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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Claim of Huss v. Tops Markets, Inc.

In 1985, claimant sustained a right shoulder injury while employed by Dunlop Tire, resulting in a permanent partial disability. In 1998, he re-injured the same shoulder while working for Tops Markets, Inc., leading to a new workers' compensation claim. An impartial specialist attributed 85% of the disability to the 1985 injury and 15% to the 1998 injury. Although a Workers' Compensation Law Judge initially rejected apportionment, the Board reversed and applied the 85/15 apportionment. Claimant appealed, contending apportionment was unwarranted due to his disclosure of the prior injury and lack of prior disability symptoms. The Appellate Division affirmed the Board's decision, finding substantial medical evidence to support the apportionment.

Workers' CompensationPermanent Partial DisabilityApportionmentPrior InjuryShoulder InjuryCausal RelationshipMedical Expert TestimonyBoard DecisionAppellate ReviewExacerbation
References
3
Case No. MISSING
Regular Panel Decision
Jul 29, 1980

Claim of Butts v. Ward La France Trucking Corp.

The Workers’ Compensation Board found claimant’s disability to be 45% attributable to a March 1976 work accident, 10% to an August 1977 nonrelated accident, and 45% to a November 1977 work accident. The employer's carrier for the second work accident appealed the 45% apportionment. The court found no substantial evidence to support the Board's apportionment, citing testimonies from Dr. Burke, who attributed 90% of disability to the first work accident, and Dr. Corradini, who believed the first accident's disability ended by January 1977 and the current disability was primarily from the nonrelated accident. Consequently, the Board's decision was reversed, and the matter was remitted for further proceedings.

Disability ApportionmentWork-Related InjuryNon-Related InjuryMedical Expert TestimonySubstantial Evidence ReviewWorkers' Compensation BoardAppellate ReviewReversal of DecisionRemittal for Further ProceedingsInsurance Carrier Dispute
References
0
Case No. MISSING
Regular Panel Decision
Jun 19, 1980

Claim of Pollara v. Air France

The Workers' Compensation Board ruled that the claimant's permanent partial disability stemmed entirely from a May 20, 1976, accident, precluding apportionment despite a prior 1953 back injury. The claimant, a former Navy boiler tender, had undergone back surgery in 1953 but returned to full duty and subsequently worked over two decades in physically demanding roles without significant issues until the 1976 incident at an airline. The appellate court affirmed the Board's decision, finding substantial evidence, including medical testimony, supported the finding that the claimant had no pre-existing compensable disability at the time of the 1976 injury. The court noted that apportionment is inapplicable when a prior condition did not constitute a compensation-related disability.

ApportionmentDisabilityBack injuryLaminectomyPre-existing conditionWorkers' CompensationMedical testimonySubstantial evidencePermanent partial disabilityAppellate review
References
8
Case No. ADJ171583 (MON 0294858) ADJ261117 (MON 0308771)
Regular
Feb 02, 2009

Camey Cresor vs. GOLDMAN, SACHS & COMPANY, ILLINOIS NATIONAL INSURANCE CO.

This case concerns an applicant seeking reconsideration of a workers' compensation award for psychiatric injury and other conditions. The applicant was found to have an $82\%$ permanent disability rating, with $80\%$ attributed to psychiatric issues after apportionment. The key dispute is the $20\%$ apportionment of psychiatric disability to non-industrial factors, which the applicant argues is improper for a finding of permanent total disability based on vocational unfeasibility. The Appeals Board denied the petition, adopting the WCJ's report which cited precedent (Hertz Corp. v. Workers' Comp. Appeals Bd. (Aguilar)) confirming that vocational unfeasibility is subject to apportionment.

Workers Compensation Appeals BoardAmended Joint Finding and Awardindustrial injurypsychelow backheadachespermanent disabilitypermanent total disabilityapportionmentnon-industrial factors
References
1
Case No. MISSING
Regular Panel Decision

Claim of Hogan v. Hilltop Manor of Niskayuna

Claimant, a respiratory therapist, sustained a work-related back injury in November 1999. She had a history of intermittent back pain but consistently performed her job duties without restriction and missed minimal work prior to the incident. Initially, a Workers’ Compensation Law Judge rejected apportionment, but the Workers’ Compensation Board reversed, attributing 50% of the disability to a preexisting condition. The appellate court reversed the Board's decision, clarifying that apportionment is not warranted where a claimant's prior condition was not disabling in a compensation sense and did not prevent them from effectively performing their job. The matter was remitted to the Workers’ Compensation Board for further proceedings.

