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Case Law Database

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

Case No. ADJ6712588
Regular
Aug 12, 2010

MARIA NAVARRO vs. STAFF CHEX, AIG INSURANCE

The Workers' Compensation Appeals Board granted reconsideration for Applicant Maria Navarro, rescinding a prior award. The Board found a potential due process violation because the Applicant claimed she was never served with the Disability Evaluation Unit's (DEU) rating. As the DEU rating was not found in the official record of proceedings, the Board returned the case for further proceedings, ordering the DEU rating be properly added to the record and served on all parties. This ensures the Applicant has an opportunity to challenge the rating and exercise her due process rights.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityDue ProcessNoticeCross-examinationDisability Evaluation UnitDEUProof of Service
References
Case No. ADJ1799490 VNO 0531984 ADJ1619817 VNO 1619817
Regular
Feb 01, 2013

TONI PARKER vs. WARNER BROTHERS STUDIOS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

In Case No. ADJ1799490, the Appeals Board granted reconsideration and rescinded the WCJ's award, returning the case for further proceedings because Warner Brothers' due process rights were violated by a lack of service of rating instructions and the DEU rating. In Case No. ADJ1619817, the Board dismissed Warner Brothers' reconsideration petition as untimely but granted removal on its own motion to clarify administrative responsibility. The Board affirmed the WCJ's findings in ADJ1619817 but deferred the designation of the administering defendant, also returning it for trial-level determination.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardDue ProcessRating InstructionsDisability Evaluation UnitDEUPermanent DisabilityIndustrial InjuryBilateral Upper Extremities
References
Case No. ADJ9229300
Regular
Mar 01, 2019

MIKE RIVERA vs. WESTERN CONSOLIDATED EQUITIES dba THE MONTEREY APARTMENTS, STATE FARM INSURANCE COMPANY

The Appeals Board granted removal, rescinded the prior Findings and Order, and returned the case to the trial level. The Board found that the applicant did not engage in ex parte communication with the Qualified Medical Evaluator (QME) because the communication was simultaneously served on opposing counsel. However, the applicant's letter and enclosed DEU rating were deemed "information" subject to Labor Code section 4062.3(b), which requires 20-day advance service on the opposing party, a requirement that was violated. Despite this violation, the Board determined that a replacement QME panel was an improper remedy due to the extensive history with the current QME and the lack of demonstrable prejudice to the defendant.

RemovalPetition for RemovalFindings and OrderQualified Medical EvaluatorQME panelEx parte communicationDisability Evaluation UnitDEUPermanent disability ratingAlmaraz/Guzman
References
Case No. ADJ6544795
Regular
Mar 28, 2011

JENNIFER GONZALEZ vs. CAL POLY POMONA ASI, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a defendant seeking reconsideration of a workers' compensation award due to a due process violation. The administrative law judge issued a decision without allowing the defendant to object to or cross-examine the Disability Evaluation Unit (DEU) rater. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter to the trial level. This is to allow the defendant the opportunity to cross-examine the DEU evaluator, thereby ensuring due process.

WCABPetition for ReconsiderationFindings and AwardDEU RatingCross-examinationDisability Evaluation UnitDue ProcessIndustrial InjuryPermanent DisabilityMedical Treatment
References
Case No. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
Case No. ADJ2266211 (GOL 0101534)
Regular
Dec 28, 2009

Miles Wallace vs. BELLAGIO & BACK DOOR BOARD SHOP, CNA CLAIMPLUS for VALLEY FORGE (PORTLAND)

Reconsideration granted; case returned to trial level to re-rate applicant's permanent disability and address other issues due to inadequate explanation of the basis of the original decision and lack of cross-examination of the DEU rater.

Permanent Disability RatingOccupational Group NumberFactors of DisabilityWork RestrictionsDEU RaterCross-examinationMedical ReportingWorkers' Compensation Appeals BoardFindings and AwardReconsideration
References
Case No. AHM 0136908
Regular
Mar 07, 2008

JUAN JESUS GARCIA vs. ALEXIS CONSTRUCTION CLEANUP INC., GRANITE STATE INSURANCE COMPANY, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior award of no permanent disability. The Board found that the medical reports were not ratable by the Disability Evaluation Unit. The case is returned to the trial level to allow examination of the DEU rater, aiming to develop the record and ensure a decision on the merits.

Workers' Compensation Appeals BoardAlexis Construction Cleanup Inc.Granite State Insurance CompanyAIG Claims ServicesJuan Jesus Garcialabor contractindustrial injuryback injurypermanent disabilityratable permanent disability
References
Case No. ADJ3107039 (SAL 0114548) ADJ1050422 (SAL 0104052)
Regular
Jan 19, 2012

ESTELA LUIS vs. COMMUNITY BRIDGES, STATE COMPENSATION INSURANCE FUND

The Appeals Board denied reconsideration of an Amended Findings and Award, affirming the judge's decision. The Board rejected a request to increase the applicant's attorney's fee due to untimeliness and failure to provide required notice to the applicant. The defendant's petition for reconsideration was denied because they failed to meet their burden to rebut the DEU's use of a 4.6% COLA for calculating permanent disability and attorney fees, as it's a reasonable methodology based on a 50-year average.

Petition for ReconsiderationWorkers' Compensation Appeals BoardAmended Findings and Awardattorney's feeuntimelyWCAB Rule 10778independent counseljurisdictionCost of Living Adjustment (COLA)State Average Weekly Wage (SAWW)
References
Case No. ADJ1503980 (GRO 0034241)
Regular
Mar 24, 2010

HAI GRIFFIN vs. CALIFORNIA MEN'S COLONY EAST, SCIF STATE EMPLOYEES EXNARD (Adjusting Agency)

The Appeals Board dismissed the defendant's petition for reconsideration, finding their prior order was not a final decision and thus not subject to reconsideration. The Board also denied the defendant's petition for removal, upholding their authority to develop the record further. This was based on inconsistencies and lack of explanation in the Agreed Medical Evaluator's (AME) reports regarding the applicant's impairment. The AME will be provided with the complete formal DEU rating and a discussion of substantial medical evidence principles to issue a supplemental report.

Workers' Compensation Appeals BoardReconsiderationRemovalFinal OrderInterlocutory OrderDiscoveryMandatory Settlement ConferenceAgreed Medical EvaluatorDEU RatingPermanent Disability
References
Case No. ADJ13757266, ADJ13757284
Regular
Jan 31, 2023

ARLEEN KETELES vs. COUNTY OF ALAMEDA, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding of 70% permanent disability for the applicant's cumulative trauma injury. The Board adopted the judge's reasoning that the defendant's arguments lacked merit. Specifically, the Board found Dr. Brose's medical opinions constituted substantial evidence and that the DEU rating was better reasoned than the defendant's rater's opinion. The defendant's contention that Dr. Brose's opinions were inconsistent with the AMA Guides was also rejected.

Workers' Compensation Appeals BoardCumulative InjuryPermanent DisabilityQualified Medical ExaminerAMA GuidesLabor Code Section 5313Findings and AwardPetition for ReconsiderationMedical OpinionImpairment Rating
References
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