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

Case No. ADJ1528926 (LBO 0378215)
Regular
Jul 02, 2012

DORIS SIMPSON vs. ORC MACRO, LIBERTY MUTUAL ORANGE

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award of back surgery for applicant Doris Simpson. The Board found the Agreed Medical Examiner's (AME) opinion regarding industrial causation for the surgery was inadequately explained. The case is returned to the trial level for further medical development, specifically to clarify whether the 2006 industrial injury contributed to the applicant's need for the surgery. The applicant has a history of prior lumbar surgeries and pre-existing degenerative conditions.

Workers' Compensation Appeals BoardDORIS SIMPSONORC MACROLIBERTY MUTUAL ORANGEADJ1528926LBO 0378215OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONPrimary Treating PhysicianDr. Mudiyam
References
Case No. VNO 0446920, VNO 0446922
Regular
Feb 28, 2008

Doris Ticsay vs. COUNTY OF LOS ANGELES/ DEPARTMENT OF SOCIAL SERVICES

The Workers' Compensation Appeals Board granted reconsideration for Doris Ticsay, rescinding a previous order that found no industrial injury to her upper extremities, knees, and headaches. This decision stems from Ticsay's assertion that the Agreed Medical Examiner's report, which formed the basis of the prior ruling, contained factual inaccuracies regarding the x-rays of her knees. The Board is remanding the case to allow Ticsay to obtain a further evaluation with the Agreed Medical Examiner to clarify these discrepancies and issue a new report.

Workers' Compensation Appeals BoardDoris TicsayCounty of Los AngelesDepartment of Social Servicesindustrial injurynew and further disabilityAgreed Medical ExaminerDr. Bernard Coopermanknee x-rayserroneous record
References
Case No. LBO 0385963
Regular
Aug 05, 2008

Audley Simpson vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration to rescind the trial judge's order, returning the case for further proceedings. The Board agreed that the spine was not an issue in dispute at the mandatory settlement conference or trial, and that the temporary disability award was likely based on this unaddressed body part. The case is remanded for the trial judge to address all disputed issues, including the use of an AME/QME and the admissibility of treating physician reports.

Workers' Compensation Appeals BoardAudley SimpsonCounty of Los Angelesindustrial injuryspineleft hipleft thightemporary disabilityFindings Award and Orderspanel QME
References
Case No. OAK 294681
Regular
Nov 14, 2007

SCOTT SIMPSON vs. GEO OPTIONS, INC., EARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision regarding permanent disability apportionment, finding substantial medical evidence supported a 50% apportionment to pre-existing conditions. The Board also upheld the WCJ's finding of unreasonable delay in medical treatment, justifying a penalty against the defendant. A minor clerical error in the award regarding penalty references was corrected.

Workers' Compensation Appeals BoardScott SimpsonGeo Options Inc.Hartford Insurance CompanyOAK 294681Opinion and Decision After Reconsiderationpermanent disabilityapportionmentspondylolisthesisqualified medical examiner
References
Case No. OXN 131251
Regular
Dec 05, 2007

DORIS STOCKS vs. THE URBAN GROUP dba THE GABLES OF OJAI, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, LEGION INSURANCE

The Appeals Board rescinded a penalty against CIGA for delayed temporary disability payments, finding penalties are not covered claims. The Board also amended the award to apportion one-third of the applicant's permanent disability to pre-existing degenerative disease, reducing the awarded permanent disability based on Dr. Berman's opinion. Consequently, the applicant's awarded permanent disability is reduced to 51%.

Workers' Compensation Appeals BoardDORIS STOCKSTHE URBAN GROUPTHE GABLES OF OJAICALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA)INTERCARE INSURANCE SERVICESLEGION INSURANCEOpinion and Decision After ReconsiderationTemporary DisabilityPermanent Disability
References
Case No. EUR 0033714 EUR 0033715 EUR 0034952 EUR 0034953 EUR 0036579
Regular
Jun 04, 2008

CALE TAYLOR vs. SIMPSON TIMBER COMPANY, A.K.A. ARCATA REDWOOD COMPANY, Permissibly Self-Insured by BROADSPIRE; LIBERTY MUTUAL, and STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The WCJ found several industrial injuries to the applicant's low back, knees, and shoulders, awarding varying percentages of permanent disability after considering apportionment and overlap. The Board affirmed the WCJ's findings, particularly noting that the applicant's arguments regarding precedent-setting cases were not applicable or were bound by established Appeals Board decisions.

