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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. ADJ7911474
Regular
Jan 22, 2019

KIA SPREWELL vs. STATE OF CALIFORNIA, RICHARD J. DONOVAN CORRECTIONAL FACILITY

This case involved Kia Sprewell's workers' compensation claim against the Richard J. Donovan Correctional Facility for injuries sustained as an office assistant. The defendant sought reconsideration of the initial award, primarily contesting the commutation method for attorney fees and the substantiality of the neurologist's medical opinions. The Workers' Compensation Appeals Board granted reconsideration in part, affirming the award of permanent disability but amending the attorney fees to be commuted from the side of the life pension award. The Board found the neurologist's opinions on apportionment and rating of various injuries, including headaches and spinal issues, to be substantial medical evidence.

Workers Compensation Appeals BoardKia SprewellRichard J. Donovan Correctional FacilityState Compensation Insurance FundPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentLife PensionAttorney Fees
References
Case No. ADJ14808611
Regular
Sep 16, 2022

KATIE Y. LAM vs. COUNTY OF ORANGE, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns an applicant who sought reconsideration of a workers' compensation award denying her claim for neck injury. The Workers' Compensation Appeals Board granted reconsideration, amending the award to include injury to the cervical spine. This amendment was based on the substantial evidence from a Qualified Medical Examiner (QME) whose reports indicated C6 radiculopathy was causally related to the applicant's employment injury. The Board found the QME's opinion well-reasoned and not contradicted by other evidence.

Cervical radiculopathyQMEAOE/COEPetition for ReconsiderationFindings and AwardSubstantial evidenceCompensable consequenceApportionmentDeputy sheriff traineeAmbulatory imbalance
References
Case No. VNO 0504152
Regular
Feb 01, 2008

Debi Surgenor vs. RALPH'S GROCERY COMPANY, SEDGWICK CMS

The Workers' Compensation Appeals Board granted reconsideration to defer the issue of applicant's need for cervical epidural injections due to an inadequate trial record, specifically concerning claim and stipulations for a cervical injury. However, the Board affirmed the original finding that lumbar epidural injections are medically necessary to treat the applicant's industrial injury, supported by medical evidence and demonstrated benefit from prior treatment. The case highlights the importance of a complete and stipulated record for medical treatment claims in workers' compensation proceedings.

Workers' Compensation Appeals BoardRalph's Grocery CompanySedgwick CMSDebi Surgenorcervical epidural injectionslumbar epidural injectionsUtilization Review denialACOEM guidelinesradiculopathyelectrodiagnostic testing
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. ADJ3649169
Regular
Feb 14, 2013

BRUCE LIBERTY vs. LOS ANGELES UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured

This case concerns an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) order denying his claim for lumbar spine injury. The applicant alleged a lumbar injury from a physical therapy incident following a compensable cervical and shoulder injury. The WCAB denied reconsideration, adopting the WCJ's report which relied on the Agreed Medical Examiner's (AME) opinion. The AME found no industrial injury to the lumbar spine, citing a lack of contemporaneous evidence and a history of degenerative disc disease. The WCAB determined the applicant's presented "new" evidence was either previously reviewed or unpersuasive, upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedBruce LibertyLos Angeles Unified School DistrictPermissibly Self-InsuredCase Number ADJ3649169Workers' Compensation Administrative Law JudgeAgreed Medical ExaminerLumbar Spine Injury
References
Case No. ADJ6879193
Regular
Feb 10, 2012

KATHERINE LAU vs. CUPERTINO UNION SCHOOL DISTRICT, KEENAN and ASSOCIATES

The Workers' Compensation Appeals Board granted reconsideration to review the application of the 1997 vs. 2005 Permanent Disability Rating Schedules. The Board reversed the WCJ's finding, determining there was insufficient pre-2005 medical evidence of permanent disability to apply the 1997 schedule. Consequently, the Board applied the 2005 schedule, reducing the applicant's permanent disability rating from 29% to 12%. One Commissioner dissented, arguing the record supported the use of the 1997 schedule based on pre-2005 indications of permanent disability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent Disability Rating1997 Schedule2005 ScheduleLabor Code Section 4660(d)Comprehensive Medical-Legal ReportTreating Physician ReportIndustrial Injury
References
Case No. ADJ8408754
Regular
Sep 01, 2017

DAVID WILSON (Deceased) vs. SECURITAS SECURITY SERVICES USA, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a decision regarding deceased applicant David Wilson's permanent disability benefits. The Board found the record inadequate to determine if applicant's right hand tremors stemmed from his industrial injury. Therefore, the case is returned to the trial level for further medical development of this specific issue by Dr. Horner. The Board did not address other contentions concerning benefit termination after death or constitutional challenges at this time.

Securitas Security ServicesSedgwick Claims Management ServicesDavid Wilson (Deceased)Michele WilsonAnthony WilsonTia CarringtonPetition for ReconsiderationFindings and Award and Orderworkers' compensation administrative law judgeWCJ
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. 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
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