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

Case No. ADJ2894818
Regular
Apr 23, 2009

DAVID L. BROWN vs. COUNTY OF MENDOCINO

This case involves a deputy sheriff's workers' compensation claim for two heart impairments sustained during a cumulative injury period. The Appeals Board denied the applicant's petition for reconsideration of a prior decision. The prior decision had returned the matter to the trial level to address potential duplication between the two heart impairments as opined by Dr. Ng. The Board found the applicant's narrow definition of apportionment was untenable and rejected the argument that the defendant failed to raise the issue of overlap.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Decision After ReconsiderationWCJSupplemental Findings Award and OrderPermanent Disability RatingApportionmentHeart ImpairmentsDeputy SheriffCumulative Injury
References
3
Case No. ADJ2894818 (SRO 0132752)
Regular
Mar 02, 2009

DAVID L. BROWN vs. COUNTY OF MENDOCINO, Permissibly Self-Insured, by CLAIMS MANAGEMENT, INC.

The Workers' Compensation Appeals Board rescinded a prior award and returned the case for further proceedings, finding that the administrative law judge erred in issuing an unapportioned permanent disability award. The Board determined that the doctor's report clearly indicated overlap between the applicant's two cardiac impairments, requiring apportionment. While there was no clear evidence for apportionment to the applicant's prior spinal disability, the Board directed the trial level to obtain a new rating that accounts for the duplication in the cardiac conditions. This decision ensures a more accurate and equitable permanent disability assessment by considering the overlap in impairments.

Workers' Compensation Appeals BoardADJ2894818SRO 0132752David L. BrownCounty of MendocinoClaims Management Inc.ReconsiderationSupplemental Findings Award OrderPermanent DisabilityApportionment
References
1
Case No. MISSING
Regular Panel Decision

the Claim of Brigandi v. Town & Country Linoleum & Carpet

This case involves an appeal by an employer and its compensation carrier against decisions made by the Workers’ Compensation Board. The decedent, a carpet layer, died from cardiac arrest during work, with an autopsy revealing underlying coronary atherosclerotic disease. His widow was awarded death benefits. The employer’s carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15 (8), asserting a preexisting permanent physical impairment. However, the Board determined that there was no evidence that the decedent’s heart condition hindered his job potential before his death, thus releasing the Special Disability Fund from liability and holding the compensation carrier responsible. The employer's subsequent application for reconsideration was denied by the Board, leading to these appeals. The appellate court affirmed the Board's decisions, concluding that the Board rationally found no proof that the decedent's heart disease impaired his job potential, a necessary condition for reimbursement under WCL § 15 (8) (d).

Special Disability FundPreexisting Permanent ImpairmentCardiac ArrestCoronary Atherosclerotic DiseaseDeath Benefits ClaimEmployer ReimbursementCarrier LiabilityBoard Decision ReviewAppellate AffirmationMedical Evidence Interpretation
References
2
Case No. MISSING
Regular Panel Decision

Claim of Milner v. Country Developers, Inc.

The Special Disability Fund appealed decisions by the Workmen’s Compensation Board which imposed liability on the Fund for a claimant's injuries. The Board found that the employer, Country Developers, continued to employ the claimant, a carpenter, with knowledge of his pre-existing permanent physical impairment, triggering liability under subdivision 8 of section 15 of the Workmen’s Compensation Law. The claimant suffered a fracture of the nose and a hip dislocation in 1964, having a history of three ruptured disc surgeries and other conditions. The appeal centered on whether the employer had sufficient knowledge of the claimant’s permanent condition. Testimony from the employer’s foreman, Mr. Pahlck, indicated awareness of the claimant's back issues, including wearing a back brace and being favored by co-workers. The court affirmed the Board’s decision, reiterating that employer knowledge is a question of fact for the Board, and its findings, if supported by substantial evidence, will not be disturbed.

