRED BROYLES vs. ATLAS VAN LINES, ARCH INSURANCE, GALLAGHER BASSETT SERVICES

In Broyles v. Atlas Van Lines, the WCAB denied the defendant's petition for reconsideration, affirming the finding of 29% permanent disability. The Administrative Law Judge and the Board found that the Qualified Medical Evaluator (QME) properly utilized the Almaraz/Guzman principles to deviate from a strict AMA Guides rating. The QME's analogy to a hernia condition was deemed substantial evidence for assessing the applicant's impairment due to limitations on lifting and its impact on daily living activities. The Board concluded the QME adequately explained the departure from the standard rating and provided sufficient reasoning for the alternative assessment.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 4660.1(d)scheduled ratingprima facie evidencerebuttableMilpitas Unified School Dist. v. Workers' Comp. Appeals Bd.Almaraz-Guzman IIIwhole person impairment (WPI)AMA Guides
References
Case No. ADJ9414071 ADJ10133403
Regular
Aug 13, 2018

Kevin McCoy vs. State of California - Pleasant Valley State Prison

This case involves an appeal regarding the permanent disability ratings for a correctional officer's right ankle and respiratory system (Valley Fever) injuries. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case to the WCJ for further proceedings. The Board found that the Agreed Medical Examiner's (AME) ankle impairment rating was properly calculated, but the Qualified Medical Examiner's (QME) report on the respiratory injury did not sufficiently explain its deviation from strict AMA Guides application. The Board emphasized that medical evaluators must adhere to the AMA Guides or clearly justify any deviations to ensure substantial evidence.

WCABPleasant Valley State Prisonlegally uninsuredState Compensation Insurance FundKevin McCoyADJ9414071ADJ10133403permanent disabilityright anklerespiratory system
References
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