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

Case No. ADJ8032740
Regular
Sep 17, 2014

LAURA RAMIREZ vs. LOYOLA MARYMOUNT UNIVERSITY, TRAVELERS

This case involved a custodian injured on the job, causing admitted industrial injury to her knee and lumbar spine. The Administrative Law Judge apportioned 50% of the permanent disability to pre-existing arthritis, a decision the applicant contested. The Workers' Compensation Appeals Board denied reconsideration, finding the apportionment supported by medical evidence indicating the industrial injury and pre-existing arthritis jointly necessitated knee replacement surgery. This aligns with precedent requiring apportionment to all causative factors, including underlying pathology.

ApportionmentPre-existing arthritisIndustrial injuryPermanent disabilityWCJPetition for reconsiderationLabor Code 4663PQMEOrthopaedic surgeonArthroplasty
References
4
Case No. WCK 0067792
Regular
Sep 20, 2007

ERNEST J. WILLIAMS vs. PINKERTON SECURITY, ESIS

This case involves an applicant who sustained an industrial injury to his right knee. The defendant sought reconsideration of the original award, arguing the judge erred in denying credit for temporary disability overpayments and in failing to apportion permanent disability to pre-existing arthritis. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter for further proceedings. The Board found that apportionment to prior arthritis, even if it necessitated knee replacement surgery, is required under current law and that the Agreed Medical Evaluator's opinion on apportionment was sufficient.

WCABPinkerton SecurityErnest J. Williamsindustrial injuryright lower extremitypermanent disabilityapportionmenttemporary disability overpaymentAgreed Medical EvaluatorAME
References
8
Case No. MISSING
Regular Panel Decision
Nov 30, 2015

Claim of Gramza v. Buffalo Board of Education

Claimant, a teacher, sustained a work-related injury to his left shoulder and neck in 2005 and was subsequently classified with a permanent partial disability. The employer sought reimbursement from the Special Disability Fund, citing the claimant's preexisting medical conditions, including rheumatoid arthritis and hypertension. The Workers' Compensation Board granted this application, prompting an appeal from the Fund. The court affirmed the Board's decision, finding substantial evidence that the claimant's rheumatoid arthritis was a permanent condition restricting hand use and hindering general employability. An independent medical reviewer's opinion further supported that the claimant's overall disability was significantly greater due to the combined effect of both conditions.

Workers' CompensationSpecial Disability FundReimbursementPreexisting ImpairmentRheumatoid ArthritisPermanent Partial DisabilityMaterially and Substantially Greater DisabilityGeneral EmployabilityIndependent Medical ReviewerAppellate Division
References
6
Case No. GRO 0029816, GRO 0029817
Significant

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision to apportion 50% of the applicant's permanent disability to a preexisting degenerative arthritis, holding that Labor Code section 4663, as amended by SB 899, permits apportionment based on causation from non-industrial factors supported by substantial medical evidence.

SB 899apportionmentcausationpermanent disabilitypreexisting arthritismedical evidencesubstantial evidenceLabor Code section 4663compensable consequenceQME
References
58
Case No. GRO 0029816, GRO 0029817
En Banc

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision, holding that under Labor Code section 4663 as amended by SB 899, apportionment of permanent disability is based on causation and may include pre-existing, non-industrial conditions like degenerative arthritis, provided there is substantial medical evidence to support the percentage of non-industrial causation.

SB 899ApportionmentCausationPermanent DisabilityPreexisting ConditionDegenerative ArthritisSubstantial Medical EvidenceMedical ProbabilityLabor Code Section 4663Compensable Consequence
References
56
Case No. SAC 296205
Regular
Jun 11, 2008

EDWARD A. CASEY vs. CITY OF FULLERTON

This case involved a firefighter/paramedic seeking increased permanent disability for knee injuries. The Appeals Board denied reconsideration, upholding the administrative law judge's decision. The judge's decision was based on the agreed medical examiner's opinion, which apportioned 30% of the permanent disability to non-industrial factors, including a prior knee injury and the natural progression of arthritis.

ApportionmentAgreed Medical Evaluator (AME)Permanent DisabilityCausationLabor Code Section 4663Labor Code Section 4664Firefighter/ParamedicKnee InjuryTotal Knee ReplacementOsteoarthritis
References
0
Case No. ADJ9781209
Regular
Aug 03, 2015

PABLO QUIJADA vs. GENERAL PRODUCTION SERVICE OF CALIFORNIA, INC, ZURICH

This case involves Pablo Quijada's workers' compensation claim for a left wrist and hand injury sustained while employed as a well puller. The initial ruling denied the claim, citing pre-existing arthritis, but the Appeals Board granted reconsideration. The Board found sufficient evidence that Quijada's employment was a contributing cause to his injury, overturning the original decision. The matter is now returned for further proceedings on the extent of his industrial injury.

Well pullerIndustrial injuryLeft wristLeft handSlip and fallOil rigPre-existing arthritisDegenerative joint diseaseUlnar impaction syndromeCausation
References
3
Case No. VNO 482752, VNO 482753
Regular
Jul 10, 2007

JESUS SANJORO vs. MOTION PICTURE AND TELEVISION FUND, Permissibly Self-Insured, Adjusted By ROYAL INDEMNITY CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's award of 46% permanent disability. The Board found, consistent with prior precedent in *Steinkamp*, that medical treatment itself is not apportionable, even if non-industrial factors contributed to the need for that treatment. Therefore, the applicant's permanent disability resulting from knee replacement surgery was not subject to apportionment based on the underlying non-industrial arthritis.

Workers' Compensation Appeals BoardSanjoroMotion Picture and Television FundRoyal Indemnity Co.VNO 482752VNO 482753Petition for ReconsiderationFindings Award and OrderSecurity OfficerBilateral Knees
References
4
Case No. ADJ9226143 ADJ9640587
Regular
Dec 02, 2020

RAUL MARTINEZ GARCIA vs. THE SUN VALLEY GROUP, INC., ZENITH INSURANCE AND TRAVELERS

The Workers' Compensation Appeals Board granted reconsideration to further study the factual and legal issues. While the WCJ found an industrial aggravation of the applicant's arthritis due to cumulative trauma, there was insufficient evidence to determine which specific body parts were injured. The Board rescinded the initial Findings and Order, remanding the case to the trial level for further proceedings to develop the medical record and clarify the extent of the industrial injury. The existing medical opinions were deemed deficient, necessitating further investigation.

AOE/COEcumulative traumaaggravationgouty arthritissecondary osteoarthritisrheumatology consultationspecific injuryFindings and OrderPetition for ReconsiderationReport and Recommendation
References
3
Case No. ADJ9822757, ADJ9826854
Regular
May 05, 2017

MIREYA CASILLAS vs. CVS PHARMACY, INC.

The Workers' Compensation Appeals Board denied CVS Pharmacy's Petition for Reconsideration. The Board adopted the WCJ's report, finding that a single physician's opinion can constitute substantial evidence, even if conflicting. This decision upholds the WCJ's findings regarding industrial injuries, including dyspepsia, fibromyalgia, rheumatological arthritis, and psyche, as reported by various medical experts. The Board specifically noted that apportionment issues were not at the forefront of the current "body parts" determination.

WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATION DENIEDSUBSTANTIAL EVIDENCEWCJ REPORTAPPORTIONMENTPSYCHERHEUMATOID ARTHRITISFIBROMYALGIADYSPEPSIAGASTROINTESTINAL
References
1
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