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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
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. 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. ADJ9709726
Regular
Jun 25, 2015

LAURA NUNEZ vs. SUTTER PACIFIC MEDICAL FOUNDATION, SUTTER HEALTH

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the finding of industrial injury AOE/COE for thoracic outlet syndrome, arguing it wasn't an issue for trial and the medical evidence was insufficient. The Board found that thoracic spine injury was an issue and that Dr. Avery's opinion provided substantial medical evidence to support the thoracic outlet syndrome finding. Any potential defects in the original WCJ opinion were cured by the WCJ's subsequent report.

Thoracic outlet syndromeAOE/COEPetition for Reconsiderationsubstantial medical evidenceG. James Avery M.D.Steven Bratman M.D.industrial injuryapportionmentWCJlabor code 5313
References
1
Case No. 2021-06-0210
Regular Panel Decision
Mar 27, 2024

Dawson, Beandy v. Optum services, Inc.

Brandy Dawson, a nurse for Optum Services, Inc., sustained injuries in June 2019 after a fall. While Optum accepted the initial claim, Dawson later developed symptoms consistent with thoracic outlet syndrome, which her authorized physicians struggled to diagnose or relate to her employment. Despite an authorized physician's referral to a brachial plexus specialist, Optum denied further specialized treatment. Dawson sought her own expert, Dr. Robert Thompson, who diagnosed neurogenic thoracic outlet syndrome and causally linked it to her work fall, recommending surgery. The Court found Dr. Thompson's opinion compelling, concluding that Dawson's thoracic outlet syndrome is work-related and that Optum unjustly denied treatment, thus granting medical treatment with Dr. Thompson and temporary total disability benefits.

Thoracic Outlet SyndromeNeurogenic TOSBrachial Plexus InjuryWork-Related InjuryMedical Treatment DisputeTemporary Disability BenefitsExpert Medical OpinionCausationPhysician ReferralDenial of Benefits
References
5
Case No. 2019-03-0262
Regular Panel Decision
Mar 11, 2021

Mays, April v. Fast Pace Medical Clinic, PLLC

April Mays, an employee, fell at work and initially received treatment for her neck and cervical spine. She sought additional treatment for her lumbar and thoracic spine, which Fast Pace Medical Clinic, PLLC, denied. The Court reviewed conflicting medical opinions from Dr. Paul Johnson, the panel-selected physician, and Dr. C.M. Salekin, an independent medical examiner. Dr. Salekin diagnosed lumbosacral radiculopathy and probable rod displacement related to the fall, recommending further evaluation. The Court found Ms. Mays presented sufficient proof to rebut Dr. Johnson's causation opinion, which stated the lumbar and thoracic pain was unrelated to the work injury without detailed explanation. Therefore, the Court granted Ms. Mays's claim for the requested lumbar and thoracic MRIs and an orthopedic evaluation.

Workers' CompensationExpedited HearingMedical Treatment DenialCausation DisputeIndependent Medical Examination (IME)Pre-existing Condition AggravationLumbar Spine InjuryThoracic Spine InjuryCervical RadiculopathyOrthopedic Evaluation
References
1
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. 2016-06-1026
Regular Panel Decision
Sep 26, 2016

Bailey, Sr., Jerry W. v. Team Construction, LLC

This case concerns Jerry W. Bailey, Sr.'s request for an expedited hearing regarding medical treatment, reimbursement for past medical treatment, and temporary disability benefits, following a workplace back strain and the subsequent discovery of a thoracic mass. The central legal question revolved around whether the thoracic mass was caused by or aggravated by the workplace accident, thereby necessitating additional medical care and resulting in his inability to work. The Court, presided over by Judge Joshua Davis Baker, found that Mr. Bailey failed to provide sufficient expert medical proof to establish a causal relationship between his workplace accident and the thoracic mass, especially in light of Dr. Daniel Burrus's opinion. Consequently, the Court denied Mr. Bailey's requested relief, concluding that he was unlikely to succeed on the merits without countervailing medical evidence.

Medical CausationThoracic MassBack StrainExpedited HearingTemporary Disability BenefitsMedical Treatment ReimbursementBurden of ProofExpert Medical TestimonyCausation TheoryOccupational Injury
References
7
Case No. ADJ6626529
Regular
Nov 05, 2015

NICOLAS WALKER vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further study the issues in this case. The WCAB rescinded the prior Findings of Fact & Award, denied the defendant's motion to be relieved of stipulation regarding the thoracic spine, and found that the applicant sustained industrial injury to his cervical spine, shoulders, and thoracic spine. The WCAB deferred issues of permanent disability, apportionment, and attorney's fees, returning the matter to the WCJ for further record development.

Workers' Compensation Appeals BoardNicolas WalkerLos Angeles Unified School DistrictSedgewick Claims Management ServicesInc.ADJ6626529Opinion and Decision After ReconsiderationFindings of Fact & AwardWCJcervical spine
References
5
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