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

Case No. ADJ4145263 (VEN 0120366) ADJ2903274 (OXN 0124883)
Regular
Jul 16, 2012

SHARON ANGELL vs. MARYMOUNT ACADEMY, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) by its servicing agent SEDGWICK CMS, for FREMONT INDEMNITY in liquidation

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original decision, remanding the case for further proceedings. The primary issue is whether applicant's fibromyalgia should be rated separately from her orthopedic injuries. The Board found no clear evidence in the record supporting the WCJ's conclusion that fibromyalgia was solely a consequence of the orthopedic conditions. On remand, the WCJ must determine the causation of the fibromyalgia and whether it warrants separate rating. The Board deferred ruling on other issues raised by the parties.

Workers' Compensation Appeals BoardCIGAFremont Indemnityliquidationreconsiderationfibromyalgiaorthopedic injuryapportionmentvocational evidencetemporary disability
References
3
Case No. ADJ824062 (VNO 0395359) ADJ1729914 (VNO 0452072) ADJ385264 (VNO 0548716) ADJ4506449 (VNO 0548713)
Regular
May 11, 2016

SHARON SPRAGUE vs. BEVERLY FABRICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE, SUPERIOR NATIONAL INSURANCE COMPANY, MIKASA, SOMPO JAPAN INSURANCE COMPANY OF AMERICA

This case involves multiple injury claims for Sharon Sprague against Beverly Fabrics and Mikasa, primarily concerning back, hip, and fibromyalgia injuries. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over permanent disability ratings and apportionment of injuries. The WCAB rescinded prior findings, finding insufficient evidence for permanent total disability and the exact causation of fibromyalgia. The matter is remanded for further proceedings to develop the record on fibromyalgia causation, permanent disability, and apportionment.

CIGASompo JapanReconsiderationJoint Findings Award OrdersPermanent DisabilityApportionmentFibromyalgiaScapula/Rhomboid StrainBilateral KneesAgreed Medical Evaluator
References
0
Case No. ADJ3316075 (VNO 0426272)
Regular
May 20, 2011

CHRISTINE COLFER AUCHTERLONIE vs. RALPHS GROCERY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address an applicant's 100% permanent disability award for cumulative trauma, including fibromyalgia. The defendant, Ralphs Grocery Company, argued for apportionment to a prior 44% permanent disability award, citing Dr. Silverman's conflicting medical reports on apportionment for fibromyalgia. The Board found Dr. Silverman's reasoning on apportionment unclear and contradictory between his 2000 and 2010 reports. Therefore, the case was returned to the trial level for further clarification on Dr. Silverman's apportionment opinions regarding the fibromyalgia disability.

ApportionmentCumulative TraumaFibromyalgiaPermanent DisabilityReconsiderationAgreed Medical ExaminerWCJLabor Code section 4664Labor Code section 4663Findings and Award
References
1
Case No. MISSING
Regular Panel Decision

Claim of Gaylord v. Ichabod Crane Central School District

Claimant, a school bus driver, suffered muscle spasms and lower back pain attributed to her work, including lifting a nonambulatory child and enduring kicks from an autistic child. After seeking chiropractic and medical treatment, she was diagnosed with fibromyalgia and permanent disability. The Workers’ Compensation Board, however, only found a minor back strain that had resolved, largely relying on a medical expert who deemed the fibromyalgia a preexisting condition. The claimant appealed for a higher degree of disability, but the Appellate Division affirmed the Board's decision, finding substantial evidence to support the Board's conclusion that the fibromyalgia was not a causally related disability.

Workers' CompensationBack InjuryFibromyalgiaCausationMedical OpinionDisabilityAppellate ReviewPreexisting ConditionSubstantial EvidenceSchool Bus Driver
References
2
Case No. ADJ4579042
Regular
Aug 02, 2010

MARY LOPEZ vs. GRANADA HILLS COMMUNITY HOSPITAL, SAFETY NATIONAL CASUALTY COMPANY

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board granted reconsideration to further study the medical evidence regarding applicant Mary Lopez's claims of psyche injury and fibromyalgia stemming from an admitted neck and back injury. Defendants contended the WCJ relied on insufficient medical evidence, specifically Dr. Levine's fibromyalgia diagnosis due to an inadequate medical history and a psychiatric report where the applicant withheld suicidal ideation from the evaluating physician. The Board found the existing medical record inadequate to establish fibromyalgia or psychiatric injury and rescinded the prior findings. The matter was returned to the trial level for further development of the medical record, potentially through Agreed Medical Examiners or an Independent Medical Examiner.

