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

Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
Significant
Feb 03, 2009

Mario Almaraz, Joyce Guzman vs. Environmental Recovery Services (a.k.a. ENVIROSERVE), State Compensation Insurance Fund, Milpitas Unified School District, Permissibly Self-Insured, Keenan & Associates, Adjusting Agent

The Appeals Board held that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable by showing that an impairment rating based on the AMA Guides would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability.

AMA Guidesrebuttable presumptionpermanent disability rating2005 Scheduleimpairment determinationmedical opinionevidentiary standardequitable awardvocational specialistsactivities of daily living
References
Case No. ADJ1078163, ADJ3341185
Significant
Sep 03, 2009

Applicant vs. Workers' Compensation Appeals Board

The court holds that a permanent disability rating under the 2005 Schedule is rebuttable, but any rebuttal evidence concerning Whole Person Impairment (WPI) must be founded within the four corners of the AMA Guides.

AMA GuidesPermanent Disability RatingRebuttablePrima Facie EvidenceWhole Person ImpairmentScheduleLabor Code Section 4660SB 899En Banc DecisionWorkers' Compensation Appeals Board
References
Case No. GRO 0029816, GRO 0029817
En Banc

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision, holding that under Labor Code section 4663 as amended by SB 899, apportionment of permanent disability is based on causation and may include pre-existing, non-industrial conditions like degenerative arthritis, provided there is substantial medical evidence to support the percentage of non-industrial causation.

SB 899ApportionmentCausationPermanent DisabilityPreexisting ConditionDegenerative ArthritisSubstantial Medical EvidenceMedical ProbabilityLabor Code Section 4663Compensable Consequence
References
Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
En Banc
Feb 03, 2009

MARIO ALMARAZ, JOYCE GUZMAN vs. ENVIRONMENTAL RECOVERY SERVICES, STATE COMPENSATION INSURANCE FUND, MILPITAS UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

In a consolidated en banc decision, the Appeals Board holds that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable and remands two separate cases to their respective WCJs to determine if the standards for rebuttal have been met.

AMA Guides2005 Schedulerebuttablepermanent disabilityinequitable awarddisproportionate awardfair and accurate measuremedical opinionsadministrative law judgeWCJ
References
Case No. GRO 0029816, GRO 0029817
Significant

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision to apportion 50% of the applicant's permanent disability to a preexisting degenerative arthritis, holding that Labor Code section 4663, as amended by SB 899, permits apportionment based on causation from non-industrial factors supported by substantial medical evidence.

SB 899apportionmentcausationpermanent disabilitypreexisting arthritismedical evidencesubstantial evidenceLabor Code section 4663compensable consequenceQME
References
Case No. SFO 0479038
Significant
Oct 26, 2005

JACK C. STRONG, Applicant vs. CITY & COUNTY OF SAN FRANCISCO, Permissibly Self-Insured

The Board holds that under Labor Code section 4664, where an employee has a prior permanent disability award for one body region and suffers a new industrial injury causing permanent disability to another region, the apportionment of overlapping disabilities is required.

SB 899apportionmentLabor Code section 4664prior permanent disabilityoverlapping disabilitiesemployer burden of proofconclusive presumptionmedical rehabilitationrebuttable presumptionfactors of disability
References
Case No. MON 0307506
Significant
Oct 26, 2005

Virginia Sanchez vs. County of Los Angeles, Tristar Risk Management (Adjusting Agent)

This en banc decision clarifies the issue of apportionment of permanent disability under Labor Code section 4664, holding that where a prior permanent disability award exists for the same body region, it is conclusively presumed to exist, and apportionment is required if the prior and current disabilities overlap.

SB 899ApportionmentLabor Code Section 4664Prior Permanent DisabilityOverlapping DisabilitiesConclusive PresumptionBurden of ProofMedical RehabilitationAbilities to Compete and EarnSame Region of the Body
References
Case No. SFO 0479038
En Banc
Oct 26, 2005

JACK C. STRONG vs. CITY & COUNTY OF SAN FRANCISCO

This en banc decision holds that Labor Code section 4664 requires apportionment of overlapping permanent disabilities from prior awards, even when involving different body regions. It establishes that the defendant must prove the prior award exists, after which the disability is conclusively presumed to exist, and the burden shifts to the applicant to disprove that the old and new disabilities overlap in their effect on the ability to compete and earn.

SB 899Labor Code section 4664apportionmentpermanent disabilityoverlapping disabilitiesprior awardconclusively presumedburden of proofrebuttable presumptionunique factors of disability
References
Case No. ADJ271398 (SFO 0505138)
Regular
Jun 09, 2009

Fernando Martinez vs. D.H. SMITH COMPANY, INC., ICW GROUP

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration and rescinded the original denial of benefits. The Board found that the applicant's injuries sustained in a vehicle collision arose out of and occurred in the course of his employment, despite his unlicensed driving contrary to employer instructions. The Court held that performing an authorized activity in an unauthorized manner does not remove the injury from the course of employment when the employer provides transportation to a job site. The Board denied the defendant's petition, affirming that the "going and coming rule" did not bar compensation in this instance.

going and coming rulescope of employmentcourse of employmentarising out of employmentemployer provided transportationunauthorized mannermaterial deviationpublic highwayincreased riskLabor Code section 3600
References
Case No. MON 0307506
En Banc
Oct 26, 2005

VIRGINIA SANCHEZ vs. COUNTY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

The Board holds that Labor Code section 4664 requires apportionment of overlapping permanent disabilities from a prior award for the same body region, with the defendant bearing the burden of proving the prior award and the applicant bearing the burden of disproving overlap.

SB 899Labor Code section 4664apportionmentprior industrial injurypermanent disabilityoverlapping disabilitiesen banc decisionpresumption of prior disabilityburden of proofmedical rehabilitation
References
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