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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ8995821
Regular
Aug 31, 2015

FERNANDO REYNOSA vs. QUALITY ALUMINUM FORGE, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case concerns a workers' compensation applicant seeking reconsideration of a decision that denied additional temporary disability indemnity and a judicial determination of medical necessity for spine surgery. The Appeals Board granted reconsideration, amending the findings to state the applicant is not owed additional temporary disability at this time and is in need of future medical treatment. The case is returned to the trial level for further development of the record specifically regarding the timeliness of utilization reviews for the proposed spinal surgery. The Board found the original record lacked sufficient detail and organization to properly address these issues.

Petition for ReconsiderationFindings and OrdersTemporary Disability IndemnityMaximum Medical ImprovementUtilization ReviewIndependent Medical ReviewRequest for AuthorizationSpinal SurgeryLow Back InjuryNeck Injury
References
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ1525286 (BAK 0139320)
Regular
May 15, 2014

JOHN TRENEER vs. PRO TECH OFFICE SERVICES, LIBERTY MUTUAL INSURANCE

The Workers' Compensation Appeals Board (WCAB) rescinded an award of 100% permanent disability for John Treneer due to an inadequate evidentiary record. The Board found uncertainty regarding whether the trial judge formally admitted and considered all submitted medical evidence, including defendant Liberty Mutual's reports. Consequently, the case was returned to the trial level for further proceedings to correct the record and potentially develop medical evidence through an Agreed or Independent Medical Examiner. A dissenting opinion argued that sufficient evidence supported the original award, and the WCJ properly exercised discretion in evaluating medical reports.

ReconsiderationFindings of Fact and AwardAgreed Medical ExaminerIndependent Medical ExaminerPermanent DisabilityQualified Medical EvaluatorSubstantial Medical EvidenceApportionmentNon-industrial InjuryDue Process
References
Case No. ADJ4478194 (ANA 0379216)
Regular
Nov 25, 2008

MILTON T. WYNN vs. BALTIMORE RAVENS, ATLANTA FALCONS, HOUSTON TEXANS, TAMPA BAY BUCCANEERS, ST. LOUIS RAMS, GULF INSURANCE COMPANY; WARD NORTH AMERICA, INC., Permissibly SelfInsured;, TRAVELERS INSURANCE COMPANY Successor in interest by merger GULF INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to allow an Independent Medical Examiner (IME) to review newly obtained medical records related to the applicant's pre-existing hip condition. The defendant argued these records were crucial for proper apportionment of permanent disability and that the IME lacked a complete history. The Board rescinded the prior award to develop the medical record further, allowing the IME to provide a supplemental report.

Workers' Compensation Appeals BoardIndependent Medical Examinersubstantial medical evidencebilateral slipped capital femoral epiphysisapportionmentpermanent disabilitycumulative traumaagreed medical examinersupplemental reportnewly discovered evidence
References
Case No. ADJ6552734
Regular
Apr 02, 2015

Diane Garibay-Jimenez vs. Santa Barbara Medical Foundation Clinic, Zurich American Insurance

This case concerns a denied request for left ulnar nerve decompression surgery. The Administrative Law Judge (WCJ) upheld the denial, finding the applicant failed to provide necessary Agreed Medical Examiner (AME) reports to the Independent Medical Review (IMR), making a further review unreasonable. However, the Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding the WCJ's order. The WCAB found the defendant failed to comply with Labor Code section 4610.5(l) by not providing all relevant medical records to IMR, thus invalidating the prior IMR determination. The matter was returned for a new IMR application, holding the defendant responsible for submitting complete records.

Workers' Compensation Appeals BoardDiane Garibay-JimenezSanta Barbara Medical Foundation ClinicZurich American InsuranceADJ6552734Opinion and Order Granting Petition for ReconsiderationExpedited Findings of Fact and OrderAdministrative Law JudgeIndependent Medical ReviewUtilization Review
References
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