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

Case No. ADJ7288330
Regular
Oct 03, 2016

GLORIA BENITEZ vs. NEWPORT SUBACUTE HEALTH CARE CENTER, ALASKA NATIONAL INSURANCE COMPANY

The applicant, Gloria Benitez, sought to reopen her workers' compensation claim to include injury to additional body parts beyond her cervical spine and psyche. The original award found injury only to the cervical spine and psyche, with a 19% permanent disability rating for the cervical spine. While the WCJ's initial decision denied injury to additional body parts, the Board granted reconsideration. The Board amended the original findings to defer the issue of injury to the alleged additional body parts, while affirming other aspects of the WCJ's order, including the appointment of a regular physician to evaluate new and further disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderNew and Further DisabilityAgreed Medical ExaminerRegular PhysicianLabor Code Section 5410Petition to ReopenIndustrial InjuryCervical Spine
References
4
Case No. ADJ9767947
Regular
Jan 18, 2017

GILBERT PEREZ vs. ABC SHEET METAL, LIBERTY MUTUAL INSURANCE

This case involves an applicant who sustained industrial injury to his left knee and abdomen. The trial judge initially found injury to these parts but also found no injury to back, psyche, lower extremities, and stress, which the applicant appealed. The appellate court annulled the denial of reconsideration, finding the trial judge improperly ruled on body parts not fully at issue. The Appeals Board rescinded the negative finding, deferred the issue of additional injured body parts, and remanded for further proceedings to determine if injury to other parts occurred.

WCABindustrial injurywelderleft kneeabdomenbackpsychelower extremitiesstressCourt of Appeal
References
0
Case No. ADJ14263093
Regular
Apr 12, 2023

CECILIA OJEDA vs. AMY'S KITCHEN, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Here's a summary of the case for a lawyer: The applicant claimed cumulative injury to her neck, bilateral wrists, shoulders, and upper extremities, which the employer initially denied for all body parts except the neck. The WCJ found injury to all claimed body parts, relying on treating physicians' reports, and found the QME's reports unsubstantial due to inconsistencies and admissions of uncertainty during deposition. The defendant sought reconsideration, arguing the QME's opinion was substantial evidence regarding injured body parts and permanent disability. The Appeals Board denied reconsideration, adopting the WCJ's reasoning that the QME's testimony was too speculative and contradictory to constitute substantial evidence for the disputed body parts.

AOE/COEPetition for ReconsiderationFindings and AwardOrthopedic Qualified Medical Examiner (QME)Substantial EvidenceCumulative InjuryBilateral WristsBilateral ShouldersBilateral Upper ExtremitiesCervical Radiculopathy
References
3
Case No. ADJ18492736
Regular
Sep 30, 2025

MARIA HERNANDEZ vs. VALLARTA FOOD ENTERPRISES, INC.; SAFETY NATIONAL CASUALTY CORPORATION

The Workers' Compensation Appeals Board reviewed a petition for reconsideration filed by Safety National Insurance, challenging a WCJ's finding that Maria Hernandez sustained injury to multiple body parts. The Board found the treating physician's report lacked substantial medical evidence due to inadequate records and a flawed job description. Additionally, the Qualified Medical Evaluator's (QME) reports were incomplete and inconsistent regarding all body parts except the left hand. Consequently, the Board granted reconsideration, rescinded the original decision, and substituted new findings, determining that Hernandez sustained a cumulative injury only to her left hand while deferring the issue of injury to other body parts for further development of the record.

WCABPetition for ReconsiderationFindings of Fact and Ordersubstantial medical evidenceQualified Medical Evaluator (QME)cumulative traumabilateral shoulderswristshandsleft hand injury
References
19
Case No. ADJ8533165
Regular
Mar 08, 2016

Margarito Trujillo vs. Cardenas Markets, Inc.

This case involves a worker claiming industrial injury to multiple body parts. The WCJ initially found injury only to the abdomen but applicant argued other claimed injuries were not addressed. The Appeals Board granted reconsideration to clarify the issues. They are rescinding the WCJ's decision and deferring the determination of injured body parts and the nature/extent of injury for further proceedings at the trial level.

