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

Case No. ADJ7877096
Regular
Jan 23, 2017

OGANES KARDZHYAN vs. DR. PEPPER SNAPPLE GROUP, CHARTIS INSURANCE CO./AIG CLAIM SERVICES

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, finding the WCJ failed to address the substantiality of Dr. Pietruszka's opinion regarding industrial causation for psoriatic arthritis, diabetes, and headaches. The Board amended the WCJ's findings to include previously established injuries and returned the matter for further proceedings. The WCJ is directed to consider Dr. Pietruszka's opinion and develop the record on orthopedic injuries. This decision is not final and allows for future reconsideration of the WCJ's new ruling.

Petition for ReconsiderationMedical OpinionPsoriatic ArthritisDiabetesHeadachesIndustrially CausedSubstantial Medical EvidenceDevelop the RecordOrthopedic InjuriesPsyche
References
Case No. STK 166227
Regular
Jan 25, 2008

Celestino Aguilar-Maldonado vs. GALLO WINERY, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of the finding that he did not sustain new and further psychological disability. The Board found that substantial evidence, including expert opinions from Drs. Mendel and Panzarella, did not support a finding of compensable psychiatric injury, noting significant exaggeration of symptoms by the applicant. Furthermore, the Board concluded that any psychological issues predated the original stipulated award and thus did not constitute "new and further" disability.

Workers' Compensation Appeals BoardNew and Further DisabilityPsyche InjuryBack InjuryStipulations with Request for AwardPetition to ReopenQualified Medical Examiner (QME)Symptom MagnificationMalingeringPredominant Cause
References
Case No. ADJ11072332
Regular
Jan 03, 2023

CHETAN THAKER vs. AON HEWITT CORPORATION, CNA CLAIM PLUS, INC., SEGWICK CLAIMS MANAGEMENT SERVICES, INC., THE HARTFORD

The Workers' Compensation Appeals Board denied the petitioner's Petition for Reconsideration. The Board adopted the findings of the Workers' Compensation Judge (WCJ), who concluded that the applicant failed to prove an industrial injury arose out of and occurred in the course of employment (AOE/COE). The WCJ found that the reports of the Qualified Medical Evaluator (QME), Dr. Pretsky, constituted substantial medical evidence, despite the petitioner's disagreements regarding the diagnosis. Furthermore, the petitioner failed to provide sufficient justification for newly discovered evidence or specific arguments regarding factual or statutory errors.

WORKERS' COMPENSATION APPEALS BOARDPETITION FOR RECONSIDERATIONDENIEDWCJ REPORTSUPPLEMENTAL PLEADINGSUBSTANTIAL MEDICAL EVIDENCEPQMEPSYCHE INJURYAOE/COELABOR CODE
References
Case No. ADJ2754339, ADJ2982695
Regular
Feb 22, 2023

VIRGINA VASQUEZ vs. KING MEAT, INC., FREMONT INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA)

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by CIGA. CIGA challenged a prior finding that allowed payment for medical treatment and a specific medical-legal report by Dr. Konstat. The Board adopted the Workers' Compensation Judge's report, which found that Dr. Konstat's treatment was reasonable and necessary, and that her 2007 medical-legal report was properly requested. The Board also determined that the prior judge's findings on reasonableness were binding in the subsequent lien trial.

CIGAPetition for ReconsiderationLien ClaimantPrimary Treating PhysicianMedical-Legal ReportsSelf-Procured TreatmentUtilization ReviewLabor Code section 4620Rules 9785(e)(3)Rules 9785(e)(4)
References
Case No. ADJ4229205 (MON 0323976)
Regular
Aug 10, 2010

ADRINE GARABEDIAN vs. DR. DANIEL BOUDAIE, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns an applicant claiming a psychiatric injury, with a prior WCJ finding the injury industrial but no good faith personnel action as a substantial cause. Due to a severely incomplete evidentiary record, including missing medical reports and hearing transcripts, the Appeals Board rescinded the prior findings. The matter is returned to the trial level for reconstruction of the entire record and a new decision by the WCJ. The Appeals Board expressed no opinion on the substantive issues of the claim.

