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

Case No. ADJ417505 (STK 173008)
Regular
Oct 07, 2008

MARSHA CRISWELL vs. COUNTY OF STANISLAUS

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award of left ankle surgery for applicant Marsha Criswell. The Board found no substantial medical evidence connecting Criswell's current ankle condition to her 2000 industrial injury, noting the ankle injury resolved and a new injury occurred in 2005. Therefore, the applicant failed to meet her burden of proof for industrial causation of the current ankle problem.

Workers' Compensation Appeals BoardReconsiderationMedical CausationIndustrial InjuryLeft Ankle SurgeryAgreed Medical ExaminerTreating PhysicianPreponderance of the EvidenceReasonable Medical ProbabilityLay Testimony
References
8
Case No. ADJ6955370
Regular
Nov 06, 2014

JOHN DELVA vs. ANDREW INTERNATIONAL aka ADVANCED TECH SECURITY, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award finding industrial injury to the applicant's right ankle. This decision followed the defendant's petition for reconsideration, arguing against the ankle injury finding. The WCAB gave significant weight to the Agreed Medical Evaluator's (AME) final opinion, which, after further review and deposition, concluded the applicant did not sustain an industrial injury to his ankle. Consequently, the WCAB found no industrial injury to any body part and awarded nothing to the applicant.

WORKERS' COMPENSATION APPEALS BOARDINDUSTRIAL INJURYRIGHT ANKLEAGREED MEDICAL EVALUATORCONTINUOUS TRAUMASPECIFIC TRAUMARECONSIDERATIONFINDINGS AND AWARDWCJSUPPLEMENTAL REPORT
References
0
Case No. MISSING
Regular Panel Decision
May 11, 1990

Claim of Johnson v. New York City Board of Education

This case involves an appeal from a decision and an amended decision of the Workers’ Compensation Board. The Board had ruled that the claimant sustained a consequential injury and subsequently restored the case to the trial calendar. The appellate court affirmed the Board's decision, finding that the claimant's physician's testimony, despite some lack of clarity, met the requirement of signifying a probability as to the cause of the injury and was supported by a rational basis. Specifically, the determination that the claimant’s left ankle fracture was a consequence of an earlier work-related ankle fracture, which left the ankle in a weakened condition, was supported by substantial evidence.

Workers' CompensationAppealConsequential InjuryAnkle FractureMedical EvidencePhysician TestimonySubstantial EvidenceAppellate AffirmationWork-Related InjuryMedical Causation
References
3
Case No. MISSING
Regular Panel Decision
Oct 02, 2003

Claim of Johnson v. OCM Boces

Claimant suffered a work-related ankle injury in 1999 and subsequently received workers’ compensation benefits. In 2001, while using crutches necessitated by ankle surgeries, the claimant slipped and sustained a consequential shoulder injury. The Workers’ Compensation Board established this additional claim, which was challenged on appeal by the employer and carrier. The appellate court found substantial evidence to support the Board’s determination that the shoulder injury was a consequence of the earlier compensable ankle injury. The court also affirmed the Board’s decision not to apportion the shoulder injury, noting the absence of medical evidence supporting such apportionment and distinguishing conflicting precedent.

Workers' CompensationAnkle InjuryShoulder InjuryConsequential InjuryApportionmentPreexisting ConditionCrutchesMedical EvidenceSubstantial EvidenceAppellate Review
References
4
Case No. ADJ4043236
Regular
Aug 26, 2010

ELIZABETH MINNIS vs. SANTA BARBARA CHAMBER ORCHESTRA SOCIETY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the administrative law judge's decision to deny a requested epidural steroid injection (ESI). The applicant, injured in 2007, sought a new ESI, claiming prior injections offered temporary relief and avoided more aggressive surgery. However, the Board found insufficient evidence that the proposed ESI was reasonable and necessary, noting the applicant’s pain returned and previous injections provided no substantial relief according to medical evaluations. The Board also noted the applicant had already received multiple ESIs, exceeding typical guideline recommendations, and that surgery had been authorized as an alternative treatment.

