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

Case No. GRO 0029816, GRO 0029817
Significant

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision to apportion 50% of the applicant's permanent disability to a preexisting degenerative arthritis, holding that Labor Code section 4663, as amended by SB 899, permits apportionment based on causation from non-industrial factors supported by substantial medical evidence.

SB 899apportionmentcausationpermanent disabilitypreexisting arthritismedical evidencesubstantial evidenceLabor Code section 4663compensable consequenceQME
References
Case No. ADJ8032740
Regular
Sep 17, 2014

LAURA RAMIREZ vs. LOYOLA MARYMOUNT UNIVERSITY, TRAVELERS

This case involved a custodian injured on the job, causing admitted industrial injury to her knee and lumbar spine. The Administrative Law Judge apportioned 50% of the permanent disability to pre-existing arthritis, a decision the applicant contested. The Workers' Compensation Appeals Board denied reconsideration, finding the apportionment supported by medical evidence indicating the industrial injury and pre-existing arthritis jointly necessitated knee replacement surgery. This aligns with precedent requiring apportionment to all causative factors, including underlying pathology.

ApportionmentPre-existing arthritisIndustrial injuryPermanent disabilityWCJPetition for reconsiderationLabor Code 4663PQMEOrthopaedic surgeonArthroplasty
References
Case No. GRO 0029816, GRO 0029817
En Banc

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision, holding that under Labor Code section 4663 as amended by SB 899, apportionment of permanent disability is based on causation and may include pre-existing, non-industrial conditions like degenerative arthritis, provided there is substantial medical evidence to support the percentage of non-industrial causation.

SB 899ApportionmentCausationPermanent DisabilityPreexisting ConditionDegenerative ArthritisSubstantial Medical EvidenceMedical ProbabilityLabor Code Section 4663Compensable Consequence
References
Case No. ADJ3625445 (AHM 0123968)
Regular
Mar 01, 2010

DAVID ROMAN vs. REGENTS, UNIVERSITY OF CALIFORNIA, Permissibly Self-Insured, Adjusted By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn a finding of 5% permanent disability after apportionment for a neck injury, arguing the medical examiner's opinion was not substantial evidence and that treatment couldn't be apportioned. The Board found the administrative law judge's reliance on the medical examiner's opinion, which attributed the worsening condition to pre-existing degenerative arthritis, was supported by substantial evidence. The Board also clarified that further medical treatment was awarded, but surgery specifically would be considered non-industrial due to the apportionment finding.

Workers Compensation Appeals BoardPermanent DisabilityApportionmentQualified Medical ExaminerSubstantial EvidenceIndustrial InjuryNeck InjuryReconsiderationWCJMMI
References
Case No. ADJ2543168
Regular
May 17, 2010

CHARLES POPPER vs. WESTSIDE EXPRESS, INC, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that the Agreed Medical Examiner's (AME) opinion on apportionment was substantial evidence, despite the original judge's finding of 100% permanent disability. The AME concluded that 25% of the applicant's permanent disability was attributable to pre-existing degenerative arthritis, consistent with recent legislative changes requiring apportionment based on causation. The Board determined that the AME's report met the criteria for substantial evidence, necessitating a re-evaluation of the disability rating.

Workers' Compensation Appeals BoardReconsiderationApportionmentLabor Code Section 4663Senate Bill 899Agreed Medical Examiner (AME)Jamie Contreras M.D.Permanent DisabilityCausationPreexisting Degenerative Arthritis
References
Case No. ADJ423782 (ANA 0339569)
Regular
Feb 19, 2013

MYRA KARAMANOS vs. NEWPORT-MESA UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Administered by KEENAN & ASSOCIATES

The Workers' Compensation Appeals Board granted reconsideration, amending the applicant's permanent disability rating from 70% to 78%. The Board found the Agreed Medical Evaluator's apportionment of two-thirds of the disability to non-industrial causes lacked substantial medical evidence. Specifically, the AME failed to adequately explain how degenerative conditions contributed to the applicant's current disability, leading the Board to affirm the WCJ's decision without apportionment. The revised award reflects 78% permanent disability and a life pension.

Workers' Compensation Appeals BoardNewport-Mesa Unified School DistrictKeenan & AssociatesPermanent DisabilityLife PensionApportionmentAgreed Medical EvaluatorDr. Larry DanzigDisability Evaluation UnitArduous Employment
References
Case No. ADJ9743499 ADJ10108398
Regular
Oct 01, 2018

JOHN MCGEE vs. CITY OF VACAVILLE

The Workers' Compensation Appeals Board granted defendant City of Vacaville's Petition for Removal, rescinding the prior order that closed discovery and set a trial date. The Board found that closing discovery prematurely would cause significant prejudice to the defendant. This decision stems from the defendant's ongoing, diligent efforts to conduct further discovery, specifically deposing a physician who relocated, while also pursuing global settlement options that included a related civil claim. The case is returned to the trial level for a status conference to determine future proceedings.

Petition for RemovalWCABWCJDiscovery ClosurePrejudiceIrreparable HarmQME PanelDegenerative Disc DiseaseAcromioclavicular ArthritisGlenohumeral Arthritis
References
Case No. SAC 296205
Regular
Jun 11, 2008

EDWARD A. CASEY vs. CITY OF FULLERTON

This case involved a firefighter/paramedic seeking increased permanent disability for knee injuries. The Appeals Board denied reconsideration, upholding the administrative law judge's decision. The judge's decision was based on the agreed medical examiner's opinion, which apportioned 30% of the permanent disability to non-industrial factors, including a prior knee injury and the natural progression of arthritis.

ApportionmentAgreed Medical Evaluator (AME)Permanent DisabilityCausationLabor Code Section 4663Labor Code Section 4664Firefighter/ParamedicKnee InjuryTotal Knee ReplacementOsteoarthritis
References
Case No. ADJ1224504 (MON 0254221)
Regular
Jun 30, 2010

ALEX JOHNSON vs. CITY OF LOS ANGELES, Permissibly Self-Insured

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the trial judge's finding of no apportionment for the applicant's knee disability. The WCAB rescinded the prior decision and returned the case for further proceedings and a new decision. This was based on the deposition testimony of the Agreed Medical Evaluator (AME), Dr. Sohn, which provided substantial medical evidence for apportionment. Dr. Sohn's opinion addressed the increase in disability due to industrial factors versus non-industrial factors such as weight and the natural progression of arthritis, consistent with apportionment statutes.

ApportionmentAgreed Medical Evaluator (AME)Permanent DisabilityReconsiderationFindings and AwardWCJSubstantial Medical EvidenceContinuous TraumaReopenCourt of Appeal
References
Case No. ADJ2748573
Regular
May 11, 2009

THOMAS HERNON vs. COUNTY OF SANTA CLARA

The Appeals Board granted reconsideration, reversing the prior finding on the applicant's occupational group number from 560 to 380 (painter), based on evidence of the applicant's actual job duties. The Board also modified the decision regarding apportionment, accepting the Agreed Medical Evaluator's opinion that 10% of the disability should be apportioned to pre-existing degenerative disease. However, the Board affirmed the application of the 1997 Permanent Disability Rating Schedule, as temporary disability payments were terminated before January 1, 2005, triggering notice requirements. Ultimately, the applicant's permanent disability was reduced to 63% after apportionment.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardApplicantDefendantPublic Service WorkerOccupational Group NumberIndustrial InjuryLow BackNeck
References
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