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Case Law Database

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

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. 2023 NY Slip Op 03113 [217 AD3d 1382]
Regular Panel Decision
Jun 09, 2023

Sywak v. Grande

Plaintiff William M. Sywak commenced an action seeking damages for injuries allegedly sustained in a motor vehicle accident, naming Barbara Grande and Joseph D. Dwyer and Robert D. Dwyer (Dwyer defendants) as parties. Plaintiff alleged serious injuries under various categories of Insurance Law § 5102 (d) and claimed economic loss beyond basic economic loss. The Supreme Court partially granted the defendants' motion for summary judgment, dismissing some serious injury claims but preserving others, including those for lumbar spine injuries. On appeal by the Dwyer defendants, the Appellate Division, Fourth Department, modified the Supreme Court's order. The appellate court granted the Dwyer defendants' motion to dismiss claims related to plaintiff's cervical spine, left hip, left arm, left shoulder, and left leg injuries under Insurance Law § 5102 (d), and also dismissed the claim for economic loss in excess of basic economic loss, noting plaintiff's prior unemployment due to a workers' compensation accident. However, the Appellate Division affirmed the denial of the motion regarding plaintiff's lumbar spine injury under the permanent consequential limitation of use and significant limitation of use categories, finding a triable issue of fact.

Motor Vehicle AccidentSerious InjuryInsurance LawSummary JudgmentAppellate DivisionCervical Spine InjuryLumbar Spine InjuryPermanent Consequential Limitation of UseSignificant Limitation of Use90/180-Day Category
References
17
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. 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. MISSING
Regular Panel Decision

Malburg v. Keller

Plaintiff commenced a personal injury action following a motor vehicle accident. The defendant moved for summary judgment, arguing the plaintiff did not sustain a serious injury under Insurance Law § 5102 (d), and the Supreme Court granted this motion, dismissing the amended complaint. On appeal, the court modified the order by denying the motion in part. It reinstated the amended complaint concerning the significant limitation of use category of serious injury for the plaintiff's cervical spine injury. This modification was based on an independent medical examination report establishing a triable issue of fact.

Personal InjuryMotor Vehicle AccidentSummary JudgmentSerious InjuryInsurance LawCervical Spine InjuryRange of MotionIndependent Medical ExaminationAppellate ReviewWorkers' Compensation
References
1
Case No. MISSING
Regular Panel Decision

Weaver v. Town of Penfield

Gerald F. Weaver, a paramedic supervisor, and other plaintiffs, sued Penfield Volunteer Emergency Ambulance Service, Inc. and the Town of Penfield for injuries sustained in an ambulance collision. Plaintiffs moved for partial summary judgment on liability and serious injury to Weaver's left shoulder, while defendant cross-moved to dismiss, arguing no serious injury occurred. The Supreme Court initially found triable issues on serious injury. However, the appellate court determined the lower court erred in considering an unalleged injury category and ultimately concluded that defendant had established a lack of serious injury. The appellate court found plaintiffs failed to provide objective medical evidence to support a serious injury claim, particularly regarding the left shoulder, and noted no cervical spine injury was alleged. Consequently, the appellate court granted defendant's cross-motion and dismissed the complaint against the defendants.

Personal InjuryMotor Vehicle AccidentSerious Injury ThresholdInsurance LawSummary JudgmentAppellate ReviewMedical EvidenceObjective FindingsShoulder InjuryRange of Motion
References
9
Case No. ADJ7924562
Regular
Sep 19, 2014

RAUL HERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The applicant sought reconsideration of a WCJ decision that found an industrial injury to the low back but not the cervical spine or left ankle, with no permanent disability or further medical treatment. The applicant argued the QME's reports were insubstantial and that prior permanent disability was not considered. The Appeals Board granted reconsideration to amend the original award to include injury to the cervical spine, affirming the remainder of the decision. Therefore, the applicant sustained injury to his low back and cervical spine.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryCervical Spine InjuryPermanent DisabilityFurther Medical TreatmentPanel Qualified Medical EvaluatorLabor Code Section 4664(b)
References
0
Case No. MISSING
Regular Panel Decision

Claim of Pulos v. Asplundh Tree

Claimant, a tree trimmer, had an existing claim for bilateral carpal tunnel syndrome and later sought to include a cervical spine condition as an occupational disease. A workers' compensation law judge initially disallowed this amendment, but the Workers' Compensation Board reversed, finding the cervical condition was dormant and non-disabling, and that the claimant's work activities aggravated it. The employer appealed this decision. The court affirmed the Board's ruling, concluding there was substantial evidence to support the finding that the claimant's preexisting cervical condition was activated by the distinctive features of his employment.

Occupational DiseaseCervical Spine InjuryCarpal Tunnel SyndromePreexisting ConditionAggravation of InjuryWorkers' Compensation LawJudicial ReviewAppellate DecisionTree TrimmingWork Activities
References
3
Case No. ADJ1337074 (GRO 0034564) ADJ1286218 (GRO 0034565)
Regular
Jun 24, 2009

Dave Gerletti vs. SANTA MARIA AIRPORT DISTRICT, GREGORY BRAGG STOCKTON

The Workers' Compensation Appeals Board denied Dave Gerletti's petition for reconsideration of an award for a cumulative trauma injury to his cervical spine and lungs. The original award found 35% permanent disability, apportioning 50% of the cervical spine disability to non-industrial factors based on a Qualified Medical Evaluator's opinion of degenerative changes. The majority affirmed the WCJ's reliance on this opinion, finding it adequately explained. A dissenting opinion argued the QME's apportionment was speculative and improperly based on age and genetics, recommending an unapportioned award for the cervical spine injury.

Workers' Compensation Appeals Boardcumulative traumacervical spinelungspermanent disabilityapportionmentQualified Medical EvaluatorAgreed Medical Examinerarthritic degenerationnon-industrial factors
References
1
Case No. ADJ7288330
Regular
Oct 03, 2016

GLORIA BENITEZ vs. NEWPORT SUBACUTE HEALTH CARE CENTER, ALASKA NATIONAL INSURANCE COMPANY

The applicant, Gloria Benitez, sought to reopen her workers' compensation claim to include injury to additional body parts beyond her cervical spine and psyche. The original award found injury only to the cervical spine and psyche, with a 19% permanent disability rating for the cervical spine. While the WCJ's initial decision denied injury to additional body parts, the Board granted reconsideration. The Board amended the original findings to defer the issue of injury to the alleged additional body parts, while affirming other aspects of the WCJ's order, including the appointment of a regular physician to evaluate new and further disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderNew and Further DisabilityAgreed Medical ExaminerRegular PhysicianLabor Code Section 5410Petition to ReopenIndustrial InjuryCervical Spine
References
4
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