Workers' Compensation Appeals BoardReconsiderationEpidural steroid injectionMedical treatmentIndustrial injuryLow backPalliative careSurgeryPhysician's assistantUtilization review
References
0
Case No. 533068
Regular Panel Decision
Jun 23, 2022

In the Matter of the Claim of Robert Diamond Jr.

Claimant, a building maintenance mechanic, sustained a right ankle fracture in a 2018 work-related slip and fall. His claim for workers' compensation benefits was established. Medical examiners, Adam Suslak and Dominic Belmonte, agreed on a 30% schedule loss of use (SLU) of the right ankle, but differed on apportionment for a prior ankle injury from 40 years ago. A WCLJ initially apportioned the award, attributing only 10.5% to the 2018 injury, but the Workers' Compensation Board modified this, finding insufficient evidence for apportionment. The Appellate Division affirmed the Board's decision, reiterating that apportionment is generally not applicable where a preexisting non-compensable condition did not hinder job performance, and the medical evidence lacked documentation for the prior injury to support an SLU finding.

Workers' CompensationSchedule Loss of UseApportionmentAnkle InjuryPreexisting ConditionMedical EvidenceMaximum Medical ImprovementJudicial ReviewAppellate DivisionNew York Law
References
12
Case No. ADJ2969856 (SAL 0073653)
Regular
Apr 01, 2009

PINA vs. MEYER TOMATORES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE

This case involves a defendant seeking reconsideration of findings that they failed to respond to a request for an epidural injection authorization and that a treating physician provided reasonable and necessary care. The Board dismissed a second petition concerning a WCJ's report, deeming it not a final order. The Board granted reconsideration of the initial petition solely to order the defendant to authorize the epidural injection. All other aspects of the original award were affirmed.

Workers Compensation Appeals BoardPetition for ReconsiderationEpidural InjectionReasonable and Necessary TreatmentUtilization ReviewBoard Rule §10510Floyd Skeren & KellyWCJ Report and RecommendationFinal OrderAggrieved Party
References
1
Case No. SDO 0251396
Regular
May 19, 2008

KENN FINKELSTEIN vs. BUILDERS STAFF CORPORATION, CENTRE INSURANCE COMPANY

The applicant sought reconsideration of a prior Workers' Compensation Appeals Board decision that denied certain medications (Nexium, Lisinopril) and epidural steroid injections, while awarding Lipitor. The Board denied reconsideration, holding that the applicant failed to follow the proper statutory procedure for disputing the employer's utilization review denials. Although there was some question about the validity of the utilization review denial for the injections, the applicant's procedural failure was the decisive factor.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Award/OrderAdministrative Law Judge (WCJ)Further Medical TreatmentPrescriptive MedicationLipitorNexiumLisinoprilEpidural Steroid Injections
References
5
Case No. ADJ9126926
Regular
May 09, 2014

TERESA GREGORY vs. CONTRA COSTA COUNTY

Defendant Contra Costa County petitioned for removal to compel a UR physician's testimony regarding a disputed knee injection. The WCJ had ordered the physician to appear for live testimony over defendant's objection. However, at the scheduled hearing, the WCJ removed the case from the calendar, stating the knee injection had already occurred and no pending issues remained. Consequently, the petition for removal was dismissed as moot because the UR physician's testimony was no longer necessary.

Petition for RemovalUtilization ReviewExpedited HearingLive TestimonyWCJMOOTDismissedWorkers' Compensation Appeals BoardRescind OrderGood Cause
References
0
Case No. ADJ1610169 (ANA 0403916)
Regular
Oct 29, 2010

MARIA ORTEGA vs. USNEYLAND RESORTS; DISNEY

This case concerns a petition for reconsideration by lien claimants challenging the disallowance of their medical liens. The initial administrative law judge disallowed the liens, finding a referral for epidural injections was not supported by evidence. Specifically, the judge noted a report by Dr. Ross, which in turn cited Dr. Trotter's opinion that post-permanent and stationary treatment, including injections, was not appropriate or necessary. The Workers' Compensation Appeals Board denied the petition for reconsideration.

Workers' Compensation Appeals BoardLien ClaimantsPetition for ReconsiderationDisallowed Lien ClaimsCompromise and ReleaseIndustrial InjuryHousekeeperBack InjuryAdministrative Law JudgeFindings and Order
References
0
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