Workers' Compensation Appeals BoardSimpson Timber CompanyBroadsPIRELiberty MutualState Compensation Insurance FundCale Taylorindustrial injurylow backleft kneeright shoulder
References
Case No. ADJ9613485
Regular
Jan 03, 2015

DORIS GONZALES vs. HARBOR FREIGHT TOOLS, SAFETY NATIONAL INSURANCE CO.

The Workers' Compensation Appeals Board denied Doris Gonzales's Petition for Removal to rescind an order continuing her case to trial. Gonzales argued she hadn't completed discovery regarding her admitted psyche injury's permanent and stationary status and a newly diagnosed condition, fibromyalgia. The majority found her petition did not demonstrate substantial prejudice or irreparable harm, rendering removal an inappropriate remedy. Commissioner Sweeney dissented, believing further discovery was necessary and the trial date premature, especially concerning the un-evaluated psyche injury.

Petition for RemovalPsyche InjuryFibromyalgiaPermanent and Stationary StatusDiscoveryWorkers' Compensation Appeals BoardAdministrative Law JudgeMandatory Settlement ConferenceDue DiligencePremature Trial
References
Case No. ADJ3332026 (OAK 0323707)
Regular
Aug 06, 2010

DORI HAMILL vs. MARTINEZ UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured

This case involves Dori Hamill's workers' compensation claim against Martinez Unified School District for a complex regional pain syndrome injury to her left lower extremity, resulting in 100% permanent disability. The Appeals Board denied the applicant's request for removal and reconsideration but granted the defendant's reconsideration. The Board deferred the issue of attorney fees, finding the original award calculation by the WCJ was insufficient. The matter was returned to the trial level for further proceedings to determine a reasonable attorney fee based on established legal criteria.

Petition for RemovalPetition for ReconsiderationFindings and Awardindustrial injurycomplex regional pain syndrometemporary disability indemnitypermanent disability indemnitypermanent and stationaryapportionmentattorney's fees
References
Case No. ADJ4420203 (SAL 0108544)
Regular
Apr 22, 2015

DORIS NOBLE vs. VEC FARMS, LLC, STATE COMPENSATION INSURANCE FUND

This case involves Doris Noble's workers' compensation claim for a bilateral knee injury. The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the Administrative Law Judge's (WCJ) finding of 100% permanent total disability. This decision relied heavily on the agreed medical evaluator's opinion and the vocational expert's assessment that the applicant's chronic pain, medication, and severe physical limitations rendered her unable to benefit from vocational rehabilitation. The Board also admonished the defense attorney for improperly citing an unpublished case.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorPermanent Total DisabilityVocational ExpertFuture Earning CapacitySheltered WorkshopOrthopedic InjuriesChronic Pain SyndromeMedication Intake
References
Case No. ADJ10443669
Regular
Oct 04, 2017

Donna Carter vs. Rose International Group, OneBeacon Insurance Group

The Appeals Board affirmed the Workers' Compensation Judge's finding that Donna Carter sustained an industrial injury to her right knee and left wrist on May 18, 2016. Despite inconsistencies in the applicant's testimony regarding a slip and fall incident, her account was corroborated by a witness who found her on the floor. Medical records from the day of the incident also supported the applicant's claim, establishing a clear mechanism of injury. The Board found that the common sense nature of a slip and fall does not require expert medical opinion to establish industrial causation for the incident itself.

ADJ10443669Rose International GroupOneBeacon Insurance GroupDonna CarterWorkers' Compensation Appeals BoardOpinion and Decision After Reconsiderationslip and fallindustrial injuryright kneeleft wrist
References
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