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

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
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 The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record.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. ADJ6674613
Regular
Mar 16, 2011

Donald Kusar vs. CITY OF LOS ANGELES

The Appeals Board granted reconsideration to address issues with the applicant's permanent disability rating after an admitted left elbow injury. The WCJ had found no permanent disability but vacated submission in companion cases involving other injuries for clarification from the Agreed Medical Examiner (AME). The applicant argued the WCJ erred by striking ratings and vacating submission in consolidated cases and that the DEU rater improperly substituted her own judgment for the AME's findings. The Board rescinded the Findings and Award, returning the matter to the trial level to rate all three consolidated cases together, and to reconsider the permanent disability rating in light of the *Blackledge* decision regarding the rater's role.

Agreed Medical ExaminerAppeals BoardConsolidated casesDEU raterDisability evaluationEn banc decisionFindings and AwardImpairment ratingMedical evidencePermanent disability
References
Case No. ADJ6630817
Regular
Dec 27, 2010

NADINE WHITEEAGLE vs. CENTRAL RECRIGERATOR SERVICES, GREAT WEST CASUALTY

This case concerns an applicant's shoulder injury resulting in 12% permanent disability. The defendant argued the Permanent Medical Evaluator (PQME) found 0% impairment and objected to the rater's consideration of surgery. However, the Appeals Board affirmed the WCJ's decision, finding the rating instruction was properly based on substantial medical evidence from the PQME's report, which included the applicant's shoulder surgery. The Board also noted the defendant's objection to the rating was untimely.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Whole Person Impairment (WPI)AMA Guides to the Evaluation of Permanent ImpairmentDistal Clavicle ResectionRater InstructionsDEU Rater
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. ADJ3711842 (ANA 0409880)
Regular
Jun 21, 2013

SEAN GILBERT vs. OAKLAND RAIDERS, ACE USA

This case concerns disputed attorney fees in a workers' compensation claim. The applicant seeks to correct a clerical error in the award regarding the distribution of permanent disability benefits between himself and his counsel. The defendant challenges the calculation of attorney fees, arguing they should be based on the present value of the award, not its full value, and claims improper ex parte communication by a DEU rater. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings to address these issues and ensure proper calculation and distribution of fees.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability IndemnityAttorney's FeesPresent ValueEx Parte CommunicationDEU RaterCross-examinationClerical ErrorLife Pension
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. 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. 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
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