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

Case No. ADJ4337031 (SAC 0363533)
Regular
Aug 19, 2011

CHARLOTTE HUDSON vs. EMG CHILDREN & FAMILY SERVICES, EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision, rescinding the judge's award of 11% permanent disability. The case is returned to the trial level to further develop the medical record regarding the applicant's gait derangement impairment and its valuation under *Almaraz/Guzman* principles. The judge must also address the vocational expert's entitlement to fees and consider the recent *Ogilvie* decision's impact on permanent disability determination.

Workers' Compensation Appeals BoardFindings and AwardPermanent DisabilityVocational ExpertAgreed Medical ExaminerAlmaraz/GuzmanOgilvieGait DerangementAntalgic GaitAMA Guides 5th Edition
References
Case No. ADJ869605
Regular
Nov 19, 2012

MILES GRAY vs. AT&T, permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant who sustained a severe right lower extremity injury, leading to multiple surgeries, significant leg length discrepancy, and fused ankle/foot, requiring constant mobility aids. The Agreed Medical Evaluator (AME) provided opinions on impairment, and vocational experts testified regarding the applicant's ability to return to work. The Workers' Compensation Appeals Board denied reconsideration of the prior award, finding substantial evidence supporting the applicant's unsuitability for rehabilitation. Defendant's supplemental reply did not alter this decision.

Agreed Medical EvaluatorVocational ExpertPetition for ReconsiderationDeniedRight Lower Extremity InjuryMultiple FracturesLeg Length DiscrepancyShoe LiftAnkle FusionGait Derangement
References
Case No. FRE 0137292
Regular
Jul 08, 2008

DEANNA PRIEST-HENSLEY vs. MICHAEL HOUSEPIAN, TIG SPECIALTY INSURANCE

This case concerns a defendant's petition for reconsideration of a workers' compensation award. The Board granted reconsideration, rescinded the award, and held that it lacked jurisdiction to alter a prior 1997 finding on the applicant's average weekly earnings and temporary disability rate. This decision was based on the statutory five-year limitation period for altering awards having elapsed before the issue was re-litigated, absent a timely filed petition to reopen.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardAverage Weekly EarningsTemporary Disability RateJurisdictionStatute of LimitationsGood CauseReopenLabor Code section 5803
References
Case No. ADJ7662819
Regular
Apr 27, 2015

JEWELL McKEE vs. MARTEN'S TRANSPORT, LTD, ACE AMERICAN INSURANCE COMPANY

This case involves an applicant alleging industrial injuries to various body parts, including psyche, hearing, and gait disorder, following a fall. The defendant sought reconsideration of the original award, primarily challenging the findings of psyche injury and gait disorder, as well as the award of temporary disability and a permanent disability increase. The Appeals Board granted reconsideration, deferring the issues of gait disorder and all permanent disability findings due to insufficient medical evidence on gait causation and the improper piecemeal determination of permanent disability. The Board otherwise affirmed the findings of industrial injury to psyche, additional temporary disability, and ordered further medical evaluation by an AME or IME.

Workers' Compensation Appeals BoardMarten's TransportACE American InsuranceIndustrial InjuryPsyche InjuryGait DisorderPermanent DisabilityLabor Code Section 4658(d)(2)Temporary DisabilityAgreed Medical Evaluator (AME)
References
Case No. ADJ8702052 ADJ8954034
Regular
Sep 13, 2018

James McClendon vs. Home Pest Defense (Rollins Inc), National Union First Insurance Company, Sedgwick Claims Management Services, Inc.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review an award of 100% permanent disability for two industrial injuries. The defendant argued for separate disability awards based on apportionment between the two injuries, citing the *Benson* case, and challenged the Agreed Medical Examiner's (AME) opinion. The WCAB rescinded the original award and returned the case for further development of the medical record, specifically to clarify the AME's ability to separately rate the two injuries. The majority found the AME's reasoning for not separately rating the injuries was not consistent with applicable standards, while a dissenting commissioner believed the AME's determination was within his expertise and that the defendant failed to meet its apportionment burden.

Workers Compensation Appeals BoardReconsiderationPermanent Total DisabilityJoint AwardApportionmentBensonAgreed Medical ExaminerFunctional Capacity EvaluationVocational ExpertDate of Injury
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. ADJ8382115
Regular
Aug 13, 2013

OBDULIA HERNANDEZ vs. ARAMARK, ACE/USA

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior finding that the defendant neglected medical treatment. The Board found that while there was conflicting evidence regarding initial MPN notice, the defendant provided notice to the applicant's attorneys post-injury. Crucially, the applicant did receive treatment within the MPN for three months, demonstrating no denial of care. Therefore, the defendant did not neglect, refuse, or deny reasonable medical treatment as required.

MPNcompensable consequence injuriespsychiatric injurysleep deprivationaltered gaitinternal injuriesweight gaingastrointestinal injuriessexual dysfunctioncognitive impairment
References
Case No. ADJ8424547
Regular
Feb 26, 2019

PAUL LOPEZ vs. BRONCO WINE COMPANY, ZENITH INSURANCE COMPANY

This case involves cross-petitions for reconsideration by the applicant and defendant regarding an administrative law judge's decision finding permanent total disability due to an industrial injury sustained by the applicant. The applicant argued the average weekly earnings were too low and disputed the medical impairment rating, while the defendant challenged the total disability finding and sought apportionment of disability. The Workers' Compensation Appeals Board denied both petitions, adopting the judge's report, and specifically noted that vocational evidence supported the finding of unemployability independent of any apportionment issues or prior felony conviction.

Industrial injuryKneesLumbar spinePsycheErectile dysfunctionAltered gaitPermanent total disabilityAverage weekly earningsVocational expertApportionment
References
Case No. MON 318383
Regular
Nov 01, 2007

PETER FERINO vs. GLENN E. THOMAS DODGE, FARMERS INSURANCE EXCHANGE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award finding a right knee injury compensable as a consequence of an admitted back injury. The WCAB determined that while the need for knee surgery was supported by substantial medical evidence, the record lacked substantial medical evidence to establish industrial causation of the knee injury as a consequence of the back injury. The case was remanded for further development of the record on the issue of causation.

Compensable consequenceExpedited hearingIndustrial causationSubstantial medical evidenceReconsiderationFindings and AwardWorkers' Compensation Appeals BoardWCJDeclaration of ReadinessMedical treatment
References
Case No. ADJ3218180 (EUR 0040749) ADJ4708435 (EUR 0040750)
Regular
Nov 19, 2010

ROBERT ZIMMERMAN vs. BRITT LUMBER COMPANY, OLD REPUBLIC INSURANCE COMPANY

This case involves an appeal of permanent disability ratings for an applicant's left upper extremity and right knee injuries. The defendant contests the ratings, arguing the Agreed Medical Examiner (AME) and WCJ improperly deviated from AMA Guides methodology, particularly by combining impairment factors without adequate justification. The Appeals Board granted reconsideration, finding the AME's explanations for deviating from the Guides were insufficient. The matter is remanded for further proceedings to obtain a more adequately justified permanent disability rating.

WCABReconsiderationPermanent Disability RatingApportionmentAMA GuidesAlmaraz/GuzmanAgreed Medical Examiner (AME)Grip LossStation and GaitDiagnosis Based Estimate
References
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