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

Case No. ADJ3525524 (LAO 0866019)
Regular
Jan 11, 2016

CECILE CONSTANTINO vs. QUEENSCARE, ALEA NORTH AMERICA

The Board granted reconsideration, finding the WCJ erred in both applying the Labor Code section 4658(d)(2) increase to a 2004 injury and in not properly apportioning disability to a prior 1993 injury. The Board determined the agreed medical evaluators' opinions regarding apportionment were substantial evidence and reversed the WCJ's finding that the AMA Guides impairment rating was successfully rebutted. Consequently, the permanent disability rating was recalculated using the scheduled AMA Guides rating and incorporating apportionment, resulting in a lower overall permanent disability percentage and award.

WCABPetition for ReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorAMA GuidesGuzmanApportionmentLabor Code section 4658(d)(2)
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. ADJ8210063
Significant

Grace Nunes, Applicant vs. State of California, DEPT. OF MOTOR VEHICLES, Legally Uninsured; STATE COMPENSATION INSURANCE FUND, Adjusting Agency, Defendants

The Appeals Board denied the applicant's Petition for Reconsideration, affirming its prior en banc decision that vocational evidence cannot substitute for valid medical apportionment from a physician, as mandated by Labor Code section 4663.

Labor Code Section 4663Vocational ApportionmentMedical ApportionmentPermanent DisabilityQualified Medical EvaluatorSubstantial EvidencePetition for ReconsiderationEn Banc DecisionWorkers' Compensation Appeals BoardApportionment Analysis
References
Case No. ADJ8210063; ADJ8621818
En Banc
Aug 29, 2023

GRACE NUNES vs. STATE OF CALIFORNIA, DEPT. OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, affirming its prior en banc decision that permanent disability apportionment must be based on a physician's medical evaluation as mandated by Labor Code section 4663, and that vocational evidence cannot substitute an impermissible 'vocational apportionment' in place of a valid medical apportionment.

VOCATIONAL APPORTIONMENTMEDICAL APPORTIONMENTPERMANENT DISABILITYQUALIFIED MEDICAL EVALUATORLABOR CODE SECTION 4663SUBSTANTIAL EVIDENCEAPPEALS BOARD EN BANCFINDINGS OF FACT AND AWARDFINAL ORDERRECONSIDERATION DENIED
References
Case No. ADJ8210063; ADJ8621818
En Banc
Jun 22, 2023

GRACE NUNES vs. STATE OF CALIFORNIA, DEPT. OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded a 100% disability award because the vocational and medical records were incomplete regarding apportionment. The case was returned to the trial level to properly evaluate whether non-industrial factors contributed to the applicant's inability to be retrained for work.

En BancReconsiderationApportionmentVocational ApportionmentMedical ApportionmentPermanent DisabilityVocational ExpertQualified Medical EvaluatorAMA GuidesLabor Code Section 4663
References
Case No. ADJ1504736 (RDG 094722) ADJ2325354 (RDG 0122147)
Regular
Jun 30, 2011

CYNTHIA CADLE vs. CHICO CREEK HEALTH CARE, CONTINENTAL CASUALTY COMPANY, CNA CLAIMS PLUS, FREMONT MEMORIAL HOSPITAL, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

In Case ADJ1504736, the Board granted reconsideration, finding applicant sustained industrial injury to her right knee as a compensable consequence of her left knee injury from February 2, 2000, remanding for determination of benefits. In Case ADJ2325354, the Board denied reconsideration and removal, affirming the WCJ's findings regarding injury on May 19, 2005, including the 18% permanent disability award and apportionment of benefits. The Board found applicant waived arguments regarding new discovery and the *Almaraz/Guzman* standard by failing to raise them timely. The WCJ's apportionment of permanent disability for the 2005 injury was upheld based on medical reports and deposition testimony.

Workers' Compensation Appeals BoardCynthia CadleChico Creek Health CareContinental Casualty CompanyCNA Claims PlusFremont Memorial HospitalTravelers Property Casualty Company of AmericaPetition for ReconsiderationPetition for RemovalJoint Findings Award and Order
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. ADJ8996451
Regular
Mar 25, 2016

ROGELIO VELASQUEZ vs. MOLOFSKY BUILDERS, INC., EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration, upholding the Workers' Compensation Judge's decision. The Judge correctly excluded permanent disability for sleep disturbance as the QME failed to provide an apportionment opinion as required by statute. Furthermore, the Judge properly rejected the QME's *Almaraz/Guzman* rating for the left knee injury, finding it unpersuasive and lacking in specific ADL deficits. Therefore, the Judge's original findings on permanent disability were affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportEpworth Scalesleep disturbancepermanent disabilityQualified Medical Evaluator (QME)apportionmentleft knee injuryAlmaraz/Guzman
References
Case No. ADJ7935217
Regular
Jun 07, 2015

LAURA CALVILLO vs. STATE OF CALIFORNIA, CDCR, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Appeals Board granted reconsideration and amended the award, finding zero permanent disability for the applicant's orthopedic injury to the right hand and wrist. This decision stems from the Board's conclusion that the Agreed Medical Evaluator's (AME) Almaraz/Guzman rating was not substantial evidence, as it lacked sufficient rationale and was contradicted by the applicant's questionable credibility and lack of objective findings. The Board otherwise affirmed the award, including a 13% permanent disability rating for the psyche injury with 20% apportionment to non-industrial causes.

Almaraz/GuzmanAgreed Medical EvaluatorApportionmentCredibilityDisability Evaluation UnitExpert OpinionFindings Order AwardGripping StrengthImpairment RatingLabor Code Section 4658(d)(2)
References
Case No. ADJ7492912
Regular
May 12, 2016

TERESA LAYMAN vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS, SAN QUENTIN STATE PRISON AND STATE COMPENSATION INSURANCE FUND

This case involves Teresa Layman's workers' compensation claim against the California Department of Corrections and Rehabilitation. The applicant's petition for reconsideration was denied by the Workers' Compensation Appeals Board. The Board adopted the WCJ's reasoning, which found a significant flaw in the Qualified Medical Evaluator's opinion. Specifically, the QME improperly combined two identical impairment ratings derived from different AMA Guides chapters, failing to properly apply the Almaraz/Guzman standard. Consequently, the $19\%$ permanent disability award, with $60\%$ apportionment to the industrial injury, was upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorAMA GuidesPermanent DisabilityApportionmentAlmaraz/GuzmanCorrectional OfficerSpinal Cord InjuryWhole Person Impairment
References
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