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

Case No. ADJ10934545
Regular
Aug 23, 2019

Richard Rodriguez vs. CPG FOODS, LLC/GALA FOOD, Cannon Cochran Management Services Inc.

The Appeals Board granted reconsideration and modified the original award, finding that the Qualified Medical Examiner's (QME) apportionment opinion lacked substantial evidence. The Board reversed the original 12% permanent disability finding, awarding 16% based on the QME's impairment rating after reviewing surveillance video evidence. The Board also clarified that treating physician reports from Dr. Mahboubian and Dr. Ahmed are admitted into evidence and may be relied upon. Finally, the Board affirmed the original findings regarding the injured body parts and the permanent and stationary date.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardApplicantDefendantsInjury AOE/COEUpper BackHipsKneesTemporary Total Disability
References
Case No. ADJ7558401
Regular
May 28, 2013

ROBERT RICE vs. PROCUT, LLC, ZENITH INSURANCE COMPANY

The WCAB granted reconsideration to address the defendant's challenge to the 45% permanent disability award. The defendant argued the Qualified Medical Evaluator's (PQME) opinion was unsubstantiated, particularly regarding the lumbar spine rating and the inclusion of pain impairment. The WCAB found the PQME's reports lacked sufficient rationale and explanation, failing to adequately justify the Almaraz-Guzman rating. Consequently, the WCAB rescinded the award and returned the case for further medical record development.

Workers' Compensation Appeals BoardProCut LLCZenith Insurance CompanyRobert Ricepermanent disabilityqualified medical evaluatorPQMEDr. Sanjay Chauhanwhole person impairmentAMA Guides
References
Case No. ADJ7614022
Regular
Apr 26, 2013

DESMOND BAILEY vs. IRON MOUNTAIN, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration, rescinded the initial award, and returned the case for further proceedings because the Agreed Medical Examiner's (AME) disability rating was not substantially supported by medical evidence. The AME failed to adequately justify his departure from the standard AMA Guides methodology, relying instead on an alternative section without sufficient explanation. The Board also dismissed the defendant's petition for removal, finding the procedural due process claim moot and lacking extraordinary circumstances. The matter will be returned to the trial level for development of the record and a new decision on permanent disability, with parties to address Labor Code section 4658(d).

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAgreed Medical ExaminerAMA GuidesWhole Person ImpairmentPermanent Disability RatingCumulative TraumaLabor Code section 4658(d)DRE Category II
References
Case No. ADJ6796006
Regular
Feb 18, 2011

MIGUEL ESPINOZA vs. SOUTHWEST AIRLINES, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding 12% permanent disability for cervical and thoracic spine injuries. The Board rescinded the prior award, finding the medical opinion supporting the 12% disability was not substantial evidence as it unreasonably departed from AMA Guides criteria. Consequently, the Board issued a new award finding 0% permanent disability and no attorney fees.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityDRE Cervical Category IDRE Thoracic Category IAMA Guides Fifth EditionWhole Person ImpairmentSubstantial Medical EvidenceDisability Evaluation Unit
References
Case No. ADJ10551600
Regular
Mar 02, 2018

JOSE TORRES vs. COUNTY OF STANISLAUS, YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration because the primary treating physician's opinion, which formed the basis of the award, was not supported by substantial evidence. The physician's impairment ratings for the applicant's neck and back were based on outdated strength testing results from 1.5 years prior to his report and conflicted with more recent findings. The Board found the physician's examination inadequate, thus rescinding the award and remanding the case for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Award OpinionPermanent Disability RatingSubstantial EvidencePrimary Treating PhysicianQualified Medical EvaluatorJamar TestingOutdated Testing ResultsInadequate Examination
References
Case No. ADJ10339693
Regular
Mar 16, 2019

CATHERINE WILSON vs. STOCKTON UNIFIED SCHOOL DISTRICT, YORK RISK SERVICES

The Workers' Compensation Appeals Board granted reconsideration to address the WCJ's decision regarding the applicant's industrial injury. The Board affirmed the finding of injury to the lumbar spine and the need for further medical treatment for that injury. However, all other issues, including injury to the shoulders and thoracic spine and the determination of permanent disability, were deferred due to the WCJ's inadequate explanation and analysis. Further proceedings are required to develop the record and clarify disputed medical opinions before a final decision on all issues can be made.

WCABPetition for ReconsiderationFindings of FactAward and OrdersIndustrial InjuryLumbar SpineThoracic SpineShouldersTemporary DisabilityPermanent Disability
References
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
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
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
Case No. OAK 0321116
Regular
Jun 25, 2008

RANDALL MINVIELLE vs. COUNTY OF CONTRA COSTA / CONTRA COSTA FIRE

The Workers' Compensation Appeals Board rescinded the prior award because the defendant failed to prove overlap between the applicant's 2004 and 1992 back injuries. Apportionment under Labor Code section 4664 was improper as the permanent disability from each injury was rated under different standards (1950 schedule vs. AMA Guides). The case was returned to the trial level to determine if both injuries could be rated under the same standard for proper apportionment.

Workers' Compensation Appeals BoardRandall MinvielleCounty of Contra CostaContra Costa Firelegally uninsuredOAK 0321116Opinion and Decision After Reconsiderationindustrial injuryfirefighterback injury
References
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