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

Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. SAL 0107786
Regular
Oct 16, 2007

MOLLY KIRKPATRICK vs. DOMINICAN SANTA CRUZ HOSPITAL, PSI ADMINISTERED BY OCTAGON RISK SERVICES

This case concerns an injured worker who had cervical spine surgery involving diskectomy, vertebrectomy, decompression, and fusion. The defendant sought reconsideration of an award granting temporary disability benefits beyond the statutory 104-week limit, arguing the surgery was not an amputation. The Appeals Board rescinded the prior award and returned the matter for further proceedings, as the definition of "amputation" in precedent excludes internal body parts like those removed during spinal fusion.

Workers' Compensation Appeals BoardDominican Santa Cruz HospitalOctagon Risk ServicesMolly KirkpatrickIndustrial InjuryCervical Spine SurgeryTemporary Disability IndemnityLabor Code Section 4656(c)AmputationDiskectomy
References
Case No. ADJ8103143
Regular
Dec 04, 2015

CHUONG VO vs. ZONARE MEDICAL SYSTEMS, INC., ONE BEACON INSURANCE COMPANY

This case involves a defendant seeking reconsideration of an order enforcing an Independent Medical Review (IMR) determination that authorized applicant's requested cervical surgery. The defendant argued a subsequent conflicting IMR determination, the WCJ's lack of jurisdiction, and an improper physician signature on the initial request voided the original IMR. The Appeals Board denied reconsideration, finding that a later IMR does not negate a prior one, the WCJ had jurisdiction to enforce the IMR, and the defendant waived the physician signature argument by proceeding with utilization review.

Independent Medical ReviewUtilization ReviewPetition for ReconsiderationLabor Code section 4610Labor Code section 4610.5anterior cervical decompression and fusionposterior cervical decompression and fusionmedical necessitywaived argumentsecondary treating physician
References
Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)
Regular
Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns applicant Dennis Timmons' petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Appeals Board reversed a prior award, finding applicant failed to prove a pre-existing permanent partial disability from a 1991 cervical fusion surgery prior to his 2000 industrial injury. Applicant argued the fusion itself constituted a previous impairment and that SB 899's apportionment changes should apply, but the Board affirmed its decision. The Board reiterated that contemporaneous medical evidence is required for SIBTF eligibility, and that SB 899 did not alter SIBTF's established requirements.

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751
References
Case No. ADJ11409956
Regular
Jun 17, 2019

OSCAR FLORES vs. ETS EXPRESS, INC.

The Workers' Compensation Appeals Board denied ETS Express, Inc.'s petition for reconsideration of an award of temporary disability benefits. The employer argued the applicant was not entitled to benefits because he refused modified work and had reached maximum medical improvement (MMI). The Board found that the medical report relied upon by the defendant was not conclusive on MMI, as it indicated potential future interventional treatment. Therefore, the Board adopted the WCJ's finding that the applicant sustained an industrial injury and is entitled to ongoing temporary disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardTemporary Disability IndemnityMaximal Medical ImprovementPanel Qualified Medical ExaminerPQMEInterventional TreatmentCervical Epidural InjectionsAnterior Cervical Discectomy
References
Case No. ADJ3383603 (VNO 0401532)
Regular
Jul 14, 2010

Abraham Burke vs. Mansur Industries, Inc., St. Paul Travelers

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior finding that terminated Abraham Burke's temporary disability benefits. The Board found that Burke's delay in deciding to undergo complex cervical surgery was reasonable given the severity of his condition and the need for multiple expert opinions. Consequently, Burke was found to continue to be temporarily totally disabled pending his recovery from the surgery, and the defendant's petition to terminate benefits was denied.

Temporary disabilityReconsiderationFindings and AwardAgreed Medical Examinersurgical interventioncervical spinefusionhardware removalkyphotic deformityplastic surgeon
References
Case No. ADJ10443530
Regular
Apr 10, 2017

ARMANDO MATA vs. SUPERMERCADO MI TIERRA, LLC, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES

The Workers' Compensation Appeals Board denied the employer's Petition for Removal but granted reconsideration for the limited purpose of deferring the issue of unreasonable delay in providing medical treatment. The Board affirmed the finding that the applicant is in need of cervical fusion surgery approved by utilization review. However, the Board ruled that the employer did not timely dispute the UR approval and therefore cannot defer payment, but the issue of unreasonable delay under Labor Code section 5814 was not properly before the Administrative Law Judge.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings of FactUtilization Review (UR)Panel Qualified Medical Evaluator (QME)Cervical Fusion SurgeryIndustrial InjuryCausationUnreasonable Delay
References
Case No. ADJ9823935, ADJ9088024
Regular
May 20, 2016

LE VAN vs. FEDEX OFFICE AND PRINT SERVICES, GALLAGHER BASSETT

The Workers' Compensation Appeals Board granted FedEx's petition for reconsideration but ultimately affirmed the original order finding treatment by Monrovia Memorial Hospital reasonable and necessary. The Board clarified that even if the cervical spine was not explicitly pled as an injured body part, FedEx authorized the treatment and failed to properly rescind that authorization. Therefore, the lien claimant is entitled to payment for the services rendered.

WCABPetition for ReconsiderationFindings and Orderlien claimantMonrovia Memorial Hospitalcervical spineDr. Wilkercervical surgeryobjection letterprimary treating physician
References
Case No. ADJ10025370
Regular
Mar 20, 2017

GEORGE GONCZERUK vs. WILCOX OAKS GOLF CLUB, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding the original findings and returning the case to the WCJ for further proceedings. The Board found inconsistencies in the record regarding the applicant's job duties and the determination of the date of injury and disability. The WCJ's initial finding of July 12, 2012, was contradicted by a later recommendation to set the date of injury as July 13, 2014, based on when the applicant was taken off work by a physician. Further development of the record is needed to clarify the cumulative trauma period and the confluence of knowledge and disability to establish the correct date of injury.

WCABPetition for ReconsiderationFindings and AwardAdministrative Law JudgeStatute of LimitationsCumulative TraumaDate of InjuryQualified Medical EvaluatorCervical MRIAnterior Cervical Discectomy and Fusion
References
Case No. ADJ8709903, ADJ8659329, ADJ8710289, ADJ9678146, ADJ10093678
Regular
Dec 13, 2019

ROBERT FRANKLIN vs. THE KROGER COMPANY DBA FOOD-4LESS (PSI) and THE KROGER COMPANY DBA FOOD-4-LESS (PSI) ADMINISTERED AND ADJUSTED BY SEDGWICK

The Workers' Compensation Appeals Board denied Kroger's Petition for Removal of a WCJ's Minute Order setting a PQME deposition. Kroger argued the order improperly limited questioning to the cervical spine, violating due process. The Board held that the WCJ's notes on the deposition's purpose do not have the force of a formal order and do not restrict the defendant's ability to cross-examine. Therefore, removal was denied.

Petition for RemovalPanel Qualified Medical EvaluatorPQMEWCJDue ProcessAOE/COECervical SpineFusion Medical TreatmentPermanent and StationaryCross-examine
References
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