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Case Law Database

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

Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
0
Case No. ADJ8550681
Regular
May 14, 2015

NANCY TOM vs. PARAMOUNT PICTURES

Applicant Nancy Tom sought reconsideration of a workers' compensation award, arguing her 9% permanent disability rating was too low. She contended for further medical evaluation regarding worsening symptoms and a claimed 40% grip loss in her right hand, plus additional impairment ratings for her thumb and knee. The Board denied reconsideration, adopting the WCJ's reasoning that Dr. Angerman's conclusory deposition testimony regarding increased impairment lacked substantial medical evidence and conflicted with AMA Guides to the Evaluation of Permanent Impairment. The Board found that Applicant failed to meet her burden of proof for a higher disability rating.

Workers' Compensation Appeals BoardParamount PicturesPermissibly Self-InsuredPetition for ReconsiderationFindings of Fact and AwardExecutive AssistantIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorOrthopedist
References
4
Case No. ADJ696907 (VNO 0543817)
Regular
Jul 23, 2010

ROBERT PERCHLAK vs. WAL-MART, AVIZENT BENTONVILLE

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding Robert Perchlak's industrial injury claim against Wal-Mart. The applicant challenged the $44\%$ permanent disability rating, arguing the rating specialist improperly disregarded physician findings. The WCAB clarified that rating specialists are limited to rating based on WCJ instructions and cannot independently assess medical impairments or deviate from AMA Guides criteria. The WCAB amended the decision to defer permanent disability and attorney's fees, returning the case for further proceedings to clarify the physician's impairment findings and ensure proper rating procedures are followed.

Workers' Compensation Appeals BoardRobert PerchlakWal-MartAvizent BentonvilleOpinion and Decision After ReconsiderationPermanent DisabilityApportionmentDr. Arthur LipperAppeals Board Rule 10602Rater Authority
References
1
Case No. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
1
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
0
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
9
Case No. ADJ4397000
Regular
Jun 10, 2011

MARIA MERCEDES FELIX vs. SEA DWELLING CREATURES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that applicant Maria Mercedes Felix has 0% whole person impairment for her back injury and requires no further medical treatment. This decision was based on the opinion of a qualified medical evaluator (PQME) whose findings were consistent with a prior medical report. The PQME's report concluded that various diagnostic tests were normal and revealed no significant clinical findings, structural alterations, or neurological impairment. Crucially, the Appeals Board clarified that a 3% pain add-on for whole person impairment is legally permissible only to increase an already established impairment rating, which was not the case here as the initial rating was zero.

Workers' Compensation Appeals BoardReconsideration deniedExpert medical evidencePanel Qualified Medical Evaluator (PQME)American Medical Association Guides (AMA Guides)Permanent ImpairmentWhole Person Impairment (WPI)DRE Lumbar Category IMedical treatmentPain add-on
References
2
Case No. MISSING
Regular Panel Decision
Feb 21, 2013

Claim of Canales v. Pinnacle Foods Group LLC

Claimant, a 52-year-old production laborer with limited education and English skills, suffered a work-related knee injury in December 2010. Her treating physician initially found a 100% temporary medical impairment, later reducing it to 80% in June and July 2011. Following an independent medical examination in July 2011, the carrier reduced her to a partial disability rate. An orthopedic surgeon determined 100% impairment again in September 2011. A Workers’ Compensation Law Judge awarded an 80% temporary disability rate for the 12-week period following the IME and a total temporary disability rate thereafter, which the Workers’ Compensation Board affirmed in February 2013. Claimant appealed, arguing the Board erred by not considering vocational factors in determining her compensation rate for temporary disability. The appellate court affirmed the Board's decision, finding that "loss of wage-earning capacity" and vocational factors apply only to the duration of permanent partial disability benefits, not to the determination of "wage earning capacity" for temporary partial disabilities under Workers’ Compensation Law § 15 (5-a).

Work-related injuryKnee injuryTemporary disabilityPartial disabilityWage-earning capacityVocational factorsWorkers' Compensation LawStatutory interpretationMedical impairmentIndependent Medical Examination (IME)
References
13
Case No. ADJ9499569
Regular
Sep 11, 2018

CHRIS HENDERSON vs. CDCR - CORCORAN STATE PRISON, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, increasing the applicant's permanent disability rating from 16% to 26%. This revision was based on incorporating the agreed medical evaluator's findings of a 14% upper extremity impairment due to decreased shoulder range of motion, which the original rating had omitted. The Board also noted the WCJ's rating instructions did not comply with established precedent regarding listing all impairments. The decision otherwise affirmed the WCJ's findings.

Workers' Compensation Appeals BoardCDCR - Corcoran State PrisonState Compensation Insurance FundPetition for ReconsiderationPermanent Disability RatingAgreed Medical EvaluatorOrthopedistEugene HarrisM.D.Temporary Disability Indemnity
References
2
Case No. ADJ1030139 (STK 0203781)
Regular
Nov 19, 2014

GERALD REESE vs. MICRODENTAL LABORATORIES, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES

The Appeals Board granted reconsideration to review the permanent disability rating for applicant Gerald Reese, who sustained an industrial injury in 2006. The primary issue was whether to include a deconditioning impairment, rated by a PQME using analogy, into the permanent disability award. The Board affirmed the WCJ's decision but amended it to defer the issue of permanent disability for further proceedings. This deferral is to allow the WCJ to issue rating instructions based on the established legal framework for incorporating AMA Guides impairments, even those addressed by analogy.

PQMEdeconditioningAMA Guideswhole person impairmentanalogyLabor Code section 4660Almaraz/Guzman IIMilpitas Unified School Dist.City of Sacramento v. Workers' Comp. Appeals Bd.rating instructions
References
3
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