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

Case No. 534205
Regular Panel Decision
Feb 09, 2023

In the Matter of the Claim of Kevin Brennan

Kevin Brennan appealed a Workers' Compensation Board decision filed September 20, 2021. The Board had disallowed his request to amend his claim to include certain consequential gastrointestinal conditions and ruled that his Workers' Compensation Law § 114-a violation disqualified him from receiving a schedule loss of use (SLU) award. Brennan had sustained a work-related back and hip injury in 1995 and was permanently disqualified from wage-replacement benefits in 2002 due to a § 114-a violation. In 2019, he sought to amend his claim for gastrointestinal issues. Both his treating physician, Atif Saleem, and an independent medical examiner, Ira Breite, could not definitively establish a causal link between his work injury/medications and the gastrointestinal conditions. The Appellate Division, Third Judicial Department, affirmed the Board's decision, finding substantial evidence supported the denial of the amendment and that a § 114-a violation indeed precludes SLU awards under Workers' Compensation Law § 15.

Workers' Compensation Law § 114-a ViolationSchedule Loss of UseWage Replacement Benefits DisqualificationConsequential Gastrointestinal ConditionsCausal RelationshipMedical Evidence SufficiencyIndependent Medical ExaminationTreating Physician TestimonyAdministrative AppealAppellate Division Review
References
19
Case No. ADJ4148815 (MON 0343933)
Regular
Nov 05, 2012

EMILY GARCIA vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration of a prior award, rescinding the original decision. They found applicant sustained an industrial injury to her right ankle and a sleep disorder, but not to her knee, hypertension, or gastrointestinal reflux. The claim for psychiatric injury was deferred due to insufficient evidence regarding the six-month employment requirement. The court also found the treating physician's report on the gastrointestinal reflux lacked substantial medical evidence.

WCABEmily GarciaCity of Los Angelesself-insuredFindings and AwardReconsiderationIndustrial InjuryRight AnklePsycheSleep Disturbance
References
10
Case No. ADJ6739372 ADJ6855448
Regular
Mar 04, 2013

KIMBERLY WESLEY BOSTON vs. COUNTY OF ALAMEDA, SEDGWICK CMS

The Appeals Board rescinded a prior award, finding insufficient medical evidence to support industrial causation for the applicant's gastrointestinal injuries. Dr. Hammerman's opinion was deemed not substantial medical evidence as he did not adequately explain how he reached a causation conclusion without an initially recommended endoscopy. The case is returned to the trial level for further medical development of the record regarding gastrointestinal complaints. The Board emphasized its duty to ensure substantial justice and develop undeveloped matters.

WCABADJ6739372ADJ6855448industrial injurypsychegastrointestinal systempermanent disabilitysubstantial medical evidenceagreed medical examinerconsulting physician
References
11
Case No. ADJ1401919
Regular
Oct 19, 2011

LUIS TORRES vs. LEW WEBB'S TOYOTA OF BUENA PARK, SEDGWICK CLAIMS MANAGEMENT, CALIFORNIA COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the finding of a mechanic's industrial injury to his right shoulder, wrist, teeth, and gastrointestinal system, resulting in 100% permanent disability. The Board adopted the WCJ's reliance on Dr. Markovitz's opinion that the gastrointestinal condition, leading to total disability, was entirely industrial. However, the issue of psychiatric injury was deferred for further consideration as the WCJ had not addressed statutory requirements. The decision also corrected a clerical error regarding the temporary disability end date.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary DisabilityPermanent DisabilityApportionmentCausationGastro paresisPsychiatric InjuryMedical Evidence
References
4
Case No. ADJ290453
Regular
Apr 11, 2014

MANUEL GOMEZ vs. FACILITIES SUPPORT SERVICES, COMPWEST INSURANCE COMPANY

This case concerns a workers' compensation applicant seeking medical treatment for his knees and compensation for gastrointestinal injury. The Appeals Board granted the applicant's petition for reconsideration, finding the defendant's utilization review process for left knee treatment was procedurally deficient. As a result, the issue of left knee treatment is deferred for further determination at the trial level. The applicant's claims of new and further gastrointestinal disability are not time-barred, but any permanent disability that existed prior to a 2011 settlement is barred by estoppel and res judicata.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndependent Medical Review (IMR)Utilization Review (UR)Senate Bill 863 (SB 863)Dubon v. World RestorationInc.Procedural DefectsMedical NecessityNew and Further Disability
References
1
Case No. ADJ3726826
Regular
Mar 04, 2010

