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

Case No. ADJ7279904
Regular
Jan 26, 2017

JORGE URIBE vs. DS WATERS OF AMERICA, INC., ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued the $69\%$ permanent disability finding for psychiatric injury lacked substantial evidence because the treating physician's GAF score correction was unexplained. The Board found the physician adequately explained the correction by detailing how the proper application of GAF criteria resulted in a revised score. Furthermore, the defendant failed to pursue discovery or object to the revised report, which was admitted into evidence. Therefore, the WCJ's finding on psychiatric permanent disability was upheld.

GAF scorepermanent disabilitypsychiatric injurylumbar spinecervical spinesubstantial evidencePetition for ReconsiderationFindings and AwardWCJprimary treating physician
References
Case No. ADJ1088185 (SAC 0369416)
Regular
May 25, 2012

DEBORAH COIL vs. CITY OF RANCHO CORDOVA

The Workers' Compensation Appeals Board (WCAB) dismissed Deborah Coil's petition for reconsideration because the WCJ's order was procedural, not a final determination of substantive rights. The WCAB reasoned that Coil's contentions about the PQME's familiarity with the AMA Guides were misplaced as those guides are not relevant to psychiatric impairment ratings. Therefore, the WCAB denied removal and dismissed the petition, allowing the PQME another opportunity to re-evaluate the applicant without her husband present. A concurring and dissenting opinion argued for removal, citing the PQME's repeated inability to produce substantial medical evidence.

Panel Qualified Medical EvaluatorPQMEPetition for ReconsiderationRemovalLabor Code Section 5900Labor Code Section 5310Final OrderSubstantial Medical EvidenceAMA GuidesAlmaraz/Guzman
References
Case No. ADJ70 84052
Regular
Mar 23, 2015

Edwin Martinez vs. Coca-Cola Enterprises, Inc.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board adopted the Workers' Compensation Judge's report, which found a compensable sleep disorder and awarded additional permanent disability. The Board also found that the judge's order regarding the Employment Development Department (EDD) lien was a non-final order and denied the defendant's related contention.

Sleep disordercompensable sleep disorderpermanent disabilityWCJ discretionEDD lienreimbursementpetition for reconsiderationabuse of discretionWPIpsychiatric injury
References
Case No. ADJ8530656, ADJ8553993
Regular
May 03, 2019

Feliciano Hernandez vs. Fresh Express, Inc., Federal Insurance Company, Sedgwick Claims Management Services

The Workers' Compensation Appeals Board granted reconsideration of a prior award, amending the applicant's permanent disability rating. The Board disagreed with the initial finding of 67% permanent disability, determining that the psychiatric impairment rating should be increased based on the Agreed Medical Examiner's opinion. This adjustment, utilizing an analogical rating method and considering the applicant's GAF score of 50, increased the total permanent disability to 73% and will include a life pension. The Board upheld the rejection of the vocational expert's total disability finding due to improper consideration of the applicant's age.

Agreed Medical ExaminerAlmaraz/GuzmanGAF scorepermanent disability ratingvocational expertsubstantial medical evidencerebuttal of scheduled ratingindustrial injuryspecific injurycumulative trauma injury
References
Case No. ADJ1108001
Regular
Dec 13, 2013

ALMA HILL vs. BMCA INSULATION PRODUCTS/GAF BUILDING MATERIALS, AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case concerns a clerical error in the Workers' Compensation Appeals Board's November 21, 2013 Opinion and Order. The original order incorrectly listed the District Office as Santa Barbara when it should have been San Bernardino. The Board has issued an order to correct this error, noting that such corrections can be made at any time without further proceedings. The reconsideration proceedings remain pending.

Workers' Compensation Appeals BoardClerical ErrorPetition for ReconsiderationDistrict OfficeSan BernardinoSanta BarbaraOpinion and OrderSupplemental ProceedingsBMCA Insulation ProductsGAF Building Materials
References
Case No. ADJ7295285
Regular
Dec 05, 2012

CARL SIRL vs. VSJ, INC., ENDURANCE INSURANCE COMPANY, FIRSTCOMP INSURANCE AGENCY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award finding applicant suffered a 23% permanent disability, including 12% for sleep disturbance. The PQME's reliance on the Epworth Sleepiness Scale for the sleep impairment rating was deemed insufficient without further explanation, particularly regarding the absence of formal sleep studies. The WCAB remanded the case to the trial level for further development of the medical record concerning the sleep disorder and its impairment rating. Defendants were directed to continue paying uncontested permanent disability indemnity for the applicant's back injury.

