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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. 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. ADJ7527781; ADJ7527786
Regular
Feb 05, 2016

OCTAVIO ESPINOZA vs. TORRES FARM LABOR, SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, amending the original award to defer the finding of permanent disability and attorney's fees. The Board denied the defendant's petition for reconsideration, affirming the original award regarding future medical treatment for internal injuries. The case is returned to the WCJ for further proceedings, including consideration of a sleep study report and development of the record concerning permanent disability. The Board agreed that substantial evidence supported the finding of industrial injury to internal organs and the need for future medical treatment.

Workers' Compensation Appeals BoardIndustrial InjuryPermanent DisabilityTemporary Total DisabilityFuture Medical TreatmentPetition for ReconsiderationFindings of FactJoint AwardWCJSubstantial Evidence
References
Case No. ADJ4602757 (LBO 0396075)
Regular
Sep 08, 2014

Janice Jablonski vs. Covina Valley Unified School District, York Risk Services Group

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration. The Board found that the report of Dr. Windman, relied upon by the WCJ for a portion of the permanent disability rating, did not constitute substantial medical evidence due to an inadequate medical history. Consequently, the Board rescinded the original Findings and Award. The case was returned to the WCJ for a new permanent disability rating, to be based solely on the report of the panel Qualified Medical Evaluator, Dr. Justice.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Disability RatingSubstantial Medical EvidenceAgreed Medical ExaminerQualified Medical EvaluatorRange of EvidenceInadequate Medical HistoryIndustrial Injury
References
Case No. ADJ8076214
Regular
Aug 27, 2018

FRANKLIN REYES vs. INSIDE & OUTSIDE POTTERY; THE HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board found that the defendant's petition improperly sought reconsideration of an interlocutory issue, which should have been addressed through a petition for removal. Even if treated as a petition for reconsideration, the Board agreed with the WCJ that the applicant's objection to the Qualified Medical Evaluator's report was timely under Labor Code section 4061. Therefore, the applicant is entitled to a psychiatric PQME.

AOE/COEPsychiatric PQMELabor Code § 4062Petition for ReconsiderationFindings and OrderWCJFinal OrderInterlocutory OrderMedical-Legal EvaluationPermanent Disability
References
Case No. ADJ8132311
Regular
Aug 12, 2019

Celia Kalbaugh vs. County of Kern

This case involves a claim by Celia Kalbaugh for 100% permanent disability due to a psyche injury sustained as a Deputy Detentions Officer. The defendant, County of Kern, contested the findings, arguing the Agreed Medical Examiner was unqualified to assess employability and that the applicant was capable of vocational rehabilitation. The Workers' Compensation Appeals Board affirmed the original award, adopting the WCJ's reasoning that the Agreed Medical Examiner's findings of profound cognitive deficits preventing work were persuasive. The Board also found the applicant's vocational consultant's opinion, supporting unsuitability for rehabilitation and the open labor market, credible.

Workers' Compensation Appeals BoardCelia KalbaughCounty of KernPetition for ReconsiderationFindings Orders and Awardpermanent disabilityDeputy Detentions Officerpsyche injuryAgreed Medical Examinervocational rehabilitation
References
Case No. ADJ6591842
Regular
Jan 28, 2013

FRANCISCO LUJAN vs. MAXON INDUSTRIES, INC., CHARTIS COSTA MESA, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case involves a worker's compensation claim by Francisco Lujan against Maxon Industries, Inc. The defendant, Maxon Industries, filed a Petition for Reconsideration arguing that the Administrative Law Judge (ALJ) erred by relying on the medical opinions of Dr. Diane Weiss. The defendant contended Dr. Weiss's reports were not substantial evidence due to perceived discrepancies in symptom severity, lack of psychological testing, alleged ex parte communication, contradiction by another doctor, disregard of videotape evidence, and non-conformity with AMA Guides. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, adopting the ALJ's report which found Dr. Weiss's opinions credible and well-reasoned, supported by the applicant's testimony and corroborated by another medical expert on the critical issue of work capacity. The WCAB also upheld the ALJ's reliance on the vocational expert's report, finding it unrebutted, and found no error in the award of attorney's fees.

Petition for ReconsiderationAgreed Medical ExaminerElectric shockSub rosa videoGAF scorePsychological testingEx parte communicationAMA GuidesVocational expertUniform Reduction Method
References
Case No. ADJ18498378
Regular
Oct 27, 2025

MARIA VENEGAS vs. MARATHON PETROLEUM COMPANY, ACE AMERICAN INSURANCE

Lien claimant, Premier Psychological Services, sought reconsideration of a Findings and Order from July 30, 2025, which denied its lien for medical-legal and medical treatment expenses. The Workers' Compensation Appeals Board (WCAB) granted the petition for reconsideration, rescinded the original F&O, and returned the matter to the trial level for further proceedings. The Board found that the medical-legal expenses were incurred for a contested claim and that the medical report from Dr. Mark Michaels constituted substantial medical evidence for an injury arising out of and in the course of employment, despite some curable deficiencies regarding interpreter information. The WCAB ordered further consideration of the medical treatment expenses and a potential updated utilization review.

Premier Psychological ServicesAdjudication Number ADJ18498378Opinion and Order Granting Petition for ReconsiderationDecision After ReconsiderationLien ClaimantPrimary Treating Physician (PTP)Dr. Mark MichaelsInjury Arising Out of and In the Course of Employment (AOE/COE)PsycheMedical-Legal Report
References
Case No. ADJ16528931
Regular
Apr 25, 2025

Marisa Kelly vs. Sacramento County Child Protective Services, PSI, County of Sacramento

Defendant sought reconsideration of a Findings of Fact, Awards and Orders (F&O) issued on February 5, 2025, which found that the applicant, Marisa Kelly, sustained a work-related psychiatric injury. The defendant contended that the medical evidence supporting this finding, specifically from the Panel Qualified Medical Examiner (PQME), was not substantial. The Workers' Compensation Appeals Board, after reviewing the petition and the WCJ's report, determined that the PQME's reasoning clearly supported the causation of the applicant's temporary disability and need for medical treatment. The Board concluded that the PQME's use of 'exacerbation' instead of 'aggravation' was immaterial, and therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardSacramento County Child Protective ServicesMarisa KellyPetition for ReconsiderationFindings of Fact Awards and OrdersInjury Arising Out of and Occurring in the Course of EmploymentAOE/COEPsycheMedical EvidencePanel Qualified Medical Examiner
References
Case No. ADJ8811286
Regular
Feb 03, 2017

Roy Lehman vs. Walgreens, Zurich American Insurance Company

In this workers' compensation case, the Appeals Board affirmed the finding that Roy Lehman is permanently and totally disabled due to an industrial injury to his low back and psyche. Defendant Walgreens appealed, arguing the finding of permanent total disability was improper due to a lack of apportionment and reliance on incorrect rating schedules. The Board found substantial medical and vocational evidence supported the total disability finding, including expert opinions that Lehman was unemployable and not amenable to rehabilitation even after considering apportionment. The Board also found the vocational expert's reports met the substantial evidence standard despite defense challenges.

Workers' Compensation Appeals BoardWalgreensZurich American Insurance CompanySedgwick Claims Management ServicesRoy LehmanOpinion and Decision After ReconsiderationFindings Award and Orderpermanent total disabilityapportionmentLabor Code Section 4663
References
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