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

Case No. ADJ14263093
Regular
Apr 12, 2023

CECILIA OJEDA vs. AMY'S KITCHEN, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Here's a summary of the case for a lawyer: The applicant claimed cumulative injury to her neck, bilateral wrists, shoulders, and upper extremities, which the employer initially denied for all body parts except the neck. The WCJ found injury to all claimed body parts, relying on treating physicians' reports, and found the QME's reports unsubstantial due to inconsistencies and admissions of uncertainty during deposition. The defendant sought reconsideration, arguing the QME's opinion was substantial evidence regarding injured body parts and permanent disability. The Appeals Board denied reconsideration, adopting the WCJ's reasoning that the QME's testimony was too speculative and contradictory to constitute substantial evidence for the disputed body parts.

AOE/COEPetition for ReconsiderationFindings and AwardOrthopedic Qualified Medical Examiner (QME)Substantial EvidenceCumulative InjuryBilateral WristsBilateral ShouldersBilateral Upper ExtremitiesCervical Radiculopathy
References
3
Case No. ADJ10045939
Regular
Feb 05, 2016

Raymond Ames vs. Goodman Global, ACE American Insurance Company

This case involves an employer's petition to remove a workers' compensation matter to the Appeals Board for review of an order allowing the applicant to obtain additional Qualified Medical Evaluator (QME) panels. The employer argued that further QME panels were not permitted without a treating physician's determination supporting the disputed body parts injured. The Appeals Board denied the petition, finding the employer failed to demonstrate irreparable harm or significant prejudice. The majority affirmed the judge's order, concluding the record supported further development of disputed body parts. One commissioner dissented, arguing the applicant failed to establish a dispute with a treating physician's report as required by statute.

QME panelpetition for removaldisputed body partsmedical record developmentirreparable harmsubstantial prejudicetreating physicianDWC Rule 31.7Labor Code section 5310WCAB Rule 10843
References
3
Case No. ADJ9312928
Regular
Sep 11, 2019

Jeffrey DaVanon vs. Oakland Athletics, ACE Insurance Company, Sedgwick Claims Management

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration. The applicant, a former professional athlete, claimed cumulative trauma injury to multiple body parts, including gastrointestinal issues, neurological problems, and a sleep disorder not initially identified. The Board found that the WCJ erred by excluding medical evidence for these later-identified body parts, as they were included in the parties' stipulations and could have arisen or worsened after the applicant's deposition. The case is returned for further proceedings, allowing admission of relevant medical records and deferring final decisions on disputed body parts and permanent disability.

Mandatory Settlement ConferencePetition for ReconsiderationCumulative TraumaProfessional AthleteStatute of LimitationsLabor Code Section 5405Labor Code Section 5412Discovery CloseBifurcationIndependent Medical Evaluator
References
6
Case No. ADJ11039762
Regular
Aug 06, 2018

ALFRED GUILING vs. GODEFELLOW BROTHERS CONSTRUCTION, LLC, AMERICAN CONTRACTORS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and dismissed their Petition for Removal. The defendant argued the judge's finding of injury to specific body parts was premature and lacked substantial evidence, as the PQME process was incomplete. The Board found removal was inappropriate, as the injury finding is a final order subject to reconsideration. They adopted the WCJ's report, concluding the applicant met their burden of proof for industrial injury to the disputed body parts.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings of Factindustrial injurybody partssubstantial evidencePanel Qualified Medical EvaluationPQMEextraordinary remedy
References
2
Case No. ADJ12582828
Regular
Jan 03, 2023

TERRY KELLY vs. SAFEWAY

This case involves a workers' compensation claim where the defendant sought reconsideration of an award finding injury AOE/COE to multiple body parts. The primary dispute centers on the applicant's occupational group number, with the applicant claiming "butcher" (420) and the defendant arguing "meat cutter" (322), impacting permanent disability ratings. The Board granted reconsideration, finding insufficient evidence to determine the occupational group number and therefore deferring permanent disability for all affected body parts pending further development of the record. The finding of injury AOE/COE to the applicant's cervical spine, thoracic spine, lumbar spine, bilateral knees, bilateral elbows, and bilateral wrists was upheld.

