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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
58
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
56
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
9
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
6
Case No. MISSING
Regular Panel Decision

Matter of Levitsky v. Garden Time, Inc.

Claimant sustained a work-related right shoulder injury in 2009. The Workers’ Compensation Board (WCB) awarded schedule loss of use (SLU) but apportioned the award, attributing most of the disability to preexisting degenerative arthritis and a 1981 injury, and only 10% to the 2009 injury. The appellate court reversed this decision, ruling that apportionment was improper. The court reasoned that a preexisting condition, even if symptomatic, does not warrant apportionment unless it was disabling in a compensation sense before the current injury. Since the claimant remained fully employed and capable of performing duties despite prior shoulder issues, the prior conditions were not considered disabling. Therefore, the claimant is entitled to the full 60% SLU award for the 2009 injury.

Workers' CompensationSchedule Loss of UseApportionmentPreexisting ConditionDegenerative ArthritisShoulder InjuryDisabilitySymptomaticAppellate ReviewReversed
References
7
Case No. MISSING
Regular Panel Decision

De La Cruz v. Chater

Pro se plaintiff Brígida De La Cruz challenged the Commissioner's denial of her application for disability benefits, alleging disability due to degenerative disc disease and arthritis. The Administrative Law Judge previously found that Ms. De La Cruz was not disabled and could return to her work as a sewing machine operator, a decision affirmed by the Appeals Council. In this federal action, the court reviewed extensive medical evidence from various treating and consultative physicians, including expert testimony from an orthopedist. The court ultimately found that the medical evidence supported the ALJ's conclusion that Ms. De La Cruz retained the residual functional capacity to perform light work, despite her back condition. Consequently, the Commissioner's motion for judgment on the pleadings was granted, affirming the denial of disability benefits.

Disability BenefitsDegenerative Disc DiseaseChronic Back PainResidual Functional CapacityAdministrative Law Judge (ALJ)Social Security AdministrationMedical Expert TestimonySubstantial Evidence ReviewJudgment on the PleadingsPro Se Plaintiff
References
3
Case No. MISSING
Regular Panel Decision
May 20, 1996

Roman v. 1185 Avenue of the Americas Associates

This case involves an appeal from an order granting the plaintiff, Victor Roman, leave to amend his bill of particulars to include additional injuries. Roman filed an action in 1989 for injuries sustained in a 1987 job site accident, initially alleging traumatic degenerative arthritis and torn muscles in his left hip. After undergoing hip replacement surgeries in 1992 and 1994, a stipulation was made in 1994 with defendant A.J. Contracting Co., allowing for further discovery if the hip surgeries were later alleged to be causally related. In 1996, Roman moved to amend his bill of particulars to include these surgeries, supported by proof of workers' compensation coverage due to the causal connection. The court granted this motion, and the appellate court affirmed, citing the policy of freely allowing amendments in the absence of prejudice, which the defendants failed to demonstrate.

Personal injurySlip and fallConstruction accidentHip replacementBill of particularsLeave to amendStipulationCausal connectionWorkers' compensationPrejudice
References
1
Case No. MISSING
Regular Panel Decision

Balodis v. Leavitt

Plaintiff John Balodis sought review of the Commissioner of Social Security's decision denying him disability insurance benefits. The Commissioner found Balodis capable of work, but Balodis alleges disability since December 2003 due to multiple injuries, including a left hip fracture and advanced degenerative arthritis of the left knee. The court reviewed the ALJ's decision, which primarily relied on opinions from Dr. Skeene and Dr. Montorfano while rejecting Dr. Goldman's opinion, who was Balodis's treating physician. The court found that the ALJ failed to properly apply the "treating physician rule" by not providing sufficient reasons for not giving controlling weight to Dr. Goldman's opinions, especially considering the potential deterioration of Balodis's condition over time. Consequently, the court denied the defendant's motion for judgment on the pleadings and remanded the case for further proceedings to reconsider Dr. Goldman's opinion and the assessment of Balodis's credibility.

Social Security DisabilityDisability Insurance BenefitsTreating Physician RuleALJ ErrorRemand for ReconsiderationMedical Evidence EvaluationResidual Functional CapacitySedentary WorkDegenerative Joint DiseaseLeft Hip Fracture
References
34
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
4
Case No. WCK 0067792
Regular
Sep 20, 2007

ERNEST J. WILLIAMS vs. PINKERTON SECURITY, ESIS

This case involves an applicant who sustained an industrial injury to his right knee. The defendant sought reconsideration of the original award, arguing the judge erred in denying credit for temporary disability overpayments and in failing to apportion permanent disability to pre-existing arthritis. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter for further proceedings. The Board found that apportionment to prior arthritis, even if it necessitated knee replacement surgery, is required under current law and that the Agreed Medical Evaluator's opinion on apportionment was sufficient.

WCABPinkerton SecurityErnest J. Williamsindustrial injuryright lower extremitypermanent disabilityapportionmenttemporary disability overpaymentAgreed Medical EvaluatorAME
References
8
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