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

Case No. LAO 801322
Regular
May 23, 2008

O.C. MARSHALL (Deceased) JENNIFER MARSHALL (Widow) vs. ARCO/BRITISH PETROLEUM; ESIS

This case concerns a widow's appeal of a denial of workers' compensation benefits for her husband's death. The Administrative Law Judge (ALJ) denied benefits, finding the death was due to natural causes and not his employment as a pipe fitter for Arco/British Petroleum. The Workers' Compensation Appeals Board affirmed the denial, finding the applicant's medical expert's opinion lacked substantial evidence due to an inaccurate history and incomplete analysis of the decedent's medical records and family history.

Workers Compensation Appeals BoardApplicantDefendantPetition for ReconsiderationFindings of Fact and OrdersAdministrative Law JudgeQualified Medical EvaluatorQMEatherosclerotic diseasehypertension
References
0
Case No. 2021 NY Slip Op 06411 [199 AD3d 1214]
Regular Panel Decision
Nov 18, 2021

Matter of Urdiales v. Durite Concepts Inc/Durite USA

Claimant Jose Urdiales appealed a Workers' Compensation Board decision denying his benefits for respiratory problems allegedly due to an occupational disease from epoxy exposure. The Board affirmed a Workers' Compensation Law Judge's ruling, crediting the employer's testimony over the claimant's regarding his work activities. Medical opinions supporting the claimant's condition were based on his disputed work history. The Appellate Division, Third Department, affirmed the Board's decision, concluding that the Board's findings on witness credibility and rejection of medical evidence based on an inaccurate work history were supported by substantial evidence.

Occupational DiseaseRespiratory IssuesEpoxy ExposureChemical ExposureCausationWitness CredibilitySubstantial EvidenceWorkers' Compensation BenefitsClaim DenialAppellate Review
References
7
Case No. MISSING
Regular Panel Decision

Santos v. American Museum of Natural History

Guaquin Garcia died after a scaffold fall during renovations at a building leased by the American Museum of Natural History. His estate sued the Museum and the general contractor for wrongful death. The Museum moved for summary judgment, arguing it lacked Labor Law liability as it didn't own, contract for, or supervise the work. The Supreme Court denied this motion, but on appeal, the order was reversed. The appellate court found the Museum, as a lessee, was not liable under Labor Law § 240, having neither contracted for nor supervised the renovation work, and thus lacked authority over safety measures.

Wrongful DeathScaffold AccidentLabor Law Section 240Summary Judgment AppealPremises LiabilityLessee LiabilityRenovation ProjectWorksite SafetyAppellate CourtBuilding Owner Responsibility
References
2
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
4
Case No. ADJ2137324
Regular
Nov 19, 2010

DEBRA ANTHONY vs. AC TRANSIT, ROSS STORES; SEDGWICK WALNUT CREEK, CAMBRIDGE CONCORD

The Appeals Board granted reconsideration and rescinded the prior award due to insufficient substantial medical evidence. The primary treating physician's reports were deemed unreliable as they were based on an inaccurate post-injury work history. The Board found the record needed further development regarding the applicant's disability and cumulative injury. The case is remanded to the trial level for further proceedings, including potentially supplemental medical reporting or deposition.

WCABADJ2137324OAK 0317296Debra AnthonyAC TransitRoss StoresSedgwick Walnut CreekCambridge ConcordOpinion and Order Granting ReconsiderationPermanent Disability
References
7
Case No. VNO 0435498
Regular
Oct 09, 2007

KATHLEEN GARLAND vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTION, Legally Uninsured (STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICE, Adjusting Agent)

The Workers' Compensation Appeals Board granted reconsideration of a prior award for psychiatric injury and hypertension aggravation due to industrial cumulative trauma. The Board found the applicant's medical evaluator's opinion unreliable due to an inaccurate and incomplete history of significant non-industrial stressors, including the death of her son. Consequently, the Board rescinded the award and remanded the case for further development of the record concerning industrial causation and apportionment.

Cumulative Trauma InjuryPsycheAggravation of HypertensionCorrectional OfficerLegally UninsuredState Compensation Insurance FundAdjusting AgentQualified Medical EvaluatorMedical OpinionSubstantial Medical Evidence
References
2
Case No. ADJ6860504
Regular
May 16, 2011

JAMES BURR vs. THE BEST DEMOLITION AND RECYCLING COMPANY, INC.; SCIF

The Workers' Compensation Appeals Board granted reconsideration, rescinded the original award, and returned the case for further proceedings. This action was taken because the Agreed Medical Evaluator's opinion was based on an inaccurate history of the applicant's injury. The Board determined that the applicant's reported fall into a five-foot hole differed significantly from witness testimony describing a fall down steps. Consequently, the medical evidence was deemed not substantial, necessitating a developed record and a new decision by the WCJ.

Workers' Compensation Appeals BoardIndustrial InjuryAgreed Medical EvaluatorSubstantial Medical EvidenceTemporary DisabilityReconsiderationFindings and AwardLay TestimonyMedical OpinionCausation
References
11
Case No. ADJ4664471
Regular
Jul 14, 2010

WILLIAM ROBERTS vs. WESTEN ENVIRONMENMTAL ENGINEERS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a decision that denied his claim for psychiatric injury. The Board found the petition was skeletal and failed to cite legal principles or evidence. Furthermore, the applicant failed to meet his burden of proving work events were the predominant cause of his alleged psychiatric disorder due to credibility issues and an inaccurate history provided to medical evaluators. The Board adopted the Workers' Compensation Judge's report and recommendation in its entirety.

Workers' Compensation Appeals BoardReconsideration DeniedPsychiatric InjuryPredominant CauseCredibility DeterminationInaccurate HistoryBurden of ProofIntoxication DefenseNeurologistPsychiatrist
References
1
Case No. SAC 112485
Regular
Oct 02, 2007

KAREN R. ROLPH vs. RALEY'S and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of MISSION INSURANCE COMPANY, in liquidation

This case concerns applicant's industrial injuries in the 1980s to her neck, back, psyche, and knees, for which Raley's was the employer and Mission Insurance Company was the insurer. The applicant sought spinal surgery, and the defendant sought reconsideration of the WCJ's order to provide it. The Appeals Board denied reconsideration, finding the second opinion physician's report was not substantial evidence as it was based on an inaccurate medical history and an incorrect legal theory that industrial injuries must be the sole cause of the need for surgery.

Workers Compensation Appeals BoardRaley'sCalifornia Insurance Guarantee AssociationMission Insurance CompanyKAREN R. ROLPHspinal surgeryindustrial injuriesLabor Code section 4062(b)second opinion physiciancausal relationship
References
4
Case No. ADJ1203673 (SBR 0341671)
Regular
Dec 30, 2008

HECTOR AGUIRRE vs. TARGET STORES

This case involves an applicant denied workers' compensation benefits for a back injury. The denial was based on two grounds: the claim was filed post-termination and thus barred under Labor Code § 3600(a)(10), and the applicant failed to prove the injury was industrially caused. The Appeals Board denied reconsideration, finding the applicant's testimony regarding prior notice to the employer was contradictory and insufficient, and that the medical evidence did not adequately establish industrial causation given incomplete or inaccurate medical histories.

Labor Code § 3600(a)(10)post-termination claimindustrial injuryburden of proofnotice of injurytermination of employmentcredible testimonymedical historycumulative injuryprior injury
References
4
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