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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ758842 (VNO 0559214)
Regular
Dec 17, 2010

JOHN PATCHETT vs. CITY OF LOS ANGELES

The Appeals Board denied the applicant's petition for removal, affirming the WCJ's decision to vacate the submission. This action was based on the DEU evaluator's testimony, which revealed deficiencies in the AMEs' reports concerning the AMA Guides. The Board found the applicant waived any objection to this testimony by failing to object at trial, and that the evaluator's expert opinion was permissible per *Blackledge v. Bank of America*. Defendant's objection, though not styled as a motion to strike, sufficiently raised the issues leading to the vacation of the rating.

Petition for RemovalOrder Vacating SubmissionDEU evaluatorAMA Guidesagreed medical evaluators (AMEs)rating instructionssubstantial evidenceobjective factors of disabilitywhole person impairmentformal rating
References
Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
Case No. ADJ1735018
Significant
Jun 03, 2010

CYNTHIA BLACKLEDGE vs. BANK OF AMERICA, ACE AMERICAN INSURANCE COMPANY

This en banc decision clarifies the distinct roles of the evaluating physician, the workers’ compensation administrative law judge (WCJ), and the disability rater in determining whole person impairment (WPI) under the AMA Guides, and remands the specific case for reassessment of the permanent disability.

AMA GuidesWhole Person ImpairmentPhysician's RoleWCJ's RoleRater's RoleFormal RatingPermanent DisabilitySubstantial EvidenceDRE Lumbar Category IIPatellofemoral Pain Syndrome
References
Case No. ANA 0402832
Regular
Jul 02, 2008

JOANN RAEKER vs. TSUCHIYAMA KAINO SUN-CARTER, ST. PAUL TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and affirmed a prior award, except for the permanent disability rating. The Board found that due process required further proceedings at the trial level regarding the permanent disability rating because the defendant was not properly served with the formal rating instructions. The case is remanded to the WCJ for a new decision on permanent disability.

Tsusohiya Kaino Sun-CarterSt. Paul Travelers Insurance CompanyFindings and AwardIndustrial InjuryTemporary Total DisabilityPermanent Disability RatingPenaltyAttorney FeeReconsiderationWCJ
References
Case No. ADJ1735018
En Banc
Jun 03, 2010

CYNTHIA BLACKLEDGE vs. BANK OF AMERICA, ACE AMERICAN INSURANCE COMPANY

An en banc decision clarifying the respective roles of the evaluating physician, the workers’ compensation administrative law judge (WCJ), and the disability rater in determining whole person impairment (WPI). The Appeals Board amended the WCJ's decision and remanded the matter for further proceedings.

AMA GuidesWhole Person ImpairmentPhysician's RoleWCJ's RoleRater's RoleFormal Rating InstructionsSubstantial Medical EvidenceDisability Evaluation UnitNon-Formal RatingsEx Parte Communication
References
Case No. ADJ6662275
Regular
Jun 13, 2011

DARRIN BEAN vs. CITY OF CHULA VISTA

This case involves an applicant seeking workers' compensation for a skin cancer injury. The applicant contests the testimony of an independent medical expert, Dr. Brigham, who offered an opinion on his impairment rating that differed from the agreed medical evaluator's (AME). The Appeals Board granted the applicant's Petition for Removal, ruling that Dr. Brigham's testimony was inadmissible as he was neither an AME nor a treating physician and his testimony was not in rebuttal to formal rating instructions. Consequently, Dr. Brigham's testimony was stricken, the prior order was rescinded, and the case was returned to the trial level for further proceedings based solely on admissible medical evidence.

Petition for RemovalAgreed Medical EvaluatorAMA GuidesWhole Person ImpairmentPermanent Disability RatingClass 1 ImpairmentClass 2 ImpairmentClass 3 ImpairmentMedical Evidence AdmissibilityRebuttal Testimony
References
Case No. ADJ11368246
Regular
Mar 03, 2020

Marta Ubillus vs. One Stop Employment Services, LLC/Vensure Employer Services, Security National Insurance Company, State National Insurance Company

The Workers' Compensation Appeals Board (WCAB) denied the lien claimant's petition for reconsideration regarding the valuation of interpreter services. The WCAB adopted the Administrative Law Judge's (ALJ) report, which found that while the defendant did not present rebuttal evidence, the ALJ had substantial evidence to make a determination. The ALJ determined a market rate of $114.97 per hour but noted the lien claimant failed to provide sufficient evidence of the duration of services on most dates, preventing application of the market rate. Consequently, the statutory rate was applied for those services.

WCABPetition for ReconsiderationDeniedLien ClaimantInterpreter ServicesMarket RateStatutory RateWCJ ReportSubstantial EvidenceFindings and Award
References
Case No. ADJ10187704, ADJ10924724
Regular
May 17, 2018

STEVEN CASE vs. GOLDEN GATE BRIDGE HIGHWAY AND TRANSPORTATION DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to increase applicant's permanent disability rating for bilateral shoulder injury from 9% to 38%. The Board found the Agreed Medical Evaluator's (AME) alternative rating, based on strength loss, was substantial medical evidence and properly considered within the AMA Guides. The WCJ erred in applying an overly restrictive interpretation of "complex or extraordinary" cases for deviating from strict AMA Guides ratings. The AME's use of strength loss data from the AMA Guides, even for an age outside the specified range, was permissible under the *Almaraz-Guzman* line of cases when justified by clinical judgment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationAgreed Medical Evaluator (AME)permanent disability ratingbilateral shouldersorthopedic AMEAMA GuidesAlmaraz-Guzmanstrength loss index
References
Case No. SDO 0321444 SDO 0321446
Regular
Jun 28, 2007

MARY BLOEMSMA vs. SAN DIEGO UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied reconsideration, upholding the use of the revised permanent disability rating schedule for applicant's pre-January 1, 2005 injury. The Board found that the treating physician's reports did not explicitly state the applicant was "permanent and stationary" with a ratable disability, a prerequisite for applying the older rating schedule under Labor Code § 4660(d). Therefore, the revised schedule was correctly applied, resulting in a 22% permanent disability rating.

Workers' Compensation Appeals BoardPermanent Disability Rating ScheduleRevised Rating SchedulePrior Rating ScheduleLabor Code Section 4660(d)Permanent and Stationary StatusTreating Physician's ReportComprehensive Medical-Legal ReportIndustrial InjuryHerniated Disc
References
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