MARIBEL ESCOBAR vs. YGNACIO VALLEY CARE CENTER, CARE WEST INSURANCE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, finding it timely filed. The Board affirmed the WCJ's finding that the applicant sustained industrial injuries to her lumbar spine and psyche, with compensable consequential injuries to her gastrointestinal system and a sleep disorder. Substantial medical evidence, including opinions from Dr. Cayton for the sleep disorder and Dr. Noriega for the gastrointestinal issues, supported the award. The Board also found Dr. Walcott's psychiatric opinion constituted substantial evidence, justifying the WCJ's disability findings.

Workers' Compensation Appeals BoardMaribel EscobarYgnacio Valley Care CenterCare West InsurancePegasus Risk ManagementFindings Award and OrderNursing AssistantIndustrial InjuriesLumbar SpinePsyche Injury
References
0
Case No. ADJ3767134 (VNO 0419005) ADJ195629 (VNO 0419004)
Regular
Mar 11, 2010

KATHY ROZA vs. DYNAMIC HOME CARE, INC., CLARENDON INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CREDIT GENERAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied all petitions for reconsideration regarding an applicant's industrial injuries. The Board affirmed the original finding that the applicant sustained injuries to her low back and gastrointestinal system, but denied claims for psychological, hip, knee, and hypertension issues. The Board found no clerical error in the finding of gastrointestinal injury and clarified that Clarendon Insurance Company's obligation to pay permanent disability indemnity was distinct from CIGA's liability. Ultimately, the Board concluded that Clarendon's petition lacked merit and its obligation to pay the awarded permanent disability indemnity was clear.

Workers' Compensation Appeals BoardCIGAClarendon Insurance CompanyCredit General Insurance Companyliquidationlicensed vocational nurseindustrial injurieslow back injurygastrointestinal system injurytemporary disability indemnity
References
1
Case No. ADJ1991870
Regular
Sep 07, 2010

TOM DRENNAN vs. SUPERIOR INSPECTION SERVICES, FIREMAN'S FUND INSURANCE COMPANY

This case involves an employer's petition for reconsideration of a WCJ's award finding industrial injury to the applicant's left knee, both hips, and gastrointestinal system as consequential to an admitted right knee injury. The defendant argues that a prior 2005 WCJ decision denying consequential injury to the left knee and hips is res judicata. The Appeals Board granted reconsideration, amending the award to remove the left knee and hip injuries, holding that the 2005 decision was final and the five-year time limit to reopen under Labor Code sections 5410 and 5804 had passed. The finding of consequential injury to the gastrointestinal system and 29% permanent disability remain affirmed.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardCompensable ConsequencesRes JudicataIndustrial InjuryLeft KneeHipsGastrointestinal SystemPermanent Disability
References
2
Case No. ADJ2356422 (VNO 0547491)
Regular
Dec 17, 2009

JENNY JONSSON vs. MARCELO POLANCO, AMERICAN HOME ASSURANCE COMPANY

The WCAB granted reconsideration, rescinded the prior award, and returned the matter for further development of the medical record due to insufficient evidence supporting the prior award's findings regarding sleep difficulties and permanent disability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryHead/Brain InjuryLeft Lower ExtremitySleep DifficultiesPermanent DisabilityFurther Medical TreatmentMedical Treatment
References
5
Case No. ADJ777354
Regular
Jul 12, 2012

WILLIAM SHIELDS vs. J.G.'S KITCHEN CONCEPTS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the lien claimant's petition for reconsideration. The lien claimant failed to appear at a hearing and their subsequent petition was unverified and lacked any legal argument. The Board found that the lien claimant's stated difficulties in securing representation do not constitute excusable neglect or good cause for their non-appearance. Therefore, the dismissal of the lien was upheld.

Workers Compensation Appeals BoardLien ClaimantPetition for ReconsiderationNotice of Intention to DismissUnverified PleadingVerification DefectGood CauseExcusable NeglectBusiness PracticesHearing Representatives
References
1
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