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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ7254961
Regular
Jan 14, 2013

LAURA VASQUEZ vs. DEL MONTE FRESH PRODUCE INC., LIBERTY MUTUAL INSURANCE

This case involves Laura Vasquez's petition for reconsideration after a Workers' Compensation Appeals Board judge denied her claim for industrial injuries. The judge found Vasquez did not meet her burden of proof, discrediting her testimony and relying on specific medical opinions while rejecting others. The Board denied reconsideration, largely adopting the judge's reasoning and affirming the sufficiency of the medical evidence against the applicant. However, one commissioner dissented, arguing for further development of the record on claims of hypertension and GERD due to potentially relevant medical commentary.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryNeck InjuryBack InjuryLower ExtremitiesUpper ExtremitiesPsycheHypertension
References
Case No. ADJ9070770
Regular
Jun 10, 2014

OSCAR GARCIA-PICEN vs. TIGHT QUARTERS, INC., CALIFORNIA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a prior ruling ordering viscosupplementation injections for an applicant's knee injury. The WCAB found the prior ruling, which deemed the defendant's utilization review (UR) denial defective due to a missing signature, to be based on an incorrect premise as the UR physician did sign the report. However, the WCAB noted the UR physician may not have been aware of the applicant's second surgery, potentially rendering the UR defective for other reasons. The case was returned to the trial level for further consideration, with a dissenting opinion arguing the UR was demonstrably defective for omitting key medical history and the treatment should have been affirmed.

Workers' Compensation Appeals BoardOscar Garcia-PicenTight QuartersInc.California Insurance CompanyADJ9070770Opinion and Decision After ReconsiderationViscosupplementation injectionsUtilization Review (UR) denialDefective UR
References
Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ2070973 (SAL 0092454)
Regular
Jun 12, 2015

CHARLENE MEEKS-CLOSE vs. RIVER RANCH FRESH FOODS, SEDGWICK CMS

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration due to untimely service on the applicant's counsel of record. The defendant failed to properly serve the petition, which is a procedural defect that deprives the applicant of due process rights. While one commissioner concurred with the dismissal on procedural grounds, she dissented regarding the merits, arguing the petition should have been granted to develop the record on the permanent disability rating. The majority opinion noted that even if properly served, the petition would have been denied on its merits.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderPermanent DisabilityLife PensionHousekeeping ExpensesMileage ExpensesUnreasonable DelayPenaltyAgreed Medical Evaluator
References
Case No. ADJ865311 (LAO 0880913)
Regular
Sep 19, 2016

MARIA AGUILERA vs. COLLINS CHIROPRACTIC GROUP, STATE COMPENSATION INSURANCE FUND

The Board denied the applicant's petition for reconsideration, affirming its prior decision to reduce her permanent disability from $100\%$ to $88\%$ after apportionment. The Board found the applicant's vocational expert's opinions unsubstantial and contrary to the well-reasoned opinions of the Agreed Medical Evaluators (AMEs). Specifically, the Board rejected Dr. Bluestone's opinion due to a failure to account for duplication in impairment factors between rheumatologic and psychiatric conditions. While one Commissioner dissented, believing the applicant to be $100\%$ permanently disabled based on Dr. Bluestone's findings and other evidence, the majority upheld the apportionment.

Workers' Compensation Appeals BoardOpinion and Order Denying Petition for ReconsiderationFindings and AwardPermanent Total DisabilityApportionmentAgreed Medical Evaluators (AMEs)Dr. BluestoneDr. FreemanDr. MajcherDr. Fedder
References
Case No. ADJ6802715; ADJ6715328
Regular
Sep 15, 2015

STEFANIE WEBB vs. THE VINTAGE CLUB, FEDERAL INSURANCE c/o CHUBB SERVICES CORP., INSURANCE COMPANY OF THE WEST, c/o FIREMAN'S FUND INSURANCE

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of a finding that applicant Stefanie Webb sustained a cumulative injury to her wrists and arms from April 19, 2004, through April 14, 2009. The insurer contended the injury period ended in 2005, citing medical opinions. However, the WCAB found that April 14, 2009, was the correct date of injury as it was the first day applicant knew her condition was work-related and suffered disability. A dissenting opinion argued that medical evidence supported an earlier cessation of injurious exposure in 2005.

Workers' Compensation Appeals BoardStefanie WebbThe Vintage ClubFederal InsuranceChubb Services Corp.Insurance Company of the WestFireman's Fund Insurancecumulative injuryspecific injurypermanent disability
References
Case No. ADJ10084576
Regular
Oct 06, 2016

ROSE SMITH vs. MEGGITT SENSING SYSTEMS PLC, THE HARTFORD

This case involves Rose Smith's workers' compensation claim where the defendant, Meggit Sensing Systems and its insurer, The Hartford, seek reconsideration of an order allowing Smith to obtain medical treatment outside their Medical Provider Network (MPN). The Appeals Board denied the petition, affirming the WCJ's finding that the defendant's failure to authorize a requested third medical opinion constituted a denial of care. This denial entitled the applicant to seek treatment outside the MPN at the defendant's expense. The defendant argued the request was procedurally deficient and not a request for treatment, but the Board found the failure to respond to the RFA for a third opinion, in context, was a failure to provide reasonable medical treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Request for Authorization (RFA)Petition for ReconsiderationDenial of Medical TreatmentThird Medical OpinionUtilization Review (UR)Primary Treating PhysicianCumulative TraumaLoss of Control
References
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