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

Case No. ADJ6714887
Regular
Nov 05, 2010

ROBERT BARGAS vs. FRESNO UNIFIED SCHOOL DISTRICT

This case involves a dispute over the permanent disability rating for a carpenter injured in 2008. The defendant school district sought reconsideration of a 31% permanent disability award. The Appeals Board granted reconsideration, finding the agreed medical evaluator's (AME) "functional" impairment rating, which led to the 31% award, was not substantial evidence. The Board rescinded the award and remanded for a new rating, requiring strict application of the AMA Guides unless the AME adequately explains any deviation.

Permanent Disability RatingAgreed Medical Evaluator (AME)Almaraz/Guzman IIAMA GuidesWhole Person Impairment (WPI)Rebuttal of ScheduleSubstantial EvidenceFunctional AssessmentAnatomic AssessmentClinical Judgment
References
Case No. ADJ6663734
Regular
Mar 16, 2017

THEODORO GONZALEZ vs. ADAMS CAMPBELL COMPANY, INCORPORATED, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a finding of total permanent disability for Theodoro Gonzalez, who suffered a severe right upper extremity amputation and psychological injury. The Board adopted the trial judge's reasoning, relying on applicant's vocational expert and medical evidence to establish his inability to benefit from vocational rehabilitation. The Board also corrected a clerical error regarding the defendant's credit for temporary disability overpayments.

Workers' Compensation Appeals BoardPetition for ReconsiderationTotal Permanent DisabilityRight Upper Extremity AmputationVocational ExpertSB 863Transferable SkillsVocational RehabilitationTemporary Total Disability OverpaymentContra Costa County v. Workers' Comp. Appeals Bd. (Dahl)
References
Case No. ADJ8393129
Regular
Feb 24, 2020

THOMAS HASSON vs. ANN TAYLOR, TRAVELERS INSURANCE

Here's a concise summary for a lawyer: This case involves a defendant's petition for reconsideration of a finding of permanent total disability due to cumulative trauma. The defendant argued the treating physician's report was unsubstantial regarding causation and functional capacity, and that apportionment to a pre-existing condition was wrongly disregarded. The Board denied reconsideration, affirming the administrative law judge's decision, finding substantial evidence supported the permanent total disability finding based on the applicant's inability to benefit from vocational rehabilitation. The Board adopted the judge's reasoning that the applicant's medical restrictions precluded him from returning to full-time employment in the open labor market.

cumulative traumapermanent total disabilitymedical evidencevocational evidencefunctional capacity evaluationresidual functional capacityapportionmentpre-existing conditionsubstantial medical evidencelabor market
References
Case No. ADJ2649808 (STK 0209059)
Regular
May 16, 2017

CHRIS ARSENAULT vs. CARPET MASTER, MID-CENTURY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding a finding of 100% permanent disability for an admitted back injury. The defendant argued the vocational expert's report was flawed and unsubstantiated, but the Board affirmed the WCJ's finding of credibility. The WCJ's decision correctly applied *Dahl* to find the applicant not amenable to vocational rehabilitation due to his functional limitations, pain, and depression. The Board also rejected the defendant's attempt to admit newly discovered evidence, as it did not meet the criteria for such admission.

Vocational evaluatorpermanent disabilityreconsiderationindustrial injuryvocational reportingmedical evidencesubjective evidencedepressionvocational rehabilitationchronic pain
References
Case No. ADJ3301539 (LBO 0315336)
Regular
Mar 21, 2017

TERESA ZAMUDIO vs. STARCO ENTERPRISES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration because the discovery order compelling a home care assessment was not a final order. However, the WCAB granted the applicant's Petition for Removal to amend the discovery order. Specifically, the WCAB rescinded the portion allowing the defendant's attorney to be present during the in-home assessment, finding no legal or equitable basis for it and that it could irreparably harm the applicant's privacy.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalHome Care AssessmentRight to PrivacyConstitutional RightsInterlocutory OrdersDiscovery OrdersFinal OrderSubstantive Rights
References
Case No. ADJ8113628; ADJ8123365; ADJ8121680; ADJ8121687; ADJ8121688; ADJ8133503; ADJ8113033; ADJ8113113; ADJ8113357
Regular
May 22, 2013

