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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. ADJ6776516
Regular
May 30, 2017

FRANCIS HARGREAVES vs. SOUTHWEST AIRLINES, ACE USA INSURANCE CO.

This case involves an applicant seeking workers' compensation benefits for injuries sustained on the job, including to his back, left shoulder, left wrist, and psyche, as well as complex regional pain syndrome, coronary artery disease, and a sleep disorder. The defendant sought reconsideration of the initial award, arguing that the medical evidence did not support the $90\%$ permanent disability finding. The Appeals Board granted reconsideration, affirming the findings of injury and treatment for Complex Regional Pain Syndrome but reducing the permanent disability to $88\%$ by excluding the sleep disorder impairment due to insufficient objective evidence. The applicant's permanent disability payments were recalculated and ordered to commence from January 21, 2011.

Workers' Compensation Appeals BoardFrancis HargreavesSouthwest AirlinesACE USA Insurance Co.Sedgwick CMSADJ6776516Opinion and Order Granting Petition for ReconsiderationFindings Award and OrderAOE/COEback injury
References
Case No. ADJ3361459
Regular
Oct 15, 2012

Christiane Flynn vs. YOLANDA'S OF VENTURA, AMERICAN HOME ASSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration and amended its prior decision regarding Christiane Flynn's injury. The applicant sustained injuries including right shoulder, brachial nerve, upper extremities, thoracic outlet syndrome, complex regional pain syndrome, psyche, and fibromyalgia. Her permanent disability was found to be 100% total, entitling her to weekly indemnity payments. A substantial attorney fee of $47,451.89 was deemed reasonable and ordered payable.

Christiane FlynnYolanda's of VenturaAmerican Home AssuranceAIG Claim ServicesADJ3361459VEN 0112129ReconsiderationAdministrative Law JudgeWaitressOccupational Group 322
References
Case No. ADJ8731635
Regular
Apr 02, 2019

Daissy Contreras vs. CRESTWOOD BEHAVIORAL HEALTH, UNION FIRE INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior award, finding the medical record inadequate to determine applicant's claim of Complex Regional Pain Syndrome (CRPS). While some physicians noted symptoms consistent with CRPS, the Agreed Medical Examiner (AME) found no objective evidence. The Board ordered the matter returned to the trial level for further development of the medical record by appointing a pain management specialist. This new evaluation will aim to diagnose the applicant's right upper extremity condition and determine its industrial causation.

Complex Regional Pain SyndromeCRPSskin injuryrashcumulative traumaAgreed Medical ExaminerAMEskin conditionright upper extremitypain management specialist
References
Case No. ADJ7781219
Regular
Nov 19, 2019

CHARLES SINCLAIR vs. RICHARD J. DONOVAN CORRECTIONAL FACILITY; Legally Uninsured; administered by STATE COMPENSATION INSURANCE FUND/ STATE CONTRACT SERVICES

This case involves Charles Sinclair, a Licensed Vocational Nurse, who sustained an injury to his hands, wrists, and upper extremities on December 21, 2010, resulting in complex regional pain syndrome. The WCJ found Sinclair to be 100% permanently disabled based on the opinions of treating physicians Dr. Baker and Dr. Pelton, and vocational expert Enrique Vega, despite conflicting opinions from other medical examiners. The defendants petitioned for reconsideration, arguing a lack of substantial evidence and insufficient apportionment to prior injuries. The Board denied reconsideration, upholding the WCJ's findings and adopting the WCJ's report, which found the defendant failed to meet their burden of proof regarding apportionment.

Complex Regional Pain SyndromeVocational ExpertApportionmentSubstantial EvidenceAgreed Medical ExaminerQualified Medical ExaminerPermanent DisabilitySynergistic EffectPain ManagementCredibility Determination
References
Case No. ADJ1901810 (SAC 0362345) ADJ381755 (SAC 0362346)
Regular
Feb 03, 2010

RONALD WILLIAMS vs. MV TRANSPORTATION, INC.; AMERICAN HOME ASSURANCE, adjusted by BROADSPIRE

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration as it was untimely filed and not properly verified. The WCAB also denied the defendant's petition for reconsideration, adopting the reasoning of the Workers' Compensation Judge. The underlying decisions found the applicant sustained an industrial injury to his low back, requiring further treatment but no permanent disability. A separate decision found an industrial injury to his right upper extremity (CRPS) and neck/upper back (myofascial pain syndrome), resulting in 75% permanent disability and entitlement to further medical treatment.

Complex Regional Pain SyndromeMyofascial Pain SyndromeAgreed Medical EvaluatorAMA Guides 5th EditionLabor Code section 4658(d)Permanent Disability IndemnityPetition for ReconsiderationUntimely FilingLack of VerificationJurisdictional Time Limit
References
Case No. ADJ8376717
Regular
Apr 12, 2019

SOOHYUN KIM vs. VALENTINO, Permissibly Self-Insured, Administered By GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) affirmed the finding of industrial injury for Complex Regional Pain Syndrome (CRPS) but rescinded the finding of chronic pain. The WCAB also rescinded the finding of permanent and total disability, finding the medical evidence supported a scheduled disability rating between 64-81%. The vocational expert's opinion was deemed insufficient to rebut the scheduled rating or establish permanent total disability. The case was returned to the trial level for further proceedings and a new permanent disability finding based on the medical reports.

Complex Regional Pain SyndromeCRPSIndustrial InjuryPermanent and Total DisabilityReconsiderationVocational ExpertMedical EvidencePermanent Disability RatingAMA GuidesLabor Code
References
Case No. ADJ9870934, ADJ9870932
Regular
Mar 13, 2019

Julio Espana vs. STOCKTON UNIFIED SCHOOL DISTRICT, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board rescinded the previous award and returned the case for further development of the record. The applicant claims his post-surgery disability, resembling Complex Regional Pain Syndrome, arose directly from treatment for his industrial injuries, arguing for an unapportioned award per *Hikida*. Medical evidence suggests a possible complication from the surgery caused increased pain and disability, but the extent to which this surgery directly caused the applicant's permanent disability requires further evaluation. Therefore, the case is remanded for an Agreed Medical Examiner to determine causation, diagnosis, and apportionment.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryPermanent Disability RatingUnapportioned AwardComplex Regional Pain SyndromeAMA GuidesQualified Medical EvaluatorMedical Malpractice LawsuitSpinal Surgery Complication
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ3516579 (VNO 0523127)
Regular
Jan 30, 2012

KELLY WHELIHAN vs. CBS RADIO, MURPHY AND BEANE (TPA)

This case involved a defendant seeking reconsideration of a workers' compensation award for an industrial injury including bilateral wrists, neck, psyche, and complex regional pain syndrome. The defendant argued the administrative law judge erred by relying on one medical opinion over another for temporary disability benefits. However, both the Petition for Reconsideration and the Petition for Removal were dismissed. The Appeals Board found both petitions to be untimely filed based on the dates of service and filing.

Workers' Compensation Appeals BoardReconsiderationRemovalFindings and AwardTemporary DisabilityIndustrial InjuryBilateral WristsNeckPsycheComplex Regional Pain Syndrome
References
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