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

Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
Case No. ADJ1455856
Regular
Aug 24, 2012

GUILLERMO HERNANDEZ vs. SPIESS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a finding of 79% permanent disability. The Board found the applicant's vocational expert's opinions regarding diminished future earning capacity unsubstantiated. Consequently, the Board amended the award to reflect 37% permanent disability based on a prior stipulation, and removed any apportionment to non-industrial factors due to lack of substantial medical evidence from the defendant.

WCABSpiess ConstructionState Compensation Insurance FundGuillermo HernandezADJ1455856GRO 0032468ReconsiderationPermanent DisabilityDiminished Future Earning CapacityDFEC
References
Case No. ADJ6408456
Regular
May 17, 2010

KENNETH M. HOOVER vs. CITY OF POMONA

The Appeals Board granted reconsideration of the WCJ's award of 100% permanent total disability. The Board found that the WCJ's decision was not supported by substantial evidence, primarily due to deficiencies in Dr. Grodan's medical reporting regarding the applicant's skin and cardiovascular conditions. The matter was returned to the trial level for further development of the record and a new decision. The Board confirmed the application of the 1997 Permanent Disability Rating Schedule and the admission of Dr. Shirman's report.

WORKERS' COMPENSATION APPEALS BOARDADJ6408456KENNETH M. HOOVERCITY OF POMONAreconsiderationFindings and Award and Orderworkers' compensation administrative law judgeWCJMay 172010
References
Case No. VNO 0507584, VNO 0508707
Regular
Apr 22, 2008

CAROLYN HOWARD vs. GOTTSCHALKS, INC., THE HARTFORD

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, finding that neither the applicant's treating physician nor the defendant's QME provided substantial evidence regarding the extent of permanent disability. The Board returned the case to the trial level for further development of the record, specifically requiring more comprehensive medical opinions on permanent disability from both physicians. The Board also directed the WCJ to make an express finding regarding injury to the applicant's thoracic spine.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardThoracic spinePsyche injuryPermanent disabilityFurther medical treatmentPermanent disability indemnitySeth Hirsch Ph.D.Jay Cohen M.D.
References
Case No. RDG 0095368; RDG 0095369; RDG 0095573; RDG 0126270
Regular
Sep 25, 2007

HENRY PHILLIPE vs. GOTTSCHALKS, LIBERTY MUTUAL INSURANCE

The Appeals Board granted reconsideration to allow reimbursement for the applicant's vocational expert fees, reversing the WCJ's decision. The Board found it reasonable for the applicant to hire his own vocational expert to rebut the defendant's expert, especially given the passage of time since the original vocational feasibility report. Consequently, the defendant was ordered to reimburse the applicant's attorney for the $1,075.00 vocational expert cost.

Workers' Compensation Appeals BoardReconsiderationExpert Witness FeesVocational ExpertLabor Code Section 5811Qualified Rehabilitation Representative (QRR)LeBoeuf argumentAgreed Medical Examination (AME)Permanent DisabilityIndustrial Injury
References
Case No. ADJ767882 (SAL 0102012)
Regular
Dec 14, 2020

Stella Avila vs. Sutter Santa Cruz, State Compensation Insurance Fund

Here's a summary for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of an award for admitted industrial injury to the applicant's spine, psyche, and upper extremities. The applicant sought total permanent disability based on a vocational expert, while the defendant argued the psychiatric injury was not compensable due to less than six months' employment and that permanent disability indemnity should not be awarded during VRMA payments. The Board affirmed the finding that prior and current employment with the employer exceeded six months, making the psychiatric injury compensable, and deemed the VRMA issue moot due to an amended award. The Board also found the vocational experts' opinions less persuasive than those of the Agreed Medical Examiners regarding the extent of permanent disability.

ADJ767882Stella AvilaSutter Santa CruzState Compensation Insurance FundPermanent DisabilityVocational Rehabilitation Maintenance AllowanceVRMAPsychiatric InjuryLabor Code Section 3208.3(d)Gottschalks Dept. Stores v. Workers' Comp. Appeals Bd. (Garcia)
References
Case No. SAC 0339541
Regular
Oct 17, 2007

HOPE HAYES vs. GOTTSCHALK'S, INC., THE HARTFORD, SPECIALTY RISK SERVICES

This case involved a dispute over contribution between insurance carriers for a cumulative trauma injury. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding that the initial petition for joinder did not timely "institute proceedings" for contribution under Labor Code § 5500.5. Consequently, the WCAB held that the claim for contribution against The Hartford was barred due to untimeliness.

Petition for RemovalPetition for ReconsiderationLabor Code Section 5500.5Institution of ProceedingsThreshold IssueContributionJoinder of Party DefendantClerical ErrorStipulations with Compromise and ReleaseCumulative Trauma Injury
References
Case No. STK 0189388
Regular
Oct 01, 2007

Frances L. Wylie vs. GOTTSCHALK'S, INC., THE HARTFORD INSURANCE Through SPECIALTY RISK SERVICES

This case concerns a dispute over the necessity and causation of left knee replacement surgery. The defendant argued the surgery was due to degenerative disease, not the industrial injury. The Workers' Compensation Appeals Board granted reconsideration primarily to address attorney's fees for enforcing the medical treatment award. The Board ultimately affirmed the original decision regarding the surgery while amending it to include attorney's fees.

Left knee replacementDegenerative diseaseIndustrial injuryCausationUtilization reviewMedical necessityAttorney's feesLabor Code section 4067Petition to ReopenCompensable consequence
References
Case No. ADJ9336762
Regular
Mar 17, 2025

Ramiro Hernandez vs. Riverside Landscape & Irrigation Inc., California Insurance Guarantee Association

The Appeals Board considered petitions for reconsideration from lien claimants RMS Medical Group and Basso Pharmacy regarding a WCJ's Findings and Order from December 11, 2024, which denied their lien claims related to applicant Ramiro Hernandez's industrial injury. The Board denied Basso Pharmacy's petition, upholding the finding that Basso Pharmacy was not properly licensed. Conversely, the Board granted RMS Medical Group's petition, ruling that their medical-legal services, performed by the primary treating physician Dr. Gottschalk, are compensable as a medical-legal expense, even with an AME in the case. Consequently, the matter was returned to the trial level for the WCJ to determine the reasonable value of RMS Medical Group's services.

Workers Compensation Appeals BoardRamiro HernandezRiverside Landscape & Irrigation Inc.California Insurance Guarantee AssociationIntercareCastlepoint InsuranceRMS Medical GroupBasso PharmacyPrimary Treating PhysicianMedical-Legal Reports
References
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