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

Case No. ADJ7927652
Regular
Oct 25, 2016

Bozenna Kasperowicz vs. Metropolitan State Hospital, State Compensation Insurance Fund

This case involves an industrial injury to the applicant, a psychiatric technician, sustained on June 14, 2011, from a patient strike to the head. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over psychiatric impairment and a sleep disorder rating. The WCAB affirmed the original award but reduced the permanent disability rating from 76% to 70% by excluding the sleep dysfunction impairment. The WCAB found Dr. O'Brien's opinion on psychiatric impairment more persuasive than conflicting medical evaluations and determined Dr. Matos's opinion on sleep impairment lacked substantial medical evidence due to staleness.

WCABReconsiderationPsychiatric ImpairmentWhole Person ImpairmentGAF ScoreSleep DisorderSubstantial Medical EvidencePermanent DisabilityQualified Medical EvaluatorInsomnia
References
Case No. ADJ7713711
Regular
Mar 11, 2016

JULIANA MASTERS vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES

The Appeals Board denied reconsideration of the WCJ's decision, upholding the finding that applicant's sleep impairment, though present, was subsumed by the physical upper extremity impairments and thus not separately ratable. The Board found the Agreed Medical Examiner's opinion on sleep disorder impairment was not substantial evidence as it was predicated on pain already accounted for in the physical injury ratings per the AMA Guides. Therefore, the applicant's permanent disability rating remained at 69%. A dissenting opinion argued the Agreed Medical Examiner's opinion should be followed, as it addressed distinct impairments beyond pain and was supported by relevant case law.

Workers' Compensation Appeals BoardAmended Findings of Fact and AwardsIndustrial InjuryUpper ExtremitiesPsycheBook BinderSleep ImpairmentAMA GuidesPermanent DisabilityAgreed Medical Examiner
References
Case No. ADJ400686 (VNO 0499836)
Regular
Nov 08, 2016

MICHAEL CURZI vs. PHARMAVITE, LLC, TRAVELERS DIAMOND BAR

In *Curzi v. Pharmavite, LLC*, the Workers' Compensation Appeals Board (WCAB) granted reconsideration to further study the case. The WCAB amended the original decision to defer issues of sleep disorder, permanent disability, apportionment, and attorney fees. This action was taken to allow for further development of the record regarding the industrial causation of the sleep disorder. The matter is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardPharmaviteLLCTravelers Diamond BarADJ400686VNO 0499836Opinion and Decision After ReconsiderationFindings and Awardcomputer operatorindustrial injury
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. ADJ6527507
Regular
Oct 18, 2010

Wayne Moore vs. EAST BAY MUNICIPAL UTILITY DISTRICT, ATHENS ADMINISTRATORS

The Appeals Board granted reconsideration, finding the WCJ improperly substituted his medical judgment for the Qualified Medical Evaluator's (QME) regarding the applicant's industrial sleep disturbance. The WCJ's finding of no industrial sleep impairment, despite the QME's opinion indicating such, was deemed erroneous. The Board rescinded the original award and remanded the case for a new rating that incorporates the QME's findings on sleep disturbance. Additionally, the WCJ must correct an identified occupational group number error in future rating calculations.

Workers' Compensation Appeals BoardWayne MooreEast Bay Municipal Utility DistrictAthens Administratorsmachinist maintenance workermachinistmachinist maintenancepermanent disabilityapportionmentQualified Medical Evaluator
References
Case No. ADJ793701 (MON 0360803)
Regular
Nov 01, 2010

RAYMUNDO CASTILLO vs. BRIMCO, LLC, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award due to insufficient medical evidence supporting the applicant's sleep disorder claim. The WCAB found Dr. Navab's report lacked specific causation, explanation for impairment rating, and failed to address specific complaints. The case is returned for further development of the record regarding the sleep disorder, including clarification from Dr. Navab and an evaluation by another specialist. The issue of the claim being barred as a post-termination claim was not reached.

Workers' Compensation Appeals BoardIndustrial InjurySleep DisorderBack InjuryPost-Termination ClaimLabor Code Section 3600(a)(10)Substantial Medical EvidencePermanent DisabilityReconsiderationFindings of Fact and Award
References
Case No. ADJ8403518, ADJ8928431
Regular
Dec 06, 2016

Marcia Ortiz vs. CITY AND COUNTY OF SAN FRANCISCO, INTERCARE

The Appeals Board affirmed the WCJ's findings for a right elbow injury and its 24% permanent disability award. However, for a left foot/ankle injury, the Board rescinded the finding of industrial sleep disorder due to lack of substantial medical evidence. The Board also amended the permanent disability rating for the left ankle injury, ultimately awarding 12% permanent disability based on the primary treating physician's opinion. This decision corrected Dr. Chen's flawed application of impairment rating guidelines and excluded the sleep disorder from compensable injury.

PQMEDr. Chensleep impairmentindustrial injurypermanent disabilityADJ8403518ADJ8928431WCJDr. MartinovskyAMA Guides
References
Case No. ADJ7527781; ADJ7527786
Regular
Feb 05, 2016

OCTAVIO ESPINOZA vs. TORRES FARM LABOR, SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, amending the original award to defer the finding of permanent disability and attorney's fees. The Board denied the defendant's petition for reconsideration, affirming the original award regarding future medical treatment for internal injuries. The case is returned to the WCJ for further proceedings, including consideration of a sleep study report and development of the record concerning permanent disability. The Board agreed that substantial evidence supported the finding of industrial injury to internal organs and the need for future medical treatment.

Workers' Compensation Appeals BoardIndustrial InjuryPermanent DisabilityTemporary Total DisabilityFuture Medical TreatmentPetition for ReconsiderationFindings of FactJoint AwardWCJSubstantial Evidence
References
Case No. ADJ6776516
Regular
May 30, 2017

FRANCIS HARGREAVES vs. SOUTHWEST AIRLINES, ACE USA INSURANCE CO.

This case involves an applicant seeking workers' compensation benefits for injuries sustained on the job, including to his back, left shoulder, left wrist, and psyche, as well as complex regional pain syndrome, coronary artery disease, and a sleep disorder. The defendant sought reconsideration of the initial award, arguing that the medical evidence did not support the $90\%$ permanent disability finding. The Appeals Board granted reconsideration, affirming the findings of injury and treatment for Complex Regional Pain Syndrome but reducing the permanent disability to $88\%$ by excluding the sleep disorder impairment due to insufficient objective evidence. The applicant's permanent disability payments were recalculated and ordered to commence from January 21, 2011.

Workers' Compensation Appeals BoardFrancis HargreavesSouthwest AirlinesACE USA Insurance Co.Sedgwick CMSADJ6776516Opinion and Order Granting Petition for ReconsiderationFindings Award and OrderAOE/COEback injury
References
Case No. ADJ7295285
Regular
Dec 05, 2012

CARL SIRL vs. VSJ, INC., ENDURANCE INSURANCE COMPANY, FIRSTCOMP INSURANCE AGENCY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award finding applicant suffered a 23% permanent disability, including 12% for sleep disturbance. The PQME's reliance on the Epworth Sleepiness Scale for the sleep impairment rating was deemed insufficient without further explanation, particularly regarding the absence of formal sleep studies. The WCAB remanded the case to the trial level for further development of the medical record concerning the sleep disorder and its impairment rating. Defendants were directed to continue paying uncontested permanent disability indemnity for the applicant's back injury.

Workers' Compensation Appeals BoardPermanent DisabilitySleep DisturbanceEpworth Sleepiness ScalePQMEAMA GuidesWhole Person ImpairmentActivities of Daily LivingDue ProcessMedical Record Development
References
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