Workers' Compensation Appeals BoardReconsiderationFindings of FactInjury AOE/COELabor Code section 5402Presumption of CompensabilityMandatory Settlement ConferencePre-Trial Conference StatementParts of Body InjuredNature and Extent of Injury
References
2
Case No. ADJ10802406
Regular
Sep 23, 2022

DAVID STEINHAUER vs. CITY OF SIMI VALLEY

The Workers' Compensation Appeals Board granted reconsideration of the WCJ's award finding applicant sustained injury AOE/COE to multiple body parts. The Board affirmed the finding of injury to most body parts but deferred the issue of right hip injury due to lack of substantial medical evidence. The Board also ruled that applicant is not entitled to further temporary disability benefits as his employment was terminated for violating company policy after he returned to modified work. The matter was returned to the WCJ for further proceedings to develop the record regarding the right hip injury and to defer permanent disability and attorney fees.

AOE/COEPetition for ReconsiderationQualified Medical ExaminerPermanent DisabilityTemporary DisabilityRight Hip InjuryLumbar SpineDrug Test TerminationModified WorkReturn to Work
References
7
Case No. ADJ11039762
Regular
Aug 06, 2018

ALFRED GUILING vs. GODEFELLOW BROTHERS CONSTRUCTION, LLC, AMERICAN CONTRACTORS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and dismissed their Petition for Removal. The defendant argued the judge's finding of injury to specific body parts was premature and lacked substantial evidence, as the PQME process was incomplete. The Board found removal was inappropriate, as the injury finding is a final order subject to reconsideration. They adopted the WCJ's report, concluding the applicant met their burden of proof for industrial injury to the disputed body parts.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings of Factindustrial injurybody partssubstantial evidencePanel Qualified Medical EvaluationPQMEextraordinary remedy
References
2
Case No. ADJ9791003
Regular
Feb 21, 2020

FRANKLIN LOPEZ DE LA CRUZ vs. BARRETT BUSINESS SERVICES, INC.

This case concerns a lien claimant, Optimal Health, seeking reimbursement for medical treatment provided to an applicant injured on July 1, 2014. The applicant's employer accepted a lumbar spine injury but denied claims for thoracic spine, cervical spine, and leg injuries. The initial WCJ disallowed Optimal Health's lien, ruling treatment outside the approved Medical Provider Network (MPN) was improper. The Appeals Board granted reconsideration, finding the applicant may self-procure treatment for denied body parts. The Board remanded the case for further proceedings to determine if the applicant sustained injury to denied body parts, if treatment was reasonable and necessary, and if fees were appropriate.

Medical Provider NetworkMPNdenied body partsself-procured treatmentlien claimantburden of proofindustrial injuryreasonable and necessary treatmentMedical Treatment Utilization ScheduleMTUS
References
2
Case No. 13-71700
Regular Panel Decision

Board of Trustees v. Kern (In re Kern)

The Plaintiffs, the Board of Trustees of benefit funds under ERISA, sought to declare debts owed by Defendant Richard Kern, principal owner of Cool Sheetmetal, Inc. (CSI), non-dischargeable in bankruptcy. The core issue was whether monies deducted from employee paychecks but not remitted to the benefit funds constituted non-dischargeable debts under § 523(a)(4) and (6) of the Bankruptcy Code. The Court ruled that monies deducted for a vacation fund are non-dischargeable because they were subject to a statutory trust, Kern acted as a fiduciary, and committed defalcation. However, deductions for union assessments and political action league (PAL) funds were deemed dischargeable, as no statutory trust was established for these. Furthermore, the Plaintiffs' claim under § 523(a)(6) for willful and malicious injury was dismissed. The Court granted summary judgment in part for Plaintiffs regarding the Vacation Fund deductions, with the exact amount to be determined at trial, and granted summary judgment in part for Defendant on the other claims.

BankruptcyNon-dischargeabilityERISAFiduciary DutyDefalcationSummary JudgmentEmployee ContributionsVacation FundUnion AssessmentsPolitical Action League (PAL)
References
10
Case No. ADJ10771579
Regular
Aug 08, 2018

Gabriel Ruano vs. Mayekawa USA, SOMPO JAPAN INSURANCE COMPANY OF AMERICA, BROADSPIRE

This case involved a worker claiming industrial injury to multiple body parts. The Appeals Board granted the employer's petition for reconsideration to correct the Findings of Fact. The Board amended the Findings to accurately reflect all injured body parts, including the psyche, and removed an incorrectly listed body part. Ultimately, the Board affirmed the original decision with these specified amendments.

Petition for ReconsiderationFindings of Factsubstantial evidencemedical reportsprimary treating physicianBal S. Grewal Ph.D.Report and Recommendationinjured body partspsychecervical spine
References
0
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