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

Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ4671941
Regular
Oct 11, 2010

GEORGE VIVEIROS vs. TURLOCK CITY TOW SERVICE, WESTPORT INSURANCE CORPORATION, SOUTHLAND CLAIMS SERVICE, INC.

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and dismissed their Petition for Removal. The Board found that the defendant failed to timely object to the applicant's request for back surgery and that substantial medical evidence supported the need for the procedure. The defendant's arguments regarding the timeliness of their objection, burden of proof, and the sufficiency of medical evidence were rejected. Consequently, the original finding and award, granting the applicant entitlement to back surgery, remains upheld.

Petition for ReconsiderationPetition for RemovalFinding and AwardBack SurgeryUtilization ReviewLabor Code section 4610Burden of ProofDWC Rule 9792.6(o)Substantial Medical OpinionAdministrative Law Judge
References
Case No. ADJ6831983
Regular
Dec 14, 2020

SHERRY BRAZIL vs. SAN MATEO COUNTY TRANSIT DISTRICT

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the Administrative Law Judge's decision. The Board gave great weight to the ALJ's credibility determination, finding no substantial evidence to warrant overturning it. The applicant sustained an admitted back injury in 2008, leading to subsequent compensable injuries to her psyche and right knee due to failed surgeries and treatment. The applicant was found to be 100% permanently and totally disabled with no basis for apportionment.

Workers' Compensation Appeals BoardPetition for Reconsideration DeniedWCJ Credibility DeterminationCompensable ConsequencesRight Knee InjuryPsyche InjuryPermanent Total DisabilityApportionmentVocational RehabilitationAMA Guides
References
Case No. OXN 126995
Regular
Nov 07, 2007

CHARLES DURHAM vs. MISSION LINEN SUPPLY, SECURITY INSURANCE COMPANY OF HARTFORD, FIDELITY AND CASUALTY COMPANY OF CONNECTICUT, ACCELERATED CLAIMS SERVICES, INC

This case involves a workers' compensation claim where the applicant sustained a low back injury. The core dispute centers on whether cognitive behavioral therapy is a compensable medical treatment for the applicant's chronic pain resulting from a failed surgery, despite the defendant's arguments about a non-industrial psychiatric component. The Workers' Compensation Appeals Board denied reconsideration, adopting the Administrative Law Judge's report that emphasized the treating physician and Qualified Medical Examiner recommendations supporting the therapy as essential to relieve the effects of the orthopedic injury.

Cognitive behavioral therapyFailed back surgeryPain managementQualified Medical ExaminerUtilization ReviewLabor Code § 3208.3Labor Code § 4600Labor Code § 4610Labor Code § 4062Compensable psychiatric injury
References
Case No. ADJ1584272
Regular
Dec 03, 2010

RICHARD SILVA vs. PAZIN & MYERS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding of 100% permanent disability for the applicant's back and psyche injuries. The Board found that the workers' compensation judge properly applied the 1997 Schedule for Rating Permanent Disabilities due to pre-existing medical reports indicating permanent disability. Substantial evidence, including the Agreed Medical Examiner's opinion on permanent total disability and the applicant's treating psychologist's opinion, supported the 100% disability rating. The defendant failed to meet its burden to prove apportionment of the disability.

ADJ1584272FRE 0244029Pazin & MyersInc.State Compensation Insurance FundFindings and AwardSeptember 142010industrial injuryback
References
Case No. ADJ81 82118
Regular
Mar 25, 2016

ROBERT DALLAS vs. PAN PACIFIC PETROLEUM, NATIONAL UNION FIRE INSURANCE COMPANY

This case concerns an applicant's industrial back injury and a dispute over authorization for spinal surgery. The defendant failed to provide a required second written notification of their Utilization Review (UR) decision to the applicant's physician and the applicant. Citing the *Bodam* precedent, the Appeals Board held that a UR decision, even if timely made, is invalid if not properly communicated. Consequently, the Board affirmed the Workers' Compensation Judge's award of surgery, determining its necessity based on available evidence.

Workers' Compensation Appeals BoardRobert DallasPan Pacific PetroleumNational Union Fire Insurance CompanyAIG Property CasualtyADJ8182118Opinion and Decision After ReconsiderationWorkers' Compensation Judge (WCJ)Industrial InjuryBack Injury
References
Case No. TI11711888
Regular

ROBERT MCFARLAND vs. CHARLES ABBOTT ASSOCIATES, ST. PAUL TRAVELERS and its property casualty affiliates and subsidiaries

In this workers' compensation case, the defendant sought reconsideration of an award finding the applicant 100% permanently disabled without apportionment. The Appeals Board denied the petition, upholding the finding that the applicant's total disability stemmed directly from unsuccessful spinal surgery following an industrial injury. The Board relied on the *Hikida* case, which permits unapportioned awards when permanent disability arises directly from unsuccessful medical treatment, even if non-industrial factors contributed to the need for that treatment. Prior stipulations regarding apportionment were deemed not binding on new and further disability claims arising from failed surgery syndrome.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentFailed Medical TreatmentHikidaAgreed Medical EvaluatorStipulationsNew and Further Disability
References
Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Case No. LBO 0307401
Regular
Jun 09, 2008

WILLIAM MUNOZ vs. THE BOEING COMPANY, CIGA BY ITS SERVICING FACILITY, CAMBRIDGE INTEGRATED SERVICES FOR FREMONT INDEMNITY COMPANY, IN LIQUIDATION

This case concerns the denial of a petition for reconsideration by the California Workers' Compensation Appeals Board (WCAB). The defendant, CIGA, sought to overturn a finding that the applicant was entitled to low back surgery recommended by his treating physician. The WCAB denied CIGA's petition because it failed to follow the statutory procedures for objecting to a spinal surgery recommendation, specifically by not timely filing for a second medical opinion. CIGA's arguments regarding administrative duties of another entity and reliance on an outdated medical report were also insufficient to warrant reconsideration.

Workers' Compensation Appeals BoardCIGAPetition for ReconsiderationFindings of FactLow Back SurgeryIndustrial InjuryWarehousemanRepetitive TraumaStipulationCompromise and Release
References
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