Workers' Compensation Appeals BoardPermanent DisabilitySleep DisturbanceEpworth Sleepiness ScalePQMEAMA GuidesWhole Person ImpairmentActivities of Daily LivingDue ProcessMedical Record Development
References
Case No. ADJ7143821
Regular
Jan 30, 2015

DANA ESPARZA vs. MICHAEL'S COMMUNICATION, ZURICH NORTH AMERICA

This case concerns an applicant's petition for reconsideration of a prior award regarding new and further psychiatric disability. The Appeals Board granted reconsideration, specifically amending the prior decision to allow reimbursement for a vocational expert's fee. While the Board affirmed the finding of increased permanent disability, it reversed the denial of the vocational expert's costs. The Board reasoned that the expert's report was reasonable and necessary when incurred and had the potential to prove disputed facts, even if it didn't ultimately rebut the permanent disability rating.

Petition to ReopenNew and Further DisabilityVocational Expert FeeLabor Code 5811ReconsiderationFindings and AwardWCJPermanent DisabilityRebuttal EvidenceAgreed Medical Examiner
References
Case No. ADJ8829857 ADJ8829856
Regular
Apr 18, 2016

DULCE ESPINOZA vs. JENCO PRODUCTIONS, INC., FIRST NATIONAL INSURANCE COMPANY OF AMERICA

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because the appealed finding, deferring development of the record on psychiatric injury, was not a final order. The Board then treated the petition as one for removal, granted it, and rescinded the deferral. Ultimately, the Board found that the applicant failed to prove industrial injury to her psyche, citing a lack of objective evidence and inconsistencies in her reporting, as well as a conflicted medical opinion.

WORKERS' COMPENSATION APPEALS BOARDDULCE ESPINOZAJENCO PRODUCTIONSINC.FIRST NATIONAL INSURANCE COMPANY OF AMERICAADJ8829857ADJ8829856Petition for ReconsiderationPetition for RemovalDecision After Removal
References
Case No. ADJ7936482
Regular
Apr 20, 2020

EXTELA MONTIEL vs. MICRO SOLUTIONS, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration to further study factual and legal issues concerning an applicant's permanent disability award. Key disputes involve the correct permanent disability indemnity rate, with the defendant arguing for a lower weekly rate based on the injury date, and the validity of the $60\%$ permanent disability finding due to conflicting medical opinions. The Board found deficiencies in the medical evidence regarding psychiatric permanent disability and issues with the apportionment of that disability. Consequently, the Board deferred resolution of temporary disability, the EDD lien, permanent disability, apportionment, and the permanent disability rate pending further record development.

Petition for ReconsiderationFindings and AwardSupervising assemblerAdmitted industrial injuryNon-admitted injuryCervical spinePsychePermanent disabilityLabor Code section 4658(d)GAF
References
Case No. ADJ588686 (SDO 0309857) ADJ2275487 (SDO 0311854) ADJ1079800 (SDO 0309856)
Regular
Mar 12, 2014

GRAZYNA KOZAK vs. QUIDEL CORPORATION, CNA INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the petition for reconsideration, affirming the WCJ's decision. The Board found the defense exhibits, including surveillance videos and vocational expert reports, were properly admitted. They also upheld the use of the AMA schedule for permanent disability, finding the applicant's earlier reports did not qualify for the prior rating schedule. Finally, the Board gave great weight to the WCJ's credibility findings regarding the applicant and found the opinions of some expert witnesses to be unsubstantial.

Petition for ReconsiderationWorkers' Compensation Appeals BoardWCJ credibility findingvocational expert reportssubrosa filmscustodian of recordspermanent disability rating schedulePDRSpermanent and stationary statussubstantial evidence
References
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