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

Case No. ADJ8045546
Regular
Jul 29, 2013

THOMAS FORD III vs. WASTE MANAGEMENT, ACE AMERICAN INSURANCE CO.

This case involves a haul truck driver's claim for a low back and right hip injury against Waste Management. The defendant sought reconsideration, arguing the applicant's right hip condition was nonindustrial due to childhood surgeries and a prior car accident, citing a PQME's opinion. The Workers' Compensation Appeals Board granted reconsideration to correct clerical errors in the original award. They affirmed the finding of industrial injury to the right hip, finding the primary treating physician's opinion more persuasive than the PQME's, and amended the award to specify temporary disability indemnity and EDD lien reimbursement. Issues of future temporary disability, permanent disability, and apportionment remain deferred.

Industrial injuryLow back injuryRight hip injuryLeft hip injuryHaul truck driverCumulative traumaQualified medical evaluatorPrimary treating physicianSubstantial medical evidenceTemporary disability indemnity
References
Case No. ADJ2594700
Regular
Nov 16, 2009

LINDA SEGOVIA vs. CITY OF STOCKTON, Permissibly Self-Insured, Adjusted By YORK INSURANCE SERVICES GROUP

The Appeals Board granted reconsideration, rescinded the prior award finding that the applicant did not sustain an industrial injury to her right hip. The AME's opinion was given more weight than the treating physicians.

Compensable consequenceReconsiderationFindings & AwardIndustrial injuryRight hipLeft hipPolice officerPermanent total disabilityMedical treatmentMedically necessary
References
Case No. ADJ7200914
Regular
Jul 19, 2012

KENNETH WILLIAMS vs. THE BOEING COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend a previous award. The Board found that the applicant's primary treating physician's apportionment of 15% of the hip disability to non-industrial factors was based on substantial medical evidence, and should have been incorporated. This amendment reduced the applicant's permanent disability rating from 72% to 66%. The dissenting opinion argued that the physician's apportionment lacked sufficient detail to constitute substantial evidence.

Workers' Compensation Appeals BoardKenneth WilliamsThe Boeing Companyaircraft mechaniccumulative injurypermanent disabilityapportionmentPhilip A. SobolM.D.orthopedist
References
Case No. SRO 0135735
Regular
Nov 06, 2007

ROBERT ANUSEWICZ vs. JOINT INDUSTRY BOARD OF PLUMBING, dba KONOCTI HARBOR INN AND RESORT, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant's entitlement to temporary disability indemnity beyond the standard 104-week limit. The Appeals Board rescinded the prior award, ruling that the applicant's hip and knee replacement surgeries did not constitute "amputations" as defined by Labor Code section 4656(c)(2)(C). Therefore, the applicant is limited to 104 weeks of temporary disability indemnity from the commencement of payments, precluding indemnity beyond January 31, 2007.

Workers' Compensation Appeals BoardRobert AnusewiczJoint Industry Board of PlumbingKonocti Harbor Inn and ResortState Compensation Insurance FundSRO 0135735Opinion and Decision After Reconsiderationtemporary disability indemnityindustrial injuryleft knee
References
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
Case No. MON 323982 MON 323983
Regular
Mar 10, 2008

Gina Malcolm vs. KELLY STAFF LEASING, CNA

This case concerns Gina Malcolm's workers' compensation claims for a right hip injury and a left shoulder injury. The applicant sought reconsideration of a decision that apportioned 25% of her permanent disability for both injuries to pre-existing, non-industrial osteonecrosis. The Board denied reconsideration, affirming the original finding that the apportionment was proper based on the Agreed Medical Examiner's opinion regarding the causation of the permanent disability.

Gina MalcolmKelly Staff LeasingCNAPetition for ReconsiderationFindings and Awardpermanent disabilityapportionmentnon-industrial factorsAgreed Medical Examiner (AME)Dr. Jeffrey Berman
References
Case No. ADJ10667998
Regular
Mar 21, 2019

GRECIA ALFARO vs. APPLE, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant who sustained admitted injuries to her thoracic spine and left arm after a slip and fall at work. The applicant also claimed industrial injury to her psyche and right hip, which the employer contested. The Workers' Compensation Appeals Board (WCAB) denied reconsideration of the judge's finding that the applicant did not sustain an industrial injury to her right hip. The WCAB deferred to the judge's credibility determination, noting that the applicant's reporting of hip pain was inconsistent and poorly documented by treating physicians. The Board also cited that one physician's opinion can constitute substantial evidence, even if it conflicts with other medical opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJCredibility DeterminationSubstantial EvidencePhysician's OpinionAdmitted InjuryDenied InjuryRight HipPsyche
References
Case No. ADJ10328682
Regular
Jun 22, 2018

EDUARDO VILLANO vs. LIVINGSTON CONCRETE SERVICES, INSURANCE COMPANY OF THE WEST

This case concerns an applicant who sustained an industrial injury to his testicle and right hip. The applicant underwent a testicle amputation and later required hip surgery, leading to ongoing temporary disability. The Workers' Compensation Appeals Board granted reconsideration, reversing a prior award of extended temporary disability benefits. The Board ruled that extended benefits under Labor Code section 4656(c)(3)(C) are only applicable when the temporary disability arises from the specific enumerated condition, in this case, an amputation, and not from a subsequent, unrelated condition like the applicant's hip injury. Therefore, the applicant is limited to the standard 104 weeks of temporary disability.

Labor Code section 4656(c)(3)(C)AmputationOrchiectomyTemporary Disability IndemnityPetition for ReconsiderationFindings and AwardWCJAppeals BoardMaximum Medical ImprovementHip Injury
References
Case No. ADJ252083 (NOR 0166266) ADJ3827633 (LAO 0784953) ADJ3395707 (LAO 0784956) ADJ629194 (LAO 0849490) ADJ2985386 (LAO 0784955) ADJ2625573 (LAO 0784951)
Regular
Apr 12, 2011

CLAUDIA DYER vs. BOEING/McDONNELL DOUGLAS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHARTIS INSURANCE

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the WCJ's findings of industrial injuries to the applicant's knees, neck, back, shoulders, hips, hands, and ankle across multiple dates. The Board found the WCJ's decision was supported by substantial evidence, specifically Dr. Nelson's well-reasoned medical opinions on causation and apportionment. CIGA's petition was also found deficient for failing to comply with procedural requirements for referencing the record. Finally, CIGA was estopped from asserting the statute of limitations defense due to the employer's knowledge of the injury and failure to provide notice of rights.

CIGAFremont InsuranceliquidationPetition for ReconsiderationJoint Findings and Awardindustrial injuryaircraft mechanickneesneckback
References
Case No. VNO 0407448
Regular
Feb 19, 2008

MICHAEL GALLAGHER vs. GENERAL MOTORS SERVICE PARTS OPERATIONS, SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) granted General Motors' petition for reconsideration, rescinding the prior award due to insufficient medical evidence on the causation of the applicant's right hip injury. The WCAB found that the judge erred in linking the hip pain to prior industrial back injuries and ordered the case returned for further development of the record, including addressing apportionment for a prior 1988 award. The Board also noted the need to clarify if the hip injury constituted a new cumulative trauma injury and how it should be rated under current schedules.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition to ReopenPermanent DisabilityApportionmentLabor Code section 4664Right Hip InjuryCausationNew and Further Disability2005 Schedule for Rating Permanent Disabilities
References
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