Occupational Group NumberMeat CutterButcherCumulative TraumaPermanent DisabilityQualified Medical EvaluatorSubstantial EvidenceFurther DevelopmentBody PartsWPI Ratings
References
11
Case No. CV-23-1472
Regular Panel Decision
Jan 09, 2025

In the Matter of the Claim of Jacquetta Brooks

Claimant Jacquetta Brooks appealed a Workers' Compensation Board decision which ruled she was entitled to a 0% schedule loss of use (SLU) award for her right arm, leg, and foot. This decision reversed a Workers' Compensation Law Judge's award of higher SLU percentages. The core of the dispute was the Board's interpretation of guidelines regarding the appropriateness of comparing injured body parts to previously injured contralateral (opposite) body parts for SLU assessment. The Appellate Division found the Board's interpretation, which limited inappropriate comparisons only to permanent contralateral impairments, to be unreasonable. The Court reversed the Board's decision, finding that temporary physical or functional impairments also make contralateral comparisons inappropriate, and remitted the matter to the Board for further proceedings consistent with this ruling.

Workers' CompensationSchedule Loss of UseContralateral ComparisonMedical Impairment GuidelinesOccupational DiseaseAppellate ReviewRemittalRange of MotionJudicial InterpretationPermanent Impairment
References
12
Case No. 13-71700
Regular Panel Decision

Board of Trustees v. Kern (In re Kern)

The Plaintiffs, the Board of Trustees of benefit funds under ERISA, sought to declare debts owed by Defendant Richard Kern, principal owner of Cool Sheetmetal, Inc. (CSI), non-dischargeable in bankruptcy. The core issue was whether monies deducted from employee paychecks but not remitted to the benefit funds constituted non-dischargeable debts under § 523(a)(4) and (6) of the Bankruptcy Code. The Court ruled that monies deducted for a vacation fund are non-dischargeable because they were subject to a statutory trust, Kern acted as a fiduciary, and committed defalcation. However, deductions for union assessments and political action league (PAL) funds were deemed dischargeable, as no statutory trust was established for these. Furthermore, the Plaintiffs' claim under § 523(a)(6) for willful and malicious injury was dismissed. The Court granted summary judgment in part for Plaintiffs regarding the Vacation Fund deductions, with the exact amount to be determined at trial, and granted summary judgment in part for Defendant on the other claims.

BankruptcyNon-dischargeabilityERISAFiduciary DutyDefalcationSummary JudgmentEmployee ContributionsVacation FundUnion AssessmentsPolitical Action League (PAL)
References
10
Case No. ADJ10771579
Regular
Aug 08, 2018

Gabriel Ruano vs. Mayekawa USA, SOMPO JAPAN INSURANCE COMPANY OF AMERICA, BROADSPIRE

This case involved a worker claiming industrial injury to multiple body parts. The Appeals Board granted the employer's petition for reconsideration to correct the Findings of Fact. The Board amended the Findings to accurately reflect all injured body parts, including the psyche, and removed an incorrectly listed body part. Ultimately, the Board affirmed the original decision with these specified amendments.

Petition for ReconsiderationFindings of Factsubstantial evidencemedical reportsprimary treating physicianBal S. Grewal Ph.D.Report and Recommendationinjured body partspsychecervical spine
References
0
Case No. MISSING
Regular Panel Decision

L&L Painting Co. v. Contract Dispute Resolution Board

L&L and Odyssey, contractors for lead-based paint removal on the Queensboro Bridge, disputed a contract drawing's interpretation with the Department of Transportation (DOT) concerning scaffolding clearance. Petitioners sought additional compensation after DOT rejected their proposed platform design, claiming a latent ambiguity in the contract. The Contract Dispute Resolution Board (CDRB) denied their claim, finding a patent ambiguity requiring pre-bid clarification. The Supreme Court upheld CDRB's decision, and this appellate court affirmed, concluding that the ambiguity was indeed patent, contrasting 'all roadways' in the note with the drawing's specific references. A dissenting opinion argued against this, stating an engineer would find no ambiguity.

Contract DisputePublic Works ContractQueensboro BridgeConstruction LawContract InterpretationAmbiguityPatent AmbiguityLatent AmbiguityCPLR Article 78Administrative Law
References
0
Case No. ADJ7288330
Regular
Oct 03, 2016

GLORIA BENITEZ vs. NEWPORT SUBACUTE HEALTH CARE CENTER, ALASKA NATIONAL INSURANCE COMPANY

The applicant, Gloria Benitez, sought to reopen her workers' compensation claim to include injury to additional body parts beyond her cervical spine and psyche. The original award found injury only to the cervical spine and psyche, with a 19% permanent disability rating for the cervical spine. While the WCJ's initial decision denied injury to additional body parts, the Board granted reconsideration. The Board amended the original findings to defer the issue of injury to the alleged additional body parts, while affirming other aspects of the WCJ's order, including the appointment of a regular physician to evaluate new and further disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderNew and Further DisabilityAgreed Medical ExaminerRegular PhysicianLabor Code Section 5410Petition to ReopenIndustrial InjuryCervical Spine
References
4
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