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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. ADJ8077522
Regular
Dec 21, 2018

FOREST BAILEY vs. LUNDAY THAGARD COMPANY, doing business as WORLD OIL CORPORATION, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PENNSYLVANIA

The applicant sought reconsideration of an award finding 87% permanent disability, arguing for permanent total disability based on a psychiatric Agreed Medical Examiner's (AME) report. The Appeals Board denied reconsideration, upholding the original award. The Board found the WCJ properly weighed the AME's opinions on psychiatric impairment over treating physicians, as required by law. Applicant's trial testimony was also considered by the AME in prior reports.

Workers' Compensation Appeals BoardForest BaileyLunday Thagard CompanyNational Union Fire Insurance CompanyPetition for ReconsiderationFindings and Awardpermanent partial disabilitypsyche injuryburn injuryAgreed Medical Examiner (AME)
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. ADJ6714887
Regular
Nov 05, 2010

ROBERT BARGAS vs. FRESNO UNIFIED SCHOOL DISTRICT

This case involves a dispute over the permanent disability rating for a carpenter injured in 2008. The defendant school district sought reconsideration of a 31% permanent disability award. The Appeals Board granted reconsideration, finding the agreed medical evaluator's (AME) "functional" impairment rating, which led to the 31% award, was not substantial evidence. The Board rescinded the award and remanded for a new rating, requiring strict application of the AMA Guides unless the AME adequately explains any deviation.

Permanent Disability RatingAgreed Medical Evaluator (AME)Almaraz/Guzman IIAMA GuidesWhole Person Impairment (WPI)Rebuttal of ScheduleSubstantial EvidenceFunctional AssessmentAnatomic AssessmentClinical Judgment
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. 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. ADJ8393129
Regular
Feb 24, 2020

THOMAS HASSON vs. ANN TAYLOR, TRAVELERS INSURANCE

Here's a concise summary for a lawyer: This case involves a defendant's petition for reconsideration of a finding of permanent total disability due to cumulative trauma. The defendant argued the treating physician's report was unsubstantial regarding causation and functional capacity, and that apportionment to a pre-existing condition was wrongly disregarded. The Board denied reconsideration, affirming the administrative law judge's decision, finding substantial evidence supported the permanent total disability finding based on the applicant's inability to benefit from vocational rehabilitation. The Board adopted the judge's reasoning that the applicant's medical restrictions precluded him from returning to full-time employment in the open labor market.

cumulative traumapermanent total disabilitymedical evidencevocational evidencefunctional capacity evaluationresidual functional capacityapportionmentpre-existing conditionsubstantial medical evidencelabor market
References
Case No. ADJ1016521 (MON 0350650)
Regular
Aug 16, 2012

DEBRA KENNEDY vs. KAISER FOUNDATION HEALTH PLAN

The Workers' Compensation Appeals Board rescinded a prior award due to procedural and evidentiary issues. Key findings were that the WCJ's decision lacked proper documentation of evidence and the permanent disability rating calculation was unclear. Additionally, the medical reporting for psychological injury and apportionment lacked thorough analysis required by statute. The case is returned to the WCJ for further proceedings and a new decision, considering a 104-week limit on temporary disability and credit for EDD payments.

Agreed Medical EvaluatorSubstantial EvidenceIndustrial InjuryLumbar SpineCervical SpineRight WristLeft WristHypertensionGERDIBS
References
Case No. ADJ7115385
Regular
Apr 17, 2017

NEVENKA GLAVAN vs. KMART, SEARS HOLDING CORPORATION

The Appeals Board denied defendant's petition for reconsideration of a Workers' Compensation Appeals Board award. The defendant argued the applicant's treating physician's psychiatric reports lacked substantial evidence and that a QME's report was more accurate. The Board found that the treating physician's opinions, which were well-reasoned and considered the applicant's medical history, constituted substantial evidence. Therefore, the Board upheld the original award finding the applicant sustained injury to her spine, psyche, and gastrointestinal/sleep disorders, resulting in 81% permanent partial disability.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationAdministrative Law JudgePermanent Partial DisabilityPsychiatric DisabilityTreating PhysicianPanel Qualified Medical EvaluatorGlobal Assessment of Function (GAF)Substantial Evidence
References
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