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

Case No. ADJ7148195
Regular
Jan 03, 2020

KARIN SMITH vs. MARIN GENERAL HOSPITAL, ATHENS ADMINISTRATORS

This case concerns defendant's petition for reconsideration of an award for applicant's back surgery. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirmed the award, and corrected a clerical error in the case number. The WCAB found that while an initial surgery request was denied via Utilization Review (UR) and Independent Medical Review (IMR), the applicant's treating physician later submitted a new request supported by documented changes in material facts, including new neurological symptoms and an MRI showing critical stenosis and potential cauda equina syndrome. Because the second request indicated an imminent and serious threat to the applicant's health and was based on new medical evidence, the 12-month UR decision validity period did not apply.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardUtilization ReviewIndependent Medical ReviewLabor Code Section 4610(k)Documented Change in ConditionLumbar Spine SurgeryNurseCauda Equina Syndrome
References
Case No. ADJ1588834
Regular
Mar 18, 2013

SOLEDAD YAP vs. MARINERS POST ACUTE NETWORK, AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration, affirming the judge's findings. The Board adopted the judge's report, which thoroughly addressed and refuted the defendant's arguments regarding temporary disability awards and the compensability of the applicant's urological condition. Defense counsel was admonished for mischaracterizing the record and citing evidence not in the record, with a warning of potential sanctions. The judge's findings, including the industrial causation of the applicant's cauda equina syndrome and associated permanent disability, were found to be supported by substantial evidence.

Petition for ReconsiderationAgreed Medical Examiner (AME)Qualified Medical Examiner (QME)Temporary DisabilityPermanent DisabilityCompensable ConsequenceCauda Equina SyndromeUrological ConditionBowel DysfunctionBladder Dysfunction
References
Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ3674012 (ANA 0386342)
Regular
Feb 17, 2015

Richard Hoover vs. Trading Places International, Clarendon Insurance Company, Subsequent Injuries Benefits Trust Fund

Here is a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board granted reconsideration to further develop the record regarding the applicant's eligibility for Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The core issue is whether the applicant had a "labor disabling" pre-existing condition before his October 2, 2002 industrial injury, a requirement for SIBTF benefits. The Board found the previous administrative law judge erred by finding no pre-existing disability without sufficient exploration of the applicant's residual pain symptoms from prior back surgeries. Jurisdiction is reserved to determine if these symptoms constituted a ratable, labor-disabling permanent disability entitling the applicant to SIBTF benefits.

Subsequent Injuries Benefits Trust FundSIBTFpre-existing disabilitylabor disablingapportionmentSB 899retroactive prophylactic work restrictioncongenial work settingresidual pain symptomsmedical evaluator
References
Case No. ADJ9094120
Regular
Nov 09, 2020

JAIME MORALES vs. SENIOR OPERATIONS, LLC, ARCH INSURANCE COMPANY

This case involves a defendant's petition for reconsideration of a finding that applicant sustained an industrial injury to his shoulders. The defendant argued the administrative law judge erred in this finding, but the Workers' Compensation Appeals Board (WCAB) denied the petition. The WCAB found that medical evidence supported the applicant's injury being consistent with his work duties. The defendant failed to present evidence to impeach the applicant's description of his work.

Petition for ReconsiderationFindings of Factindustrial injuryshoulderscumulative periodcertified metal fitterspinepsycheLabor Code section 5412date of injury
References
Case No. ADJ1926394
Regular
Dec 08, 2010

FRANCISCO COSTA vs. RALPH'S GROCERY COMPANY

In this workers' compensation case, the Appeals Board granted reconsideration to amend the award to include future medical treatment. However, they affirmed the judge's finding of 80% permanent disability, which included a 20% apportionment to the applicant's pre-existing congenital spinal stenosis. The applicant argued against apportionment, but the Board found that medical evidence supported the conclusion that the pre-existing condition aggravated the industrial injury and led to more severe permanent disability. The Board clarified that "lighting up" a dormant condition is no longer a bar to apportionment under current law.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityApportionmentCongenital Spinal StenosisCauda Equina SyndromeLower Back InjuryUrologic System InjuryGI Tract Injury
References
Case No. ADJ1926394 (POM 0267363)
Regular
Jul 20, 2009

Francisco Costa vs. Ralph's Grocery Company

The Workers' Compensation Appeals Board granted reconsideration of a $100\%$ permanent disability award to Francisco Costa. Defendant Ralph's Grocery Company argued that $20\%$ of the disability should be apportioned to Costa's pre-existing congenital spinal stenosis, citing medical opinions. The Board found that the medical record justified apportionment but lacked sufficient detail on the basis for the physicians' opinions. Consequently, the Board rescinded the award and returned the case to the trial level for further development of the medical record regarding apportionment.

WCABRalph's Grocery CompanyFrancisco Costapermanent disabilityapportionmentcongenital spinal stenosiscauda equina syndromedecompression surgeryQMEsubstantial medical evidence
References
Case No. ADJ7766654
Regular
Dec 10, 2015

Janice Taylor vs. Blue Go Transit Management, QBE North America

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review a decision regarding applicant Janice Taylor's industrial spine and psyche injuries. The defendant contended that a utilization review (UR) decision denying requested home health care services was timely communicated. However, the WCAB found the UR decision untimely because it was not served on the applicant's attorney as required by regulation. Consequently, the WCAB affirmed the applicant's entitlement to home health care services based on prior stipulations and substantial medical evidence, while deferring the issues of an epidural steroid injection and physical therapy.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeUtilization ReviewRequest for AuthorizationIndependent Medical ReviewLabor Code 4600(h)Neri HernandezActivities of Daily Living
References
Case No. ADJ1784264 (MON 0302991) ADJ2898466 (MON 0339769)
Regular
Oct 14, 2011

GIRGIS FAM vs. UCLA MEDICAL CENTER, permissibly self-insured, Administered by Sedgwick Claims Management Services

This case concerns the selection of a child care provider for a permanently and totally disabled applicant. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration. The WCAB reversed the judge's decision, allowing the applicant to select his own child care provider, reasoning that this service is personal, similar to selecting a physician. The Board emphasized that the continuity of care and applicant's confidence in the provider outweigh the employer's desire to use a licensed and bonded provider selected by them.

Workers' Compensation Appeals BoardPetition for ReconsiderationSupplemental Findings and AwardPermanently totally disabledCaretaking servicesChild care servicesGardening servicesPool maintenance servicesStructural modificationsCauda-equina syndrome
References
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