MARIA FLORES, CATALINA VACA, DORA ALVITER, GERARDO CARRILLO, MARIA GUTIERREZ vs. KAR AUCTION SERVICES dba ADESSA, INC., ZURICH NORTH AMERICA c/o GALLAGHER BASSETT

The Appeals Board granted the applicant's Petition for Removal, rescinding the prior consolidation order. The Board found that despite common employer and last date of work, individual cumulative trauma claims involving different body parts and injury dates necessitate separate medical evaluations. Post-termination defenses also require individualized determinations of disability and knowledge for each applicant. Therefore, the Board concluded there are insufficient common issues of law or fact to justify consolidating these diverse claims.

Petition for RemovalJoint Order of Consolidationcumulative trauma claimspost termination defensesAOE/COELabor Code section 3600(a)(10)(D)Labor Code section 5412date of injuryoccupational diseasesdisability
References
Case No. ADJ8077522
Regular
Dec 21, 2018

FOREST BAILEY vs. LUNDAY THAGARD COMPANY, doing business as WORLD OIL CORPORATION, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURG, PENNSYLVANIA

The applicant sought reconsideration of an award finding 87% permanent disability, arguing for permanent total disability based on a psychiatric Agreed Medical Examiner's (AME) report. The Appeals Board denied reconsideration, upholding the original award. The Board found the WCJ properly weighed the AME's opinions on psychiatric impairment over treating physicians, as required by law. Applicant's trial testimony was also considered by the AME in prior reports.

Workers' Compensation Appeals BoardForest BaileyLunday Thagard CompanyNational Union Fire Insurance CompanyPetition for ReconsiderationFindings and Awardpermanent partial disabilitypsyche injuryburn injuryAgreed Medical Examiner (AME)
References
Case No. VNO 388892, VNO 388897
Regular
Dec 21, 2007

DARRELL BOWEN vs. GALPIN MOTORS, INC., LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision regarding Darrell Bowen's claim against Galpin Motors and Liberty Mutual. While affirming the original decision, the Board amended one finding of fact to assess a 25% penalty for unreasonable delay in providing medical treatment, not exceeding $10,000. The parties were directed to adjust this penalty with jurisdiction reserved.

Workers' Compensation Appeals BoardReconsiderationWCJ reportMedical treatment delayPenalty assessmentUnreasonably delayedJurisdiction reservedOpinion and OrderDecision After ReconsiderationFindings of Fact
References
Case No. ADJ7792304
Regular
Aug 08, 2012

RUBEN AYALA HERNANDEZ vs. ANAWALT LUMBER COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The defendant sought reconsideration of a WCJ's finding of industrial injury and a 15% penalty for delayed temporary disability benefits. The Appeals Board granted reconsideration and affirmed the finding of industrial injury, giving great weight to the WCJ's credibility assessment of the applicant's testimony. However, the Board reversed the penalty, finding the defendant had a reasonable basis to question the applicant's claims given testimony that the applicant never reported an injury.

Workers' Compensation Appeals BoardCumulative Industrial InjuryTemporary Total DisabilityLabor Code §5814(a)Petition for ReconsiderationFindings and OrderReport and RecommendationCredibility AssessmentSubstantial EvidenceGood Faith Personnel Action
References
Case No. GRO 0027359
Regular
Feb 29, 2008

TERESA KENNEDY vs. SANSUM SANTA BARBARA MEDICAL FOUNDATION CLINIC, ROYAL SUN ALLIANCE

The Workers' Compensation Appeals Board granted reconsideration and reversed a penalty assessed against the defendant for unreasonably delaying bariatric surgery follow-up care. The Board found no basis for the penalty as the defendant reasonably relied on medical opinions indicating the applicant's weight loss had resolved obesity-related issues impacting the industrial injury. The matter of attorney's fees under LC 5814.5 was returned to the trial level for further proceedings due to ambiguity in the original award.

Bariatric surgeryWorkers' Compensation Appeals BoardLabor Code section 5814Penalty assessmentReconsiderationQualified Medical EvaluatorAttorney's feesUnreasonable delayFollow-up careMedical treatment necessity
References
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