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

Case No. ADJ2709955 (MON 0356320)
Regular
Jun 21, 2017

Mario Cocola vs. California Hospital Medical Center

The Workers' Compensation Appeals Board denied Mario Cocola's petition for reconsideration, upholding the finding that he sustained $69\%$ permanent disability from industrial injuries. Cocola argued the administrative judge erred by disregarding the Agreed Medical Examiner's opinion that he was totally disabled from the open labor market due to orthopedic injuries. The Board agreed with the judge's report that the physician's opinion lacked sufficient objective basis for the change in work restrictions. A dissenting opinion argued the medical and vocational evidence supported a $100\%$ permanent disability finding and requested clarification from the medical examiner.

Petition for ReconsiderationFindings of Fact and Awardpermanent disabilitycumulative traumalumbar spinecervical spinepsychecervicogenic headachesEmergency Unit CoordinatorAgreed Medical Examiner
References
1
Case No. ADJ79 96674
Regular
Mar 24, 2016

ARLZENIA HASLEY vs. EL CENTRO REGIONAL MEDICAL CENTER

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Removal, which sought to invalidate the medical evidence of the Agreed Medical Examiner (AME), Dr. Luros. The WCAB found that removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. The defendant's arguments regarding flawed medical opinions and the AME's unavailability can be addressed through standard appeal procedures. Furthermore, the defendant filed a supplemental pleading without prior permission, which was disregarded by the Board.

Petition for RemovalArlzenia HasleyEl Centro Regional Medical CenterTriStar Risk ManagementWCABWCJsubstantial prejudiceirreparable harmreconsiderationsupplemental pleading
References
2
Case No. LBO 279827
Regular
Apr 21, 2008

DEENNISE NOVAK vs. GOODHEW AMBULANCE SERVICE, NATIONAL UNION FIRE INSURANCE, c/o BROADSPIRE, a CRAWFORD COMPANY

The Appeals Board granted reconsideration because the WCJ improperly disregarded the Agreed Medical Evaluator's opinion and made a finding without adequate medical evidence. The Board found that due to conflicting medical opinions and the AME's unclear stance, further development of the medical record is required. Consequently, the matter is returned to the trial level for a WCJ to appoint a "regular physician" to re-examine the applicant and address all outstanding medical issues.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryRight KneeHead InjuryNeurological SystemBack InjuryNeck InjuryShoulder Injury
References
12
Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
Case No. ADJ6945712
Regular
Nov 29, 2011

CLAY WELDON vs. WALLACE KUHL & ASSOCIATES, U.S. FIDELITY AND GUARANTEE COMPANY

The Workers' Compensation Appeals Board (WCAB) reversed an award of spinal surgery for applicant Clay Weldon. The WCAB found that the Agreed Medical Examiner (AME), Dr. Bruce McCormack, provided substantial medical evidence that the surgery was not reasonable or appropriate at this time. Dr. McCormack's opinion, based on the ACOEM Guidelines and his examination, concluded there was no instability or radiculopathy justifying surgery. The WCAB found the WCJ's reasoning for disregarding the AME's opinion insufficient and therefore rescinded the award.

Workers' Compensation Appeals BoardFindings and Awardindustrial injuryspinal surgeryAgreed Medical ExaminerACOEM Guidelinesutilization reviewsubstantial medical evidenceradiculopathysegmental instability
References
3
Case No. ADJ7682048 MF ADJ7682067
Regular
Oct 03, 2014

EDGAR DIAZ vs. STATE OF CALIFORNIA, CORRECTIONS & REHABILITATION PAROLE

This case concerns an applicant who claimed industrial injuries as a parole officer. The Workers' Compensation Appeals Board rescinded a prior award of total permanent disability and remanded the case for further proceedings. The Board found that the vocational expert's opinion supporting total disability lacked substantial evidence due to an incomplete employment history and contradictions with other evidence. Furthermore, the Board determined that existing medical opinions from Agreed Medical Examiners provided a basis for apportionment of permanent disability to non-industrial factors, which the trial judge had improperly disregarded.

ApportionmentPermanent DisabilitySubstantial EvidenceVocational ExpertMedical EvidenceContinuous TraumaSpecific InjuryBody PartsPreexisting FactorsNonindustrial Factors
References
8
Case No. ADJ9709726
Regular
Jun 25, 2015

LAURA NUNEZ vs. SUTTER PACIFIC MEDICAL FOUNDATION, SUTTER HEALTH

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the finding of industrial injury AOE/COE for thoracic outlet syndrome, arguing it wasn't an issue for trial and the medical evidence was insufficient. The Board found that thoracic spine injury was an issue and that Dr. Avery's opinion provided substantial medical evidence to support the thoracic outlet syndrome finding. Any potential defects in the original WCJ opinion were cured by the WCJ's subsequent report.

Thoracic outlet syndromeAOE/COEPetition for Reconsiderationsubstantial medical evidenceG. James Avery M.D.Steven Bratman M.D.industrial injuryapportionmentWCJlabor code 5313
References
1
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
0
Case No. VNO 0439261, VNO 0439262
Regular
May 08, 2008

CAROL SIERRAS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration, reversing the trial judge's decision to deny the applicant's fibromyalgia claim. The Board found the trial judge erred by disregarding the Agreed Medical Examiner's (AME) opinion on causation without sufficient justification, emphasizing that medical causation is a question for expert opinion. The case was remanded for further proceedings, including potential apportionment of disability.

Workers Compensation Appeals BoardCarol SierrasLos Angeles Unified School DistrictSedgwick Claims ManagementAmended Findings and Awardscumulative trauma injurypsychelumbar spinebilateral kneespermanent disability
References
0
Case No. ADJ1168599
Regular
May 29, 2009

STANLEY ANGEL (Deceased) WANDA ANGEL (Widow) vs. DOW CHEMICAL COMPANY, CRAWFORD & COMPANY, TRAVELERS

This case concerns a widow's petition for reconsideration of a denial of death benefits for her husband, Stanley Angel, who died of multiple myeloma. The Appeals Board previously ruled that there was insufficient substantial medical evidence to establish that Mr. Angel's exposure to toxic chemicals during his employment with Dow Chemical Company caused his illness. The widow argued the Board erred in disregarding the opinion of her Qualified Medical Evaluator, Dr. Harrison, and misapplied the burden of proof. However, the Board affirmed its prior decision, finding Dr. Harrison's revised opinion lacked a solid basis and was inconsistent with other evidence regarding the extent and duration of exposure.

Multiple MyelomaIndustrial InjuryToxic Chemical ExposureQualified Medical Evaluator (QME)Medical CausationLatency PeriodSubstantial Medical EvidenceBurden of ProofReconsiderationOccupational Medicine
References
7
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