Workers Compensation Appeals BoardReconsiderationFibromyalgiaPsyche InjuryQualified Medical EvaluatorSubstantial Medical EvidenceMedical HistoryDue ProcessIndustrial InjuryNeck Injury
References
15
Case No. MISSING
Regular Panel Decision

Matter of Sheldon v. Kelly

The case concerns a New York City police officer, a first responder at the World Trade Center site, who developed fibromyalgia after WTC exposure. She applied for accidental disability retirement (ADR) benefits under the WTC presumption, which places the burden on the police pension fund to disprove a service-related injury. The Medical Board and Board of Trustees denied her application, concluding her fibromyalgia and chronic fatigue syndrome were not WTC-related. The appellate court found that fibromyalgia qualifies as a "new onset disease" under relevant law and that the respondents failed to rebut the WTC presumption with competent evidence. Therefore, the court reversed the lower court's decision, granted the petition, annulled the Board's determination, and remanded the matter for further proceedings, entitling the petitioner to ADR benefits.

World Trade Center presumptionFibromyalgiaAccidental Disability RetirementPolice OfficerFirst ResponderWTC ExposureMusculoskeletal DiseaseChronic Fatigue SyndromeBurden of ProofCausation
References
7
Case No. MISSING
Regular Panel Decision

Matter of Bland v. Gellman, Brydges & Schroff

This case involves consolidated appeals from several decisions by the Workers’ Compensation Board concerning a claimant. The appeals address issues such as a variance request for aquatic therapy for thoracic outlet syndrome, the causal relationship of fibromyalgia and myofascial pain syndrome, the degree of partial impairment and loss of wage-earning capacity, entitlement to Botox therapy for migraines, and reimbursement for medical and travel expenses. The Court affirmed the Board's findings regarding the application of Shoulder Injury Medical Treatment Guidelines, the denial of aquatic therapy, the lack of causal relationship for fibromyalgia, the 50% loss of wage-earning capacity, and the denial of reconsideration for medical/travel expenses and labor market attachment. One appeal related to fibromyalgia care and Botox therapy was dismissed as the claimant was no longer aggrieved.

Workers' CompensationAppellate ReviewAquatic TherapyThoracic Outlet SyndromeFibromyalgiaMyofascial Pain SyndromeWage-Earning CapacityMedical Treatment GuidelinesVariance RequestReconsideration
References
23
Case No. MISSING
Regular Panel Decision

Casselbury v. Colvin

Plaintiff Pamela L. Casselbury sought judicial review of the denial of her disability insurance benefits application by the Commissioner of Social Security. The Plaintiff appealed the decision of Administrative Law Judge (ALJ) Thomas P. Tielens, arguing it lacked substantial evidence and applied erroneous legal standards. The District Court, presided over by Judge Elizabeth A. Wolford, denied the Commissioner's motion for judgment on the pleadings and granted the Plaintiff's motion in part. The court found the ALJ erred in evaluating Plaintiff's fibromyalgia as a non-medically determinable impairment and improperly weighted the opinions of treating physicians Dr. Koh and Dr. Datta, particularly regarding the subjective nature of fibromyalgia symptoms. Consequently, the case was remanded for further administrative proceedings to properly consider the fibromyalgia diagnosis and the treating physicians' opinions, potentially requiring testimony from a vocational expert if non-exertional limitations are significant.

Disability benefitsSocial Security ActFibromyalgiaTreating Physician RuleALJ errorRemandMedical evidenceChronic painDegenerative disc diseaseMental impairment
References
24
Case No. ADJ660645 (LAO 0798224)
Regular
May 11, 2009

Norma Flores vs. FIRST DATA ORLANDI VALUTA, ST. PAUL TRAVELERS INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The defendant appealed, arguing the administrative law judge erred by relying on a speculative medical opinion, finding 100% permanent disability, and failing to address the applicant's fibromyalgia claim. The Board affirmed the award, but amended the findings to include fibromyalgia as an industrially injured condition, aligning with the judge's recommendation.

Workers' Compensation Appeals BoardAgreed Medical Examiner (AME)Industrial InjuryNeck InjuryBack InjuryPsyche InjuryTemporary DisabilityPermanent DisabilityFibromyalgiaPetition for Reconsideration
References
0
Case No. ADJ10268942, ADJ10268936, ADJ10268937, ADJ12179713
Regular
Aug 06, 2019

SANDRA VELASQUEZ vs. CITY OF HOPE NATIONAL MEDICAL , CENTER

The Workers' Compensation Appeals Board granted reconsideration to address applicant's claims of injury to her right knee and fibromyalgia. The Board found that the Agreed Medical Examiner's opinions on fibromyalgia were not substantial evidence as the physician deferred to a specialist, and further development of the record was needed for the right knee claim. The Board rescinded the original award and returned the matter to the judge for further proceedings on these deferred issues, affirming all other aspects of the original decision.

WCABAOE/COEPetition for ReconsiderationJoint Findings and AwardWCJAgreed Medical Examiner (AME)Substantial EvidenceFibromyalgiaRheumatologistRight Knee Arthroscopy
References
0
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