Workers' Compensation LawSpecial Disability FundEmployer LiabilityPre-existing Permanent ImpairmentEmployer KnowledgeSubstantial EvidencePermanent Partial DisabilityFracture of NoseHip DislocationRuptured Discs
References
3
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
3
Case No. ADJ2630861 (LAO 0880530)
Regular
Nov 16, 2012

MARTHA PONCE vs. ASHLEY & J PHARMACY CORP, dba ROSS MEDICAL PHARMACY, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award, rescinding the permanent disability award for applicant's sleep loss. While the applicant was found to have sustained cumulative trauma injury to her neck, back, and psyche, the Board determined that an additional impairment rating for sleep loss was duplicative of existing orthopedic and psychiatric ratings. The original award of 53% permanent disability was reduced to 47%, and the attorney's fees were adjusted accordingly. The Board also rejected the defendant's argument for apportionment to a specific back injury, as the cumulative trauma finding was already final.

Workers Compensation Appeals BoardAshley & J Pharmacy CorpEmployers Compensation Insurance CompanyMartha PonceOpinion and Order Granting ReconsiderationDecision After Reconsiderationsleep losscumulative trauma injuryneckback
References
0
Case No. MISSING
Regular Panel Decision

SR International Business Insurance v. World Trade Center Properties, LLC

Royal Indemnity Company, an insurer in the ongoing World Trade Center (WTC) litigation, sought to enjoin a declaratory judgment action filed in New York State Supreme Court by the Port Authority, Silverstein Parties, and WTC Retail LLC (collectively, "the Insureds"). The Insureds' state action aimed to declare that a "Conceptual Framework" for WTC redevelopment would not adversely affect their insurance recovery rights. Royal, joined by other insurers, argued that the injunction was necessary under the All Writs Act and exceptions to the Anti-Injunction Act. The court, presided over by Judge Mukasey, denied Royal's motion, ruling that the injunction did not fall within the narrow exceptions of the Anti-Injunction Act, specifically the "necessary in aid of its jurisdiction" clause. The court emphasized that the WTC coverage litigation constituted in personam contract disputes and that parallel state and federal actions, even with overlapping issues, do not impair federal jurisdiction, and therefore, an injunction merely to prevent duplicative litigation or preclusive effects is not permissible.

Anti-Injunction ActAll Writs ActFederal vs. State JurisdictionDeclaratory Judgment ActionWTC Insurance LitigationConcurrent JurisdictionInjunction DenialIn Rem vs. In PersonamDuplicative LitigationCollateral Estoppel
References
25
Case No. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
1
Case No. ADJ7927652
Regular
Oct 25, 2016

Bozenna Kasperowicz vs. Metropolitan State Hospital, State Compensation Insurance Fund

This case involves an industrial injury to the applicant, a psychiatric technician, sustained on June 14, 2011, from a patient strike to the head. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over psychiatric impairment and a sleep disorder rating. The WCAB affirmed the original award but reduced the permanent disability rating from 76% to 70% by excluding the sleep dysfunction impairment. The WCAB found Dr. O'Brien's opinion on psychiatric impairment more persuasive than conflicting medical evaluations and determined Dr. Matos's opinion on sleep impairment lacked substantial medical evidence due to staleness.

WCABReconsiderationPsychiatric ImpairmentWhole Person ImpairmentGAF ScoreSleep DisorderSubstantial Medical EvidencePermanent DisabilityQualified Medical EvaluatorInsomnia
References
0
Case No. ADJ10243412
Regular
Jun 10, 2019

DEBRA LUX vs. COUNTY OF SANTA BARBARA

This case involves an injured firefighter seeking workers' compensation for a right knee injury. The defendant sought reconsideration of a finding of 17% permanent disability, arguing the administrative law judge erred by combining range of motion and diagnosis-based impairments, and by not apportioning the diagnosis-based impairment. The Appeals Board denied reconsideration, finding the medical evaluator adequately explained the departure from standard AMA Guides methodology for rating the combined impairments. The Board also affirmed no apportionment of the diagnosis-based impairment as no substantial evidence showed non-industrial factors contributed to the need for surgery.

Workers' Compensation Appeals BoardApplicantDefendantPermissibly Self-InsuredAdministered by CORVELFirefighterIndustrial InjuryRight KneePermanent DisabilityWhole Person Impairment
References
5
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