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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. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ1315350 (VNO 0557111)
Regular
Apr 20, 2012

LINDA KAMBOW vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, VALLEY STATE PRISON FOR WOMEN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by an inmate laborer for orthopedic and psychiatric injuries. The Workers' Compensation Appeals Board denied reimbursement to Hepps Pharmacy for medications, as no prescription was provided. The Board also reversed an award to Southern California Mental Health Associates for psychiatric treatment, ruling that inmate psychiatric injuries are not compensable under Labor Code section 3208.3(j). The Board found that the psychiatric injury was a consequence of the industrial orthopedic injury, and thus not a compensable independent non-industrial condition requiring treatment to relieve orthopedic effects.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code 3208.3(j)Inmate laborerIndustrial orthopedic injuryNon-industrial psychiatric treatmentPrimary treating physicianSubstantial medical evidenceCompromise and Release AgreementLien trial
References
Case No. ADJ3817836 (SJO 0250881)
Regular
May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability
References
Case No. ADJ287866 LAO 0813289 ADJ7596806
Regular
Apr 30, 2012

CHESTER JACKSON vs. FEDERAL EXPRESS

This case involves a workers' compensation claim by Chester Jackson against Federal Express. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision. The WCAB affirmed the original decision but amended it to include penalties and interest owed to Dr. Friedman, pursuant to Labor Code section 4622(b), for specific dates of service. The exact amounts are to be adjusted by the parties.

Workers' Compensation Appeals BoardReconsiderationAmended DecisionPenaltiesInterestLC4622(b)Dates of ServiceFederal ExpressChester JacksonFriedman Psychiatric Med
References
Case No. ADJ1167311 (LBO 0303498) ADJ749429 (LBO 0296277)
Regular
Apr 29, 2011

RAMON ZIEBA vs. BAILLY SHOWCASE, SAFECO INSURANCE COMPANY

The Workers' Compensation Appeals Board denied lien claimant Dr. Halote's petition for reconsideration. Dr. Halote sought reimbursement for psychiatric treatment, arguing it was separate from a psychiatric injury claim. However, the only issue presented at trial was whether the applicant sustained a psychiatric injury arising out of and occurring in the course of employment. The Board found that the issue of the reasonableness of psychiatric treatment, for admitted orthopedic injuries, was not raised at trial and was therefore waived. Thus, the Board denied reconsideration as Dr. Halote could not raise this new issue for the first time on appeal.

Workers' Compensation Appeals Boardpsychiatric injuryAOE/COElien claimantPetition for ReconsiderationFindings of Factadministrative law judgeLabor Codecompensabilitypsychiatric treatment
References
Case No. MON 271718, MON 271720, MON 271721
Regular
Oct 04, 2007

ANDRES FORBES vs. CITY OF LOS ANGELES

A lien claimant, Dr. Friedman, sought reconsideration of stipulated workers' compensation awards, arguing a denial of due process when the applicant settled a psychiatric injury claim without his prior notice or opportunity to object. The Board affirmed the stipulated awards, ruling that while Dr. Friedman, as a lien claimant, is entitled to due process, the applicant's stipulations did not dismiss the underlying cases. Consequently, Dr. Friedman can still pursue his lien claim by proving a compensable psychiatric injury, as he now qualifies as a party for that issue.

Workers' Compensation Appeals BoardLien claimantDue processStipulated awardsDismissal with prejudiceCompensable industrial injuryPsychiatric treatmentMandatory settlement conferenceBurden of proofLabor Code section 3208.3
References
Case No. ADJ2441046 (SAL 0080759)
Regular
Jul 18, 2014

ELIZABETH GUTIERREZ vs. MERVYN'S ESTATE, CALIFORNIA SELF-INSURERS SECURITY FUND

The WCAB denied Mervyn's Estate's petition for removal, upholding the WCJ's decision allowing applicant Elizabeth Gutierrez to pursue her psychiatric claim. The WCJ found Gutierrez's testimony credible regarding her inability to attend two prior psychiatric evaluations due to lack of transportation reimbursement. While the WCAB denied removal as an extraordinary remedy, it reiterated that further missed appointments may result in the denial of her psychiatric claim.

Petition for Removalpsychiatric claimqualified medical evaluatormissed appointmentstransportation expensescredible testimonyextraordinary remedysubstantial prejudiceirreparable harmreconsideration
References
Case No. ADJ11952165
Regular
Nov 25, 2019

BILL HUMPHREY vs. CITY OF SAN LUIS OBISPO, PSI Through CJPIA, administered by YORK RISK GROUP

This case involved applicant Bill Humphrey's claim for psychiatric injury against the City of San Luis Obispo. The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that Humphrey sustained an industrial psychiatric injury. The Board affirmed the judge's determination that while a job reclassification was a good faith personnel action, it was not the substantial cause of the injury. Instead, increased job duties and applicant's internal pressure were deemed the predominant causes of his psychiatric condition.

Labor Code Section 3208.3good faith personnel actionpsychiatric injurypredominant causesubstantial causemultilevel analysisRolda v. Pitney BowesInc.panel qualified medical evaluatorPQME
References
Case No. ADJ1635668 (OXN 0148383)
Regular
May 08, 2014

MARTHA MORALES vs. RICK BORQUEZ, D.D.S., STATE FARM INSURANCE

This case involves a lien claimant seeking payment for psychiatric treatment and medication provided to the applicant. The initial WCJ disallowed the lien, finding the psychiatric treatment was not for a compensable consequence of the industrial injury and that the lien claimant failed to meet its burden of proof. The Appeals Board rescinded this decision, holding that the applicant's psychiatric condition was a compensable consequence of the industrial injury, as evidenced by the Compromise and Release, a QME's report, and the employer's prior payments for such treatment. The matter was returned to the trial level for further proceedings to determine the amount due to the lien claimant.

Workers Compensation Appeals BoardLien ClaimantOrchid Multispecialty Medical GroupPsychiatric TreatmentCompensable ConsequenceUtilization ReviewQualified Medical EvaluatorBurden of ProofPreponderance of the EvidenceCompromise and Release
References
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