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

Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ2428736 (SJO 0217650)
Regular
Jan 26, 2017

PAMELA GRAHAM vs. MONTESSORI SCHOOL OF FREMONT; CIGA

This Workers' Compensation Appeals Board decision denies reconsideration, upholding the administrative law judge's finding that the defendant failed to meet their burden of proof on apportionment. The Board found the orthopedic agreed medical examiner's opinions on apportionment were not substantial evidence because they lacked detailed reasoning, failed to explain the causal connection between degenerative disc disease and permanent disability, and did not adequately address apportionment to non-industrial causes. Therefore, the defendant's petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedApportionmentBurden of ProofMedical OpinionReasonable Medical ProbabilitySpeculativePertinent FactsAdequate Examination
References
Case No. ADJ556119 (VNO 0500866), ADJ2527731 (VNO 0500867), ADJ3849638 (VNO 0500870)
Regular
Sep 10, 2013

ALVARO AGUILLA vs. FULLMER CONSTRUCTION COMPANY, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to review the applicant's permanent disability apportionment. The Board found the Agreed Medical Examiner's (AME) apportionment opinion regarding pre-existing degenerative disc disease and obesity to be inconsistent and lacking substantial medical evidence. Due to the AME's failure to provide a well-supported basis for apportionment, the Board rescinded the previous award. Consequently, the applicant was awarded 100% permanent disability without apportionment.

ApportionmentAgreed Medical Examiner (AME)Substantial Medical EvidencePermanent DisabilityWCJReconsiderationVocational RehabilitationCausationCumulative TraumaDegenerative Disc Disease
References
Case No. LBO 0327414
Regular
Jun 12, 2008

GREGORIO PEREZ vs. MSX INTERNATIONAL, CHUBB GROUP OF INSURANCE COMPANIES

The Workers' Compensation Appeals Board granted reconsideration to reduce applicant's permanent disability from 70% to 46% after apportionment. The Board found that while the applicant sustained an industrial injury to his left lower extremity and back, a significant portion of his back disability was attributable to pre-existing degenerative disc disease, as supported by medical evidence. The Board apportioned the back disability by comparing the applicant's current light work restriction to a prophylactic restriction from very heavy work due to his underlying condition.

ApportionmentPermanent DisabilityDegenerative Disc DiseaseIndustrial InjuryNon-Industrial FactorsMedical EvidenceSupplemental ReportDepositionWCJAppeals Board
References
Case No. ADJ3125678
Regular
Jul 01, 2011

CLORIA HSI vs. LOS ANGELES UNIFIED SCHOOL DISTRICT; Permissibly Self-insured, Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Workers' Compensation Appeals Board denied reconsideration of an apportionment decision. The applicant claimed her back injury and subsequent disability were entirely work-related and that she had no prior back issues. However, an Agreed Medical Evaluator (AME) found that pre-existing degenerative disc disease and scoliosis, evidenced by an MRI, were responsible for 50% of the applicant's permanent disability. The Board upheld the WCJ's decision to apportion based on the AME's opinion, as apportionment is permissible even for asymptomatic pre-existing conditions.

Workers' Compensation Appeals Boardapportionmentpermanent disabilityagreed medical evaluatordegenerative disc diseasescoliosislumbar spinedextroscoliosisnonindustrial causesasymptomatic condition
References
Case No. ADJ3649169
Regular
Feb 14, 2013

BRUCE LIBERTY vs. LOS ANGELES UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured

This case concerns an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) order denying his claim for lumbar spine injury. The applicant alleged a lumbar injury from a physical therapy incident following a compensable cervical and shoulder injury. The WCAB denied reconsideration, adopting the WCJ's report which relied on the Agreed Medical Examiner's (AME) opinion. The AME found no industrial injury to the lumbar spine, citing a lack of contemporaneous evidence and a history of degenerative disc disease. The WCAB determined the applicant's presented "new" evidence was either previously reviewed or unpersuasive, upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedBruce LibertyLos Angeles Unified School DistrictPermissibly Self-InsuredCase Number ADJ3649169Workers' Compensation Administrative Law JudgeAgreed Medical ExaminerLumbar Spine Injury
References
Case No. ADJ1702463
Regular
Jul 11, 2011

SONYA WILLIAMS vs. APOLLO COURIERS, SUA INSURANCE COMPANY

This case concerns Sonya Williams' petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB denied her petition, upholding the administrative law judge's finding that her industrial injury to the neck and upper back on December 3, 2007, caused 18% permanent disability after 50% apportionment to pre-existing degenerative disc disease. The applicant argued the Agreed Medical Examiner's (AME) apportionment was not substantial evidence and that a credit for her third-party settlement was improperly allowed. The WCAB found the AME's opinion was substantial evidence, well-reasoned, and based on adequate evaluation and review of medical records. The WCAB adopted the judge's reasoning, denying reconsideration.

Workers Compensation Appeals BoardReconsiderationFindings and AwardStipulationsIndustrial InjuryThird Party ClaimNet RecoveryPermanent DisabilityApportionmentAgreed Medical Examiner
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ9184413
Regular
Oct 27, 2020

JEFFREY SPRINGER vs. RJ DONOVAN CORRECTIONAL FACILITY, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by Jeffrey Springer against RJ Donovan Correctional Facility. The Applicant sustained injuries resulting in industrially caused hypertension, hypertensive kidney disease, and hypertensive heart disease. The primary dispute centered on how to combine a prior 28% permanent disability rating for kidney disease with a new 49% rating for heart disease. The defendant argued these were part of a single cardiovascular system and sought to subtract the prior award's monetary value from the new rating. The WCJ found the injuries to the kidney and heart were distinct, justifying combining them, and awarded 63% permanent disability after deducting the prior award's value. The Appeals Board denied the defendant's petition for reconsideration, adopting the WCJ's reasoning.

Workers Compensation Appeals BoardRJ Donovan Correctional FacilityLegally UninsuredState Compensation Insurance FundPetition for ReconsiderationPermanent DisabilityHypertensionHypertensive Kidney DiseaseHypertensive Heart DiseaseHypertensive Cardiovascular Disease
References
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