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

Case No. SFO 0492831
Regular
Jan 23, 2008

ELIAS MONTOYA vs. ASTON BARNES, INC., STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration to clarify the application of Labor Code section 4656 regarding temporary disability indemnity limits. The Board held that "new and further" disability does not extend the 104-week limit under section 4656(c)(1), nor do spinal disc excisions and bone grafts qualify as "amputations" under section 4656(c)(2)(C). Consequently, the applicant is entitled to temporary disability indemnity only up to two years from the date of the first payment.

Workers' Compensation Appeals BoardElias MontoyaAston Barnes Inc.State Compensation Insurance FundSFO 0492831Opinion and Decision After ReconsiderationTemporary Disability IndemnityIndustrial InjuryThoracic SpineChest Injury
References
3
Case No. ADJ15278643
Regular
Apr 19, 2023

FRANCIS GOODWIN vs. ORANGE COUNTY FIRE AUTHORITY, CORVEL CORPORATION

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued that the Labor Code Section 3212.1 cancer presumption did not apply because the applicant's date of injury was beyond the statutory 105-month extension period following his termination of service. However, the Board found that the applicant's essential thrombocytosis, a bone marrow cancer, developed within the statutory period, even though it manifested later. The Board relied on the IME's opinion that bone marrow cancers generally have a 5-10 year latency period, supporting the applicant's claim that the condition developed during his service.

Cancer presumptionLabor Code 3212.1Essential thrombocytosisLatency periodManifestationDevelopmentReasonable medical probabilityIndependent Medical ExaminerCarcinogen exposureFirefighter
References
4
Case No. MISSING
Regular Panel Decision
Dec 21, 1998

Murphy v. Islat Associates Graft Hat Manufacturing Co.

This case involves a construction accident where an iron worker (plaintiff) was injured after falling from a crane boom in 1985. The plaintiff had previously secured partial summary judgment on liability against the premises owner under Labor Law § 240 (1). A jury initially found James A. Jennings Co., Inc. (general contractor) 30% liable and Atlantic Detail and Erection Corporation (employer) 70% liable for a $2,000,000 award. The Supreme Court, Appellate Division, reversed the judgment, vacated the award, and granted Jennings' motion for common-law indemnification against Atlantic, citing Atlantic's sole responsibility for the plaintiff's work and safety. The court also found insufficient evidence to prove that a subsequent 1987 accident, which caused further injuries, was a direct result of the original 1985 accident, thus mandating a new trial on damages.

Construction AccidentLabor Law § 240(1)Common-Law IndemnificationJury VerdictDirected VerdictRemand for DamagesCausationKnee InjuryIron WorkerThird-Party Defendant
References
2
Case No. ADJ484574 (ANA 0392117)
Regular
Apr 12, 2010

HECTOR ROMAN vs. D L BONE & SONS, INC., STATE COMPENSATION INSURANCE FUND

Here's a summary of the case in four sentences for a lawyer: The defendant seeks reconsideration of a Workers' Compensation Appeals Board decision that awarded psychiatric injury benefits to an applicant injured within six months of employment. The Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings. The core issue is whether the applicant's fall due to a rotted beam, while employed less than six months, constitutes a "sudden and extraordinary employment condition" for psychiatric injury. The Board found the fall, though sudden, was not sufficiently extraordinary given the applicant's role as a painter regularly working at heights, thus likely precluding psychiatric benefits under Labor Code § 3208.3(d).

Workers' Compensation Appeals Boardindustrial injurybilateral wristsneckbackpsychiatric injurypermanent disabilityapportionmentfurther medical treatmentLabor Code section 3208.3(d)
References
6
Case No. ADJ322417 (LAO0855230)
Regular
Oct 21, 2019

Miguel Hernandez vs. D.L. Bone & Sons, Inc., State Compensation Insurance Fund

The Workers' Compensation Appeals Board (WCAB) dismissed a petition for reconsideration of an administrative order suspending a lien claimant's Petition for Medical Information. The WCAB granted removal, finding the administrative law judge erred by issuing the order sua sponte without notice or hearing, violating due process. This procedural error caused irreparable harm and prejudice. Consequently, the WCAB rescinded the order and returned the case to the trial level for proceedings consistent with due process.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Suspending ActionPetition for Medical InformationFranchise Tax Board (FTB) suspended corporationDue ProcessSua SponteNotice and HearingInterlocutory Order
References
11
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
1
Case No. ADJ8369887
Regular
Feb 23, 2015

JERYL SUTTLE vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE, Administered By ESIS

The Workers' Compensation Appeals Board denied Jeryl Suttle's petition for reconsideration. The Board adopted the Administrative Law Judge's report, which found that the applicant's contentions were not supported by the evidence. Specifically, the removal of a bone growth stimulator for an MRI was deemed necessary for treatment evaluation, not a medical-legal exam. The IMR decision upheld the denial of this treatment, and reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization ReviewIndependent Medical Reviewbone growth stimulatorMRIspinal surgeonmedical-legal examtreating physicianadministrative law judge
References
0
Case No. LAO 854789
Regular
Oct 09, 2007

Juana Manriquez vs. KENVIN, INC., dba CORDOVAN & GREY LTD, STATE COMPENSATION INSURANCE FUND

The applicant sought extended temporary disability benefits, claiming a rotator cuff debridement during shoulder arthroscopy constituted an "amputation" under Labor Code section 4656(c)(2)(C). The Board denied reconsideration, affirming the WCJ's finding that "debridement" of an internal body part, like bone, does not meet the statutory definition of amputation. This definition requires the severance or removal of a limb or body appendage, conforming to the common understanding of the term.

Juana ManriquezKenvin IncState Compensation Insurance FundLAO 854789Petition for ReconsiderationAugust 6 2007 Findings and Ordershoulder arthroscopyamputationLabor Code section 4656(c)(2)(C)temporary disability
References
4
Case No. ADJ6801375
Regular
Jul 13, 2010

MICHAEL DAVID HERNANDEZ vs. VINCE'S ITALIAN TO GO, PREFERRED EMPLOYERS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award. The WCAB found that the applicant was not entitled to medical treatment outside the employer's Medical Provider Network (MPN) for a meniscus transplant or graft. The applicant failed to follow the required procedures for obtaining a second and third opinion within the MPN before seeking treatment from an out-of-network physician. Therefore, the WCAB concluded there was no showing that treatment outside the MPN was justified under the relevant rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNFurther Medical TreatmentSports Medicine DoctorMedical Meniscus TransplantGraft ProcedureDr. Patrick O'MearaDr. John DeSantisSubspecialist
References
2
Case No. MISSING
Regular Panel Decision
Aug 08, 1986

Cea v. Combined Life Insurance

The employer and its carrier appealed a Workers' Compensation Board decision that found the claimant's disabling back condition to be a compensable occupational disease, not apportionable with a preexisting condition. The claimant, a life insurance salesman, alleged that excessive driving in his job aggravated a prior back condition, leading to permanent disability. While he had undergone surgery for a nonmalignant bone tumor in 1970 and received a veteran's disability pension, the Board found his condition was not disabling prior to his employment as a salesman. The court affirmed the Board's decision, concluding that the claimant's employment activities acted on the preexisting condition to cause a disability that did not previously exist, and therefore, apportionment was not required.

Occupational DiseaseApportionmentPreexisting ConditionBack InjuryLife Insurance SalesmanExcessive DrivingAggravation of InjuryWorkers' CompensationDisabilityCausal Relationship
References
3
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