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

Case No. ADJ7352906
Regular
Jul 10, 2012

ANA PEREZ vs. PALOMINO JANITORIAL SERVICES, ENDURANCE INSURANCE COMPANY, FIRST COMP INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a "take nothing" finding, upholding the WCJ's decision that applicant Ana Perez failed to prove an industrial injury. The WCJ found applicant's testimony not credible due to inconsistent reporting of the injury date, mechanism, and prior medical history. The medical evidence, including a PQME report, concluded no reasonable evidence of an industrial injury existed, citing inconsistent history and denial of trauma in contemporaneous medical records. Therefore, applicant did not meet her burden of proof to establish an industrial injury.

ReconsiderationWCABWCJcredibility determinationamended claimmechanism of injuryinconsistent historyGarden Grove Hospitaldenies traumafibromyalgia
References
Case No. ADJ3190249 (SFO 0500553)
Regular
Mar 24, 2010

Quintella Eutsey vs. CITY & COUNTY OF SAN FRANCISCO, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted removal, dismissing the defendant's petition for reconsideration. The Board found the prior administrative law judge's order improperly limited discovery into the applicant's psychiatric injury claim. The Board rescinded the previous order, allowing further deposition to explore the applicant's full medical history relevant to her psyche claim, as this is discoverable when a psychological injury is at issue. Both parties were admonished to conduct themselves professionally during future discovery.

removalpetition for reconsiderationdiscovery disputepsyche injurydeposition testimonyright lower extremityindustrial injurypersonal lifefamily lifepast history
References
Case No. ADJ9805248
Regular
Aug 30, 2017

FRANCISCO PEREZ vs. MASSIVE PRINTS, HARTFORD/ SENTINEL INSURANCE COMPANY

The Appeals Board granted reconsideration of the WCJ's award due to questions regarding the substantiality of the Qualified Medical Evaluator's (QME) opinion. The Board found the QME's report and deposition testimony unreliable due to an incorrect work history, inadequate examination, and potentially flawed application of disability rating guidelines. Consequently, the Board affirmed the original award but deferred issues of permanent disability, apportionment, and attorney fees, returning the case to the WCJ for further proceedings and potentially a new medical evaluation.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentAttorney FeesQualified Medical EvaluatorAgreed Medical ExaminerSubstantial EvidenceMedical Opinion
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ10968178
Regular
May 24, 2019

MIRNA GUERRA vs. KENNERLEY SPRATLING, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award finding applicant sustained bilateral wrist and hand injury AOE/COE. The WCAB found that neither the applicant's treating physician, Dr. Mirza, nor the defense qualified medical examiner, Dr. Roth, provided substantial medical evidence. Dr. Roth's report failed to address aggravation of any pre-existing condition by the applicant's work duties. Dr. Mirza's reports suffered from inconsistencies, inadequate medical history, and lack of reasoning. Therefore, the WCAB rescinded the award and returned the case to the WCJ for further record development.

AOE/COEPetition for ReconsiderationFindings of FactAward and OrderWCJbilateral wristsbilateral handscumulative traumaprimary treating physicianqualified medical examiner
References
Case No. ADJ8741844
Regular
Jan 14, 2014

CARLOS MIRANDA vs. PACIFIC EXCHANGE, HANOVER INSURANCE GROUP

The Appeals Board rescinded the prior finding of injury to the applicant's back, concluding it was not supported by substantial evidence. The Board found the medical report relied upon by the trial judge was based on an inaccurate and incomplete history provided by the applicant, inconsistent with other statements and undisputed trial evidence. Therefore, the applicant did not sustain an industrial injury to his back, and the case was returned for further proceedings on other alleged body parts.

WCABReconsiderationFindings of FactLabor CodeStatute of LimitationsIndustrial InjuryAOE/COESubstantial EvidenceInaccurate Medical HistoryIncomplete Medical History
References
Case No. ADJ7898288
Regular
Nov 19, 2012

vs. LAMPS PLUS, OLD REPUBLIC INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a "take nothing" award for an applicant claiming cumulative trauma injury. The Board adopted the WCJ's report, which found the applicant failed to meet his burden of proof due to inconsistent testimony and unreliable medical evidence. The WCJ's credibility findings, based on the applicant's demeanor and conflicting statements regarding his medical history and work absences, were given great weight. Consequently, the Board concluded that the evidence did not demonstrate a cumulative trauma injury arising out of and in the course of employment, and further development of the medical record was not warranted.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedGarza v. Workers' Comp. Appeals Bd.Old Republic Insurance CompanyMilestone Insurance CompanyColdiron v. Compuwave Corp.cumulative trauma injuryAOE/COEtake nothing
References
Case No. ADJ4669093
Regular
Mar 15, 2010

JAMES C. RIALS III vs. SWIFT TRANSPORTATION, AIG CLAIM SERVICES

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration because the order taking the matter off-calendar was not a final order subject to reconsideration. The WCAB treated the petition as one for removal and denied it, finding no evidence of significant prejudice or irreparable harm justifying removal. The applicant sought to re-litigate permanent disability for his right groin, thigh, and hip injuries, issues previously decided and appealed. The WCAB adopted the WCJ's report, which detailed the extensive history of the claim and noted these issues had already been litigated.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOrder Taking Off-CalendarFinal OrderLabor Code Section 5900Substantial PrejudiceIrreparable HarmWCJ ReportDisability Rating
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. ADJ9122601 ADJ9122724
Regular
Mar 08, 2017

WENDY SHALVOY vs. WARNER BROTHERS HOME ENTERTAINMNET, INC.

The applicant claimed her employer violated Labor Code section 132a by withholding temporary disability benefits, which she believed led to differential treatment in a layoff. The WCJ initially issued a "take nothing" order on her entire application. The Appeals Board granted reconsideration to correct a clerical error, finding the WCJ inadvertently applied the "take nothing" order to the wrong part of the applicant's claim. The Board affirmed the WCJ's decision that the applicant failed to prove a violation of section 132a, amending the order to specify she takes nothing regarding her petition for enhanced benefits under that section.

Workers' Compensation Appeals BoardLabor Code section 132aPetition for ReconsiderationJoint Findings and OrdersAdministrative Law JudgeTemporary Total DisabilitySeverance PackageDifferential TreatmentClerical ErrorPetition for Enhanced Benefits
References
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