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

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. ADJ635934
Regular
Sep 09, 2010

FRANCES LARUE vs. NORDMAN, CORMANY, HAIR & COMPTON, STATE COMPENSATION INSURANCE FUND

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's award finding permanent total disability and no apportionment for an applicant's back injury. The Board rescinded the award, finding the judge erred by relying on an orthopedist's opinion that failed to properly apportion disability to pre-existing scoliosis. The case is remanded for further proceedings to incorporate the apportionment opinion of the defendant's medical expert, who found 70% of the disability attributable to non-industrial scoliosis. A dissenting opinion argued that the defendant's medical expert's apportionment was also insufficient.

ApportionmentPermanent Total DisabilityQualified Medical EvaluatorOrthopedistDegenerative ScoliosisCausationLabor Code Section 4663Senate Bill 899Substantial EvidenceFindings and Award
References
Case No. ADJ10773450
Regular
Feb 20, 2018

RONALD WOODWARD vs. RESULTS RADIO, PACIFIC COMPENSATION INSURANCE COMPANY

The WCAB granted reconsideration to address the WCJ's finding that a QME's apportionment opinion lacked substantial evidence. The Board found that the QME's opinion, based on medical expertise and a recent MRI showing degenerative conditions, constituted substantial evidence despite the absence of pre-injury medical records. The WCAB rescinded the WCJ's findings and returned the case for further proceedings, including potentially obtaining a supplemental report from the QME after reviewing prior treatment records, and for a new decision on permanent disability and apportionment.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactQualified Medical EvaluatorApportionmentSubstantial EvidencePermanent DisabilityLumbar SpineLeft KneeLeft Ankle
References
Case No. ADJ3265357
Regular
Sep 09, 2009

MARTHA MENDEZ vs. YMCA OF SAN FRANCISCO, TRAVELERS WALNUT CREEK

The Workers' Compensation Appeals Board granted reconsideration and remanded the case to the trial level for recalculation of the permanent disability award. The Board found that the Agreed Medical Evaluator's (AME) opinion of November 8, 2007, which attributed 50% of the applicant's increased permanent disability to non-industrial degenerative changes supported by MRI studies, constituted substantial evidence. This opinion superseded the previous award, which did not adequately account for these degenerative conditions. Therefore, the Workers' Compensation Judge must now recalculate the permanent disability award based on this 50% non-industrial apportionment.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPetition to ReopenIndustrial InjuryPermanent DisabilityApportionmentAgreed Medical EvaluatorDegenerative ChangesMRI Studies
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. ADJ8062477
Regular
Apr 08, 2025

ANTONIO MARTINEZ vs. BARODA FARMS, ZENITH INSURANCE COMPANY

Antonio Martinez sustained an industrial injury to his cervical, thoracic, and lumbar spine while working for Baroda Farms, resulting in a 66% permanent partial disability award. Defendant Zenith Insurance Company petitioned for reconsideration of the initial Findings and Award (F&A) concerning apportionment and the application of Labor Code section 4658(d). The Workers' Compensation Appeals Board granted reconsideration, affirming the F&A but amending it to defer the issues of Labor Code section 4658(d) and attorney fees. The case has been returned to the trial level for further proceedings to ensure all parties receive due process.

WCABPetition for ReconsiderationFindings and AwardPermanent Partial DisabilityApportionmentLabor Code Section 4658(d)Substantial Medical EvidencePQMEMedical OpinionReasonable Medical Probability
References
Case No. ADJ8240882; ADJ8240881; ADJ8615401
Regular
Apr 21, 2025

ROBERT S. HAPPENY vs. STATE OF CALIFORNIA, CALIFORNIA INSTITUTE FOR WOMEN

Applicant Robert S. Happeny sustained industrial injuries during his employment as a correctional officer, leading to a finding of permanent and total disability by the WCJ due to his inability for vocational retraining. The WCJ also issued an unapportioned award, concluding that apportionment to nonindustrial factors was not proven. Defendant challenged this decision via a petition for reconsideration, disputing the method of combining disabilities and the reliability of vocational reports. The Appeals Board granted reconsideration, affirming the WCJ's determination of permanent and total disability based on vocational infeasibility and the lack of established apportionment, ultimately rescinding the original decision and substituting new findings of fact.

ADJ8240882ADJ8240881ADJ8615401correctional officerindustrial injuryheartpsycheright wristrespiratory systemlumbar spine
References
Case No. ADJ2552674 (STK 0182074), ADJ2434993 (LAO 0814353), ADJ815249 (STK 0199201)
Regular
Jan 24, 2012

CARLOS GASCA vs. HOWARD MARTIN FARMS, CIGA through its servicing facility INTERCARE INSURANCE for PAULA INSURANCE, in liquidation, CALIFORNIA INDEMNITY

The Workers' Compensation Appeals Board rescinded the prior award and remanded the case for further proceedings. The Board found that Dr. Abelow's medical opinion lacked substantial evidence due to factual inaccuracies and assumptions, particularly regarding the applicant's injury causation and apportionment. Additionally, Dr. Kimmel's psychiatric opinion failed to meet legal causation standards, deferring to orthopedic findings. The lien claimant's contentions will be reviewed anew by the WCJ upon remand.

Workers' Compensation Appeals BoardCarlos GascaHoward Martin FarmsCIGAIntercare InsurancePaula InsuranceCalifornia IndemnityJoint Findings and AwardAdministrative Law JudgeReconsideration
References
Case No. ADJ3843514
Regular
Sep 15, 2008

Ramona J. Ornelas vs. COUNTY OF SACRAMENTO

Reconsideration granted to address errors in permanent disability rating and apportionment. Matter returned for new rating considering walker use and clarifying apportionment.

RAMONA J. ORNELASCOUNTY OF SACRAMENTOADJ3843514SAC 0274104OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONLEFT MINOR SHOULDERLEFT MINOR WRISTBILATERAL KNEESPSYCHE
References
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
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