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

Case No. ADJ9344211
Regular
Dec 01, 2017

Patricia Preston vs. Los Angeles Unified School District, SEDGWICK CLAIMS MANAGEMENT SERVICES

The applicant sought reconsideration of a workers' compensation award, challenging the permanent disability rating primarily based on the chosen medical evaluation method. The applicant argued the Range-of-Motion (ROM) method, favored by her treating physician, should have been used instead of the Diagnosis-Related Estimates (DRE) method employed by a Qualified Medical Evaluator (QME). Additionally, she contended that her vocational expert's opinion supported a finding of total permanent disability. The Board denied reconsideration, affirming the administrative law judge's decision, finding the QME's DRE rating supported by substantial evidence and the applicant's vocational evidence insufficient to prove total disability. A dissenting opinion argued that findings of multi-level spinal involvement supported the use of the ROM method for a potentially higher rating and questioned the QME's justification for choosing DRE.

Workers' Compensation Appeals BoardPatricia PrestonLos Angeles Unified School DistrictSedgwick Claims Management ServicesADJ9344211Permanent Disability RatingRange-of-Motion MethodDiagnosis-Related Estimates MethodApportionmentDr. Fenton
References
6
Case No. ADJ9376675
Regular
Oct 20, 2015

JESSICA FIELD vs. INGLEWOOD POLICE DEPARTMENT, ADMINSURE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the permanent disability rating, arguing the DRE method, rather than the ROM method, was improperly applied by the QME. The Board adopted the WCJ's report, which found the QME's reliance on the DRE method, specifically Category IV, was supported by substantial medical evidence and properly applied under the AMA Guides, Fifth Edition. The defendant's contention that the rating was invalid under *Blackledge* was also rejected, as the QME report met legal and regulatory requirements.

Workers' Compensation Appeals BoardPetition for ReconsiderationDENIEDINGLEWOOD POLICE DEPARTMENTADMINSUREPermanent DisabilityAMA Guides Fifth EditionDRE MethodLumbar Spine Category IVwhole person impairment
References
2
Case No. ADJ10489999
Regular
Feb 01, 2019

Sean Lawson vs. Zenith Insurance Company

This case involves a dispute over the permanent disability rating for applicant Sean Lawson's low back injury. The defendant, Zenith Insurance Company, argues that the Range of Motion (ROM) method used by the Qualified Medical Evaluator (QME) was inappropriate, and the Diagnosis-Related Estimates (DRE) method should have been applied as there was only one level of radiculopathy. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's finding that the ROM method was appropriate based on the QME's expert opinion and the AMA Guides' provision for its use with multi-level involvement. However, one Commissioner dissented, believing the DRE method was mandated given the lack of evidence for multi-level radiculopathy.

WCABPetition for ReconsiderationPermanent DisabilityApportionmentNon-industrial factorsDiagnosis-Related Estimates (DRE) methodRange of Motion (ROM) methodQualified Medical Evaluator (QME)AMA GuidesMultilevel radiculopathy
References
1
Case No. MISSING
Regular Panel Decision

Claim of Ayala v. DRE Maintenance Corp.

The dissenting opinion concerns whether the Workers’ Compensation Board erred in finding a causal relationship between the decedent’s depression, resulting from a 1978 shooting accident, and his death in 1988. The dissent argues that substantial evidence supports the Board's finding. Dr. Hugo Morales, the decedent’s treating psychiatrist, clearly testified that while drug-alcohol abuse was the immediate cause of death, the decedent's severe and unabated 10-year depression was also a contributing factor. Dr. Morales’ medical opinion, meeting the "significant probability” and "rational basis” tests, indicated a clear relationship between the emotional status and death. Therefore, the dissenting justices would affirm the Board's decision.