ApportionmentPreexisting ConditionDisabilityWorkers' Compensation BoardBack InjuryRespiratory TherapistSubstantial EvidenceAppellate ReviewDegenerative Disc DiseaseJob Duties
References
7
Case No. ADJ2628303
Regular
Apr 01, 2014

GLORIA CAIRES vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE

The Appeals Board rescinded the original award and returned the case for further proceedings due to insufficient medical evidence on apportionment. Specifically, the Board found that the opinions of the orthopedic and psychiatric medical evaluators regarding the apportionment of permanent disability lacked substantial medical evidence. The orthopedic evaluator's apportionment methodology, referencing an AMA Guides example, was deemed improper under current Labor Code sections 4663 and 4664. The psychiatric evaluator's apportionment was also found insufficient as it did not adequately explain how psychiatric permanent disability should be apportioned separately from injury causation.

Workers' Compensation Appeals BoardPermanent Disability ApportionmentQualified Medical Evaluator (PQME)Agreed Medical Evaluator (AME)American Medical Association Guides to the Evaluation of Permanent ImpairmentRange of Motion MethodDiagnosis-Related Estimate (DRE) MethodCompensable ConsequenceCausation of Permanent DisabilitySubstantial Medical Evidence
References
12
Case No. ADJ3817836 (SJO 0250881)
Regular
May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability
References
3
Case No. ADJ8203843
Regular
Aug 15, 2016

GARY KUBECK vs. CALETTI JUNGSTEN CONSTRUCTION, AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the defendant sought reconsideration of the original finding that the applicant sustained $71\%$ permanent disability, arguing the judge improperly rejected the Agreed Medical Evaluator's (AME) apportionment opinion on psychiatric injury. The Board granted reconsideration, amending the award to include $35\%$ non-industrial apportionment to the applicant's psychiatric disability. This resulted in a revised permanent disability award of $68\%$. The Board found the AME's opinion on apportionment constituted substantial medical evidence and was not unpersuasive.

ApportionmentAgreed Medical Evaluator (AME)Psychiatric InjuryPermanent DisabilityFindings and AwardPetition for ReconsiderationIndustrial InjuryNon-industrial ApportionmentCausationSubstantial Medical Evidence
References
4
Case No. ADJ372822 (RIV 0084399) ADJ7532289
Regular
May 03, 2018

William Sigler vs. County of Riverside

The Appeals Board granted reconsideration to allow further development of the medical record regarding the applicant's claim of psychiatric injury. The Board found that the administrative law judge erred by conflating the causation of psychiatric injury with the apportionment of orthopedic disability. The applicant must prove that actual work events were the predominant cause of his psychiatric injury, a standard distinct from the apportionment of permanent disability. The Board also noted a due process violation regarding the applicant's right to cross-examine the disability rater.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code section 3208.3Predominant causeActual events of employmentCompensable consequence injuryApportionmentAgreed Medical ExaminerPetition for ReconsiderationFindings and Award
References
6
Case No. ADJ1437076 (ANA 0355949), ADJ2064657 (ANA 0355947), ADJ3681784 (ANA 0355948), ADJ495794 (ANA 0355945), ADJ1053460 (ANA 0355946)
Regular
Sep 12, 2019

Ernest Martinez vs. THE HARTFORD, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and affirmed the Workers' Compensation Judge's findings with minor amendments. The Board clarified the award for temporary disability in one claim and corrected clerical errors in another. The applicant, an attorney, raised multiple contentions regarding various injuries, including disputes over permanent disability awards, apportionment of psychiatric disability, and defendant's alleged non-compliance with prior orders. The Board largely adopted the Judge's reasoning, finding Dr. Cohen's apportionment of psychiatric disability to be substantial evidence and rejecting arguments for a single combined permanent disability award.

ADJ1437076ADJ2064657ADJ3681784ADJ495794ADJ1053460Petition for ReconsiderationJoint Findings Awards and OrdersWCJCumulative TraumaHeart Injury
References
3
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