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Case Law Database

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

Case No. OAK 0326623
Regular
Jan 22, 2008

HENRIETTA BARCLAY vs. RITE AID, TRAVELERS INSURANCE COMPANY

The applicant's claim that the excision of her distal clavicle constitutes an "amputation" under Labor Code section 4656(c)(2)(C) was denied, as the Board held that term refers to external body parts. However, the Board deferred the issue of temporary disability indemnity, allowing further proceedings on the applicant's claims of unreasonable medical treatment delays estopping the defendant from asserting the statutory limits. The Board also declined to rule on the constitutionality of the statute, citing lack of jurisdiction.

Workers' Compensation Appeals BoardRite AidTravelers Insurance CompanyReconsiderationIndustrial InjuryRight ShoulderSurgeryExcisionDistal ClavicleAmputation
References
2
Case No. LAO 0854553
Regular
Oct 01, 2007

DANIEL A. LONG vs. RYANS EXPRESS MOTORCOACH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that the applicant's temporary disability payments for a right shoulder injury terminated on February 28, 2007. The Board ruled that the surgical removal of a distal clavicle spur does not constitute an "amputation" under Labor Code Section 4656(c)(2), which requires severance of an external body part. Therefore, the applicant is not entitled to extended temporary disability benefits beyond the statutory 104-week limit.

Distal clavicleAmputation exceptionSection 4656(c)(2)Temporary disability termination104-week limitation240-week limitationRight shoulder surgeryRotator cuff tearJacob Tauber M.D.Hawkins v. Amberwood Products
References
2
Case No. 2018-07-0436
Regular Panel Decision
Nov 25, 2020

Hart, Jeannie v. ThyssenKrupp Elevator Corp.

This appeal concerns the appropriate medical impairment rating for an employee, Jeannie Hart, who sustained a work-related shoulder injury while employed by ThyssenKrupp Elevator Corp. The employer challenged a six percent medical impairment rating, arguing a portion was attributable to a non-work-related condition (AC arthrosis). The Appeals Board found that the distal clavicle resection, performed due to the pre-existing AC arthrosis, was not causally linked to the work injury. Consequently, the Board modified the trial court's award, determining that only a three percent medical impairment rating was directly related to the work injury, based on the authorized physician's testimony.

Medical Impairment RatingShoulder InjuryAC ArthrosisDistal Clavicle ResectionLabral TearBiceps TendinitisCausationPre-existing ConditionAMA GuidesPermanent Partial Disability
References
9
Case No. 2017-08-1057
Regular Panel Decision
May 26, 2020

Thomas, Kenneth v. Thompson Industrial Services

Kenneth Thomas, a machine operator, sustained a left-shoulder injury at work in February 2017. His authorized treating physician, Dr. Jay Saenz, performed surgery and later recommended additional surgery due to continued pain, diagnosing tendinosis and AC joint arthritis. Thompson Industrial Services refused to authorize the second surgery, arguing the need was not related to the initial work injury. An Expedited Hearing was held to determine whether Thompson must authorize the surgery and pay ongoing temporary disability benefits. The Court concluded that Thompson must authorize the distal clavicle revision surgery, finding the work injury likely exacerbated the AC joint arthritis, but denied Mr. Thomas's request for past and future temporary disability benefits due to insufficient evidence regarding the duration of disability.

Shoulder InjuryRotator Cuff TearAC Joint ArthritisBiceps TendonExpedited HearingMedical Treatment AuthorizationTemporary Disability BenefitsCausationPre-existing Condition AggravationMedical Evidence
References
3
Case No. 2023-07-6858
Regular Panel Decision
May 29, 2024

Pond, Kayla v. DARDEN RESTAURANTS, INC.

Kayla Pond sustained a left-shoulder injury on October 25, 2021, while working for Darden Restaurants, Inc., leading to a labral tear and rotator cuff tear. Her treating physician, Dr. David Pearce, initially assessed a 7% impairment, later reduced to 6%, which he admitted was 'inflated' and did not strictly follow AMA Guides due to the inclusion of an incidental distal clavicle resection. Darden's records review physician, Dr. David Lochemes, countered with a 2% impairment, arguing that the AMA Guides explicitly prohibit rating incidental resections and that only work-related injuries should be considered. The Court, citing Hart v. Thyssenkrupp Elevator Corporation, found that Darden rebutted the presumption of correctness of Dr. Pearce's opinion regarding the causal relationship of the AC arthritis and resection. Ultimately, the Court adopted Dr. Lochemes's 2% impairment rating, concluding that Dr. Pearce's assessment did not adhere to the AMA Guides, and awarded Ms. Pond $8,254.72 in permanent partial disability benefits.