Workers' Compensation Appeals BoardDecision After ReconsiderationIndustrial InjuryPsycheGood Faith Personnel ActionPetition for RemovalEAMS recordReconstitute RecordTrial Level ProceedingsFindings of Fact Rescinded
References
Case No. ADJ10305591
Regular
May 23, 2018

SAYDA LOPEZ ESPANA vs. DR. DANA ROCKEY, STATE FARM CALIFORNIA WORKERS' COMPENSATION CLAIMS

The Workers' Compensation Appeals Board denied the petition for reconsideration filed by the defendant. The Board adopted the findings of the Administrative Law Judge (WCJ) who found the applicant's medical evidence persuasive. The WCJ gave great weight to the applicant's credible testimony and found her treating physician's report more convincing than the defense's Qualified Medical Evaluator. The Board affirmed that the WCJ's credibility determinations and reliance on one physician's opinion, even if inconsistent with others, constituted substantial evidence.

Continuous TraumaPetition for ReconsiderationWCJ Credibility DeterminationsSubstantial EvidenceMedical ReportingQME EvaluationTreating PhysicianDismissal of ClaimPost-Termination ClaimLabor Code § 5412
References
Case No. ADJ1761452
Regular
Aug 19, 2011

ERIC VOLLMER vs. DR. SMOOTHY ENTERPRISES, CLARENDON NATIONAL INSURANCE COMPANY, AMERICAN ALL RISK LOSS ADMINISTRATORS

The Workers' Compensation Appeals Board denied defendant's Petition for Removal, finding no substantial prejudice or irreparable harm to justify this extraordinary remedy. The Board also denied the Petition for Disqualification as defendant failed to allege valid grounds or provide required supporting documentation. The applicant sustained multiple injuries in 2005, and subsequent awards were amended to address a lien claim. The WCJ's actions were deemed within his authority to clarify issues and facilitate resolution.

RemovalDisqualificationPetition for RemovalPetition for DisqualificationWorkers' Compensation Appeals BoardWCJOrder Vacating Findings and AwardMandatory Settlement ConferenceFindings and AwardPermanent Disability
References
Case No. GOL 94377, GOL 94518
Regular
Oct 15, 2007

ROSE SAMLER vs. JOHN GRUBE/ROBERT SCOTT, D.D.S., AMERICAN MANUFACTURERS MUTUAL INSURANCE COMPANY, DR. JOHN ARGUELLES, NATIONAL SURETY CORPORATION

The Workers' Compensation Appeals Board granted reconsideration to correct a clerical error, identifying National Surety Corporation as the proper co-defendant instead of "National Insurance Company." The Board affirmed the original award of 33% permanent disability and further medical treatment, but deferred the issues of temporary disability and the EDD lien claim. American Manufacturers Mutual Insurance Company remains responsible for paying benefits, subject to pro rata reimbursement by National Surety Corporation.

Workers' Compensation Appeals BoardCumulative injuryHygienistNeckLeft shoulderBackUpper extremitiesBilateral thumbsPermanent disabilityFurther medical treatment
References
Case No. ADJ11025609
Regular
Apr 30, 2018

DONNA IVES vs. DR MYERS DISTRIBUTING COMPANY, PREFERRED EMPLOYERS INSURANCE COMPANY

In this workers' compensation case, the Appeals Board rescinded the WCJ's decision and returned the matter for further proceedings. The Board found that the defendant improperly modified the applicant's Request for Authorization (RFA) for treatment by a chiropractic neurologist. Instead of referring the request for medical utilization review, the claims administrator authorized treatment with a general chiropractor. The Board emphasized that claims adjusters cannot modify RFAs and that medical necessity decisions must be made by physicians.

WCABPetition for ReconsiderationFindings of FactWCJindustrial injurychiropractic neurologistMedical Provider Network (MPN)Request for Authorization (RFA)Utilization Review (UR)Medical Treatment Utilization Schedule (MTUS)
References
Case No. ADJ3203306 (LAO 0871862)
Regular
Jul 13, 2011

Vanessa Bruce vs. SOUTHWEST HEALTHCARE MEDICAL, TRAVELERS

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that found industrial injury to the lumbar spine but denied injury to the internal systems and sleep disorder. The applicant argued the WCJ erred by ignoring a stipulation for injury to the left lower extremity, hip, and buttocks, and by rejecting evidence of an industrially-caused sleep disorder. The WCAB granted reconsideration, amended the findings to include injury to the left lower extremity, left hip, and buttocks, but otherwise affirmed the original decision, finding no industrial basis for the sleep disorder.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryLumbar SpineInternal SystemsSleep DisorderLeft Lower ExtremityLeft HipButtocks
References
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