Workers' CompensationDepressionCausationDeath BenefitsMedical TestimonyPsychiatric EvaluationCausal RelationshipDrug-Alcohol AbuseDissenting OpinionTreating Physician
References
1
Case No. ADJ9473303
Regular
Oct 30, 2017

PEDRO SOTELO vs. TRI-STATE EMPLOYMENT SERVICES, INC. dba PIRATE STAFFING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FOR LUMBERMEN'S UNDERWRITING ALLIANCE in liquidation, SEDGWICK

The Appeals Board granted reconsideration, finding the Agreed Medical Evaluator's (AME) reports lacked substantial evidence for permanent disability and apportionment due to unexplained DRE Category II ratings. However, the Board amended the order to not strike the AME's reports entirely, as good cause was not shown for their exclusion. The case is returned to the trial level for further development of the record regarding permanent disability and apportionment, potentially through a new AME or QME.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAgreed Medical Evaluator (AME)Permanent DisabilityApportionmentSubstantial EvidenceDRE Category IIAMA GuidesWhole Person Impairment (WPI)
References
9
Case No. MON 0339411
Regular
Jul 21, 2008

Dionisio Jimenez vs. NUPAC APARTMENTS, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over the proper method used to rate the applicant's permanent disability following a back and leg injury. The defendant contends the Agreed Medical Examiner improperly used the Range of Motion (ROM) method instead of the Diagnosis-Related Estimate (DRE) method per the AMA Guides. The Appeals Board rescinded the prior award and returned the case to the trial level for further development of the record. This development will address why the ROM method was used and clarify the appropriate rating methodology.

Workers' Compensation Appeals BoardDionisio JimenezNupac ApartmentsState Compensation Insurance FundMON 0339411Opinion and Decision After ReconsiderationFindings and AwardIndustrial InjuryBack InjuryRight Leg Injury
References
2
Case No. ADJ7669411
Regular
Jul 23, 2013

OSCAR HUERTA vs. HIGGINS & LOVETT CONSTRUCTION, TOWER SELECT INSURANCE CO.

This case involves a workers' compensation claim for a laborer injured on November 2, 2010, to his neck and back. The defendant disputes the finding of 51% permanent disability, primarily arguing that the panel qualified medical evaluator's (PQME) report was not substantial evidence. The Appeals Board has granted reconsideration to further review the PQME's lumbar impairment rating, specifically questioning whether "non-verifiable radicular complaints" sufficiently supported the DRE Category III rating. The Board has rescinded the prior award and returned the case for further development of the record.

Occupational Group 480Panel Qualified Medical Evaluator (PQME)Dr. DawdyDRE Category IIIRadiculopathyLumbar ImpairmentSubstantial Medical EvidenceFurther Development of the RecordAmended Findings and AwardLumbar Spine
References
6
Case No. ADJ9854290
Regular
Apr 10, 2017

MARY VIEIRA vs. PASO ROBLES TANK, INCORPORATED., OLD REPUBLIC GENERAL INSURANCE CORPORATION, GALLAGHER BASSETT SERVICES

This case involves defendant's petition for reconsideration of a finding of total permanent disability due to an admitted industrial right ankle injury complicated by Complex Regional Pain Syndrome (CRPS). Defendant argues the Qualified Medical Evaluator's (QME) report lacks substantial evidence due to failure to review prior injury records and for not using DRE ratings. The Appeals Board granted reconsideration to admit a supplemental QME report that reviewed the prior injury records and did not alter the QME's opinions. The Board intends to admit this supplemental report unless good cause is shown within 15 days.

Complex Regional Pain SyndromeCRPSQualified Medical EvaluatorQMEsubstantial evidenceDRE ratingsAMA Guidessupplemental reportPetition for ReconsiderationFindings and Award
References
0
Case No. ADJ6820630
Regular
Mar 19, 2018

MARK COLLINS vs. ENTERTAINMENT PARTNERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The WCAB dismissed the Defendant's Petition for Reconsideration because it was not filed from a final order. The Board granted the Defendant's Petition for Removal to rescind the WCJ's order vacating submission and appointing a new physician. The WCJ erred by refusing to accept the AME's rating based on the Diagnosis-Related Estimate (DRE) method, as physicians have discretion to use the most accurate method. However, the AME's own deposition testimony indicated that the Range of Motion (ROM) method, mandated by the WCJ, would yield a higher impairment rating. Therefore, the matter is returned to the trial level for the WCJ to obtain a permanent disability rating using the existing record and potentially consulting a DEU rater.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAgreed Medical Examiner (AME)Range of Motion (ROM) methodDiagnosis-Related Estimates (DRE) methodAmerican Medical Association's Guides (AMA Guides)Whole Person Impairment (WPI)cumulative traumaspinal injury
References
6
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