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Case Law Database

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

Case No. ADJ6976775
Regular
Jul 20, 2015

STEPHANIE HOBBS vs. COUNTY OF LOS ANGELES

This case involves an applicant whose permanent disability rating was challenged. The administrative law judge (WCJ) found a combined permanent disability of 61%, but the applicant argued the WCJ erred by not adopting an agreed medical evaluator's "alternative manner" of calculating cervical spine impairment. While the WCJ correctly rejected the evaluator's method as lacking substantial evidence under *Guzman*, the Appeals Board granted reconsideration. The Board rescinded the award to allow the medical evaluator to provide a revised opinion that fully complies with *Guzman* standards for establishing cervical spine impairment.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryCumulative TraumaCustody AssistantPermanent DisabilityApportionmentNeck InjuryPsyche Injury
References
9
Case No. ADJ9709071
Regular
Apr 26, 2023

MAGGIE LUQUIN vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to study the case of Maggie Luquin against the City of Los Angeles. The Board rescinded the previous Amended Findings and Award and returned the matter to the trial level for further discovery. This decision specifically addresses the defendant's contentions regarding the adequacy of the Agreed Medical Evaluator's (AME) report for the cervical spine's pain add-on and the impairment to the applicant's right knee. The WCAB found the AME's report substantial evidence for the cervical spine and other body parts but remanded for further evaluation of the knee injuries.

AOE/COEAgreed Medical Evaluator (AME)substantial medical evidenceAMA Guidespermanent disability ratingcervical spinebilateral elbowsbilateral kneespain add-onorthopedic impairment
References
7
Case No. ADJ10550274
Regular
Mar 24, 2023

MEENA CHANDOK vs. SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of a prior award finding the applicant permanently totally disabled due to a subsequent industrial injury combined with pre-existing disabilities. SIBTF argued that an elective tubal ligation and pre-existing cervical and thoracic spine impairments were improperly rated. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, finding that the tubal ligation constituted a ratable impairment under the AMA Guides, and evidence of prior treatment for the spinal conditions predated the industrial injury. The WCAB adopted the reasoning of the Workers' Compensation Judge (WCJ), who found no legal basis to exclude an elective surgery from impairment rating and that SIBTF failed to rebut the applicant's medical evidence.

Subsequent Injuries Benefits Trust FundPre-existing disabilityRatable impairmentElective tubal ligationCervical spineThoracic spineAMA GuidesLabor Code section 4751FergusonProphylactic work restriction
References
12
Case No. 528952
Regular Panel Decision
Feb 27, 2020

Matter of Saputo v. Newsday, LLC

Claimant John Saputo suffered work-related neck and shoulder injuries in 2016, leading to a workers' compensation claim. Initially, a Workers' Compensation Law Judge awarded him a schedule loss of use for his arms, finding no permanent neck impairment, but the Workers' Compensation Board later rescinded this award due to a possible residual neck impairment and remitted for further development of the record. On appeal, the Appellate Division modified the Board's decision, clarifying that a claimant can receive a schedule loss of use award for schedule injuries even if they also have a nonschedule permanent partial disability classification, provided they returned to work at pre-injury wages and receive no award for the nonschedule injury. However, the Court affirmed the Board's finding of substantial evidence for the claimant's residual cervical spine impairment of an unknown severity. The matter was ultimately remitted to the Workers' Compensation Board for further proceedings consistent with the Appellate Division's decision.

Workers' Compensation LawSchedule Loss of Use (SLU)Permanent Partial DisabilityCervical Spine InjuryShoulder InjuryMaximum Medical Improvement (MMI)Wage-Earning CapacityMedical Expert TestimonyAppellate ReviewRemittal
References
6
Case No. ADJ7924562
Regular
Sep 19, 2014

RAUL HERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The applicant sought reconsideration of a WCJ decision that found an industrial injury to the low back but not the cervical spine or left ankle, with no permanent disability or further medical treatment. The applicant argued the QME's reports were insubstantial and that prior permanent disability was not considered. The Appeals Board granted reconsideration to amend the original award to include injury to the cervical spine, affirming the remainder of the decision. Therefore, the applicant sustained injury to his low back and cervical spine.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryCervical Spine InjuryPermanent DisabilityFurther Medical TreatmentPanel Qualified Medical EvaluatorLabor Code Section 4664(b)
References
0
Case No. ADJ1337074 (GRO 0034564) ADJ1286218 (GRO 0034565)
Regular
Jun 24, 2009

Dave Gerletti vs. SANTA MARIA AIRPORT DISTRICT, GREGORY BRAGG STOCKTON

The Workers' Compensation Appeals Board denied Dave Gerletti's petition for reconsideration of an award for a cumulative trauma injury to his cervical spine and lungs. The original award found 35% permanent disability, apportioning 50% of the cervical spine disability to non-industrial factors based on a Qualified Medical Evaluator's opinion of degenerative changes. The majority affirmed the WCJ's reliance on this opinion, finding it adequately explained. A dissenting opinion argued the QME's apportionment was speculative and improperly based on age and genetics, recommending an unapportioned award for the cervical spine injury.

Workers' Compensation Appeals Boardcumulative traumacervical spinelungspermanent disabilityapportionmentQualified Medical EvaluatorAgreed Medical Examinerarthritic degenerationnon-industrial factors
References
1
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
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. 526688
Regular Panel Decision
Dec 27, 2018

Matter of Bufearon v. City of Rochester Bur. of Empl. Relations

Claimant Kamren Bufearon sustained work-related injuries in a motor vehicle collision on March 4, 2016, for which his workers' compensation claim was established for injuries to his left shoulder, left hip, and lower back. Subsequently, he sought to amend his claim to include a causally-related cervical spine injury, which was initially approved by a Workers' Compensation Law Judge. However, the Workers' Compensation Board reversed this decision, finding that the claimant failed to sufficiently demonstrate a causal relationship between his cervical spine condition and the March 4, 2016 incident. The Appellate Division affirmed the Board's decision, noting that the medical testimony from two physicians contained conflicting findings and equivocal narratives regarding causation. The court concluded that the Board was entitled to reject the physicians' opinions as speculative, particularly since neither physician had reviewed the claimant's prior medical records for a pre-existing cervical spine fusion surgery.

Cervical spine injuryCausal relationshipMedical evidenceSubstantial evidence reviewAppellate DivisionWorkers' Compensation BoardPre-existing conditionCredibility of physiciansBurden of proofMotor vehicle accident
References
13
Case No. ADJ11065177
Regular
Apr 09, 2019

FRANK ROMANO vs. PROVIDENCE HEALTH AND SERVICES, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior award that found 4% permanent disability. The Board found the orthopedist's apportionment of lumbar spine impairment to nonindustrial daily activities to be unsubstantiated. Specifically, the doctor could not identify specific nonindustrial activities causing impairment or link them to the found impairment. Therefore, the Board awarded an unapportioned 7% permanent disability for the applicant's industrial lumbar spine injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanent DisabilityApportionmentSubstantial Medical EvidenceMedical OpinionLumbar Spine DRE Category IIWhole Person ImpairmentAMA GuidesMuscle Spasm
References
9
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