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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ865311 (LAO 0880913)
Regular
Sep 19, 2016

MARIA AGUILERA vs. COLLINS CHIROPRACTIC GROUP, STATE COMPENSATION INSURANCE FUND

The Board denied the applicant's petition for reconsideration, affirming its prior decision to reduce her permanent disability from $100\%$ to $88\%$ after apportionment. The Board found the applicant's vocational expert's opinions unsubstantial and contrary to the well-reasoned opinions of the Agreed Medical Evaluators (AMEs). Specifically, the Board rejected Dr. Bluestone's opinion due to a failure to account for duplication in impairment factors between rheumatologic and psychiatric conditions. While one Commissioner dissented, believing the applicant to be $100\%$ permanently disabled based on Dr. Bluestone's findings and other evidence, the majority upheld the apportionment.

Workers' Compensation Appeals BoardOpinion and Order Denying Petition for ReconsiderationFindings and AwardPermanent Total DisabilityApportionmentAgreed Medical Evaluators (AMEs)Dr. BluestoneDr. FreemanDr. MajcherDr. Fedder
References
Case No. ADJ6802715; ADJ6715328
Regular
Sep 15, 2015

STEFANIE WEBB vs. THE VINTAGE CLUB, FEDERAL INSURANCE c/o CHUBB SERVICES CORP., INSURANCE COMPANY OF THE WEST, c/o FIREMAN'S FUND INSURANCE

The Workers' Compensation Appeals Board (WCAB) denied reconsideration of a finding that applicant Stefanie Webb sustained a cumulative injury to her wrists and arms from April 19, 2004, through April 14, 2009. The insurer contended the injury period ended in 2005, citing medical opinions. However, the WCAB found that April 14, 2009, was the correct date of injury as it was the first day applicant knew her condition was work-related and suffered disability. A dissenting opinion argued that medical evidence supported an earlier cessation of injurious exposure in 2005.

Workers' Compensation Appeals BoardStefanie WebbThe Vintage ClubFederal InsuranceChubb Services Corp.Insurance Company of the WestFireman's Fund Insurancecumulative injuryspecific injurypermanent disability
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ3015289 (FRE 0242633)
Regular
Jan 06, 2012

SHARON LONG vs. KAISER FOUNDATION HOSPITALS administered by KAISER PERMANENTE

This case involves applicant Sharon Long's claim for workers' compensation benefits due to cumulative trauma sustained as a registered nurse for Kaiser Foundation Hospitals. The Workers' Compensation Appeals Board granted reconsideration, reversing the initial denial of industrial injury. The Board found that Dr. Dureza's opinion, which attributed 33% of applicant's injuries to cumulative trauma from her nursing duties, constituted substantial evidence of industrial causation. The Board remanded the case for further proceedings on orthopedic benefits and the psychiatric injury claim, deferring the EDD lien.

Workers' Compensation Appeals BoardKaiser Foundation HospitalsSharon LongIndustrial InjuryCumulative TraumaRegistered NurseNeck InjuryLow Back InjurySpine InjuryPsyche Injury
References
Case No. ADJ2631872 (AHM 0118132)
Regular
Aug 09, 2010

ANH NGUYEN vs. HOMETOWN BUFFET, DISCOVER RE

This case concerns a lien claimant's petition for reconsideration after the WCJ denied their claim for psychological treatment. The initial ruling found the claimant failed to prove the treatment was necessary for the industrial injury, which had prior settlement for orthopedic issues. The Appeals Board granted reconsideration, finding the medical evidence regarding psyche injury was insufficient and ordered the case returned for further development of the record. A dissenting opinion argued the claimant had ample opportunity to present evidence and should not be given another chance.

Lien claimantPetition for ReconsiderationFindings and OrderWCJPsychological Assessment ServicesDr. Nelson FloresQME reportsubstantial evidenceindustrial injurypsyche injury
References
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