Left Shoulder InjuryLabral TearRotator Cuff TearDistal Clavicle ResectionAMA GuidesImpairment Rating DisputeCausation of InjuryTreating Physician Presumption RebuttalPermanent Partial Disability BenefitsMedical Expert Testimony
References
2
Case No. 10-74894-ast
Regular Panel Decision

International Tobacco Partners, Ltd. v. United States Department of Agriculture

This case involved cross-motions for summary judgment between the Debtor, International Tobacco Partners, Ltd., and the United States Department of Agriculture (USDA). The core dispute centered on whether assessments under the Fair and Equitable Tobacco Reform Act (FETRA) constituted excise taxes and their priority in bankruptcy. The Court determined that FETRA assessments are indeed excise taxes, serving a public purpose by aiding the tobacco industry's transition from subsidies to a free market. Consequently, the USDA was granted a priority claim for prepetition assessments from June 25, 2007, to June 24, 2010, and eligibility for an administrative claim for postpetition assessments starting June 25, 2010.

Bankruptcy LawExcise TaxRegulatory FeesSummary JudgmentPriority ClaimsAdministrative ClaimsTobacco Industry RegulationGovernment SubsidiesFair and Equitable Tobacco Reform Act (FETRA)Chapter 11
References
51
Case No. MISSING
Regular Panel Decision

Liebman v. New Jersey Manufacturers Insurance

A physician, acting as plaintiff, brought a jury trial action against an insurance company, the defendant, under the New York State No-Fault Law to recover fees for surgical procedures and subsequent hospital visits, as well as attorneys' fees. The core dispute revolved around whether certain surgical procedures (arthroscopy, arthrotomy, excision of torn medial meniscus) were separate and distinct for billing purposes, and if post-operative hospital visits constituted reimbursable care or included follow-up care under the Workers’ Compensation Board medical fee schedule. The jury found arthroscopy and arthrotomy to be separate procedures, but arthrotomy and excision were not. They also determined the hospital visits were follow-up care. The court, finding the issues novel and unique, awarded the plaintiff $4,425 plus interest in attorneys' fees, exceeding the statutory maximum.

No-Fault LawInsurance ClaimMedical Billing DisputeAttorneys' FeesJury TrialSurgical ProceduresWorkers' Compensation ScheduleNovel and Unique IssuesOrthopedic SurgeryArthroscopy
References
7
Case No. SFO 0492831
Regular
Jan 23, 2008

ELIAS MONTOYA vs. ASTON BARNES, INC., STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration to clarify the application of Labor Code section 4656 regarding temporary disability indemnity limits. The Board held that "new and further" disability does not extend the 104-week limit under section 4656(c)(1), nor do spinal disc excisions and bone grafts qualify as "amputations" under section 4656(c)(2)(C). Consequently, the applicant is entitled to temporary disability indemnity only up to two years from the date of the first payment.

Workers' Compensation Appeals BoardElias MontoyaAston Barnes Inc.State Compensation Insurance FundSFO 0492831Opinion and Decision After ReconsiderationTemporary Disability IndemnityIndustrial InjuryThoracic SpineChest Injury
References
3
Case No. ADJ1022165
Regular
Jul 07, 2014

TIMETHY SMITH vs. WEST COAST AGGREGATES, INC., STATE COMPENSATION INSURANCE FUND

This case involves an applicant who sustained industrial injuries to his right clavicle and elbow, and the Workers' Compensation Appeals Board (WCAB) amended an award after reconsideration. The WCAB found the applicant also sustained injury to his lumbar spine and internal systems, but not his thoracic spine or psyche. Defendants were granted credit for temporary disability overpayments against both permanent disability and life pension awards. Issues regarding attorney's fees and the precise calculation of future benefits were deferred.

Workers' Compensation Appeals BoardSupplemental Findings of Fact and AwardReconsiderationIndustrial InjuryLumbar SpineInternal InjuryRight ClavicleRight ElbowChronic PainTemporary Disability Indemnity
References
0
Case No. ADJ8249857
Regular
Jan 19, 2016

LARRY ADAIR vs. CITY OF SAN DIEGO

The applicant sought reconsideration of a workers' compensation award for skin cancer, arguing the permanent disability rating was insufficient and jurisdiction should be reserved due to the progressive nature of the disease. The Appeals Board granted reconsideration, affirming the original award but amending it to include a finding that the applicant is entitled to the presumption of compensability for skin cancer under Labor Code section 3212.1. The Board found no substantial evidence that the applicant's skin cancer was an insidious progressive disease warranting jurisdiction reservation, as it had been excised and declared permanent and stationary.

ADJ8249857Petition for ReconsiderationAmended Findings and Awardarising out of and in the course of employmentAOE/COEpermanent disabilityreservation of jurisdictionsubstantial medical evidenceprimary treating physicianpanel qualified medical evaluator
References
0
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