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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings.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. ADJ3512142 (MON 0288509)
Regular
Jan 12, 2009

JOSE LUIS LARA vs. BRATIFF HOME CORP. dba METRO DINER and SCOTT BROFFMAN as substantial shareholder; UNINSURED EMPLOYERS BENEFIT TRUST FUND

The Appeals Board reversed the WCJ's finding that the applicant was an employee of Metro Diner on the date of injury, concluding that he was an independent contractor.

Workers' Compensation Appeals BoardBratiff Home Corp.Metro DinerScott BroffmanUninsured Employers Benefit Trust FundADJ3512142MON 0288509Opinion and Order Granting ReconsiderationDecision After ReconsiderationAdministrative Law Judge
References
Case No. ADJ10159316
Regular
Sep 25, 2017

Rowdy Rushing vs. Foster Farms

The Workers' Compensation Appeals Board denied reconsideration of a decision finding that Rowdy Rushing did not sustain a left shoulder injury arising out of and occurring in the course of employment with Foster Farms. The Administrative Law Judge found the applicant's testimony regarding a pallet striking his arm not credible, noting inconsistencies with coworker statements and medical reports. Specifically, the applicant's account of the incident and the mechanism of injury was deemed unlikely and not supported by Dr. Ozaeta's medical opinion, which concluded the MRI findings were inconsistent with the described incident. Therefore, the Board affirmed the judge's take-nothing order.

Workers' Compensation Appeals BoardFoster FarmsRowdy RushingFindings and OrderTake nothing orderIndustrial injuryLeft shoulderOctober 92015Taper/packer
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ4225526 (GOL 0092072)
Regular
Apr 20, 2017

JESUS ARROYO vs. JOHN CRAVENS PLASTERING, STATE COMPENSATION INSURANCE FUND

This case involves Jesus Arroyo's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, adopting the reasoning of the workers' compensation administrative law judge. Medical evidence from Dr. Markovitz established that Arroyo suffered a total and permanent disability resulting from industrial injuries, including an aortic aneurysm repair and subsequent strokes. The Board found Dr. Markovitz's opinions constituted substantial medical evidence, despite conflicting defense opinions, and affirmed that all necessary medical care and permanent disability were industrially caused.

Workers' Compensation Appeals BoardJesus ArroyoJohn Cravens PlasteringState Compensation Insurance FundPetition for ReconsiderationAgreed Medical ExaminerGerald Markovitzechocardiogramaortic root dilationexpanding aortic aneurysm
References
Case No. ADJ8608456 MF\nADJ8608504\nADJ8523009\nADJ8551858\nADJ8609068
Regular
Oct 07, 2015

HORACIO CABRERA, Deceased MARIBEL BARAJAS, Widow, Guardian Ad\nLitem for LITZY CABRERA, LESLY\nCABRERA, MARIA CABRERA AND\nKASSANDRA CABRERA; BRIANNA\nCABRERA, for herself and Guardian Ad Litem for STEFANI ARIAS, ANTONIO SOLARES, MODESTO DOMINGUEZ, JOHNATHAN ALONSO vs. MV CONTRACTING, STAR INSURANCE COMPANY

In this workers' compensation case, the employer sought reconsideration of a ruling finding a fatal motor vehicle accident and related injuries industrial. The employer argued the administrative law judge erred in admitting evidence and presuming compensability due to a failure to issue timely denial notices. The employer also contended the "going and coming rule" barred the claims as the accident occurred during a standard commute. The Board denied reconsideration, affirming the judge's findings that the injuries were industrial and not barred by the going and coming rule, largely adopting the judge's reasoning.

WCABPetition for ReconsiderationDenying PetitionRulings and Order Admitting EvidenceFindings of FactMotor Vehicle AccidentIndustrial InjuriesFatal Industrial InjuryDependentsNotice of Denial
References
Case No. ADJ2934117 (STK 0214084)
Regular
Jun 06, 2011

BENNIE MADAVE vs. STOCKTON UNIFIED SCHOOL DISTRICT

This case involves an applicant seeking workers' compensation for a right shoulder rotator cuff repair surgery denied by a WCJ. The WCJ ruled the need for surgery stemmed from a subsequent non-industrial accident, not the initial industrial injury. The Appeals Board granted reconsideration, rescinded the original order, and returned the case for further medical record development. This is because the medical evidence failed to definitively determine if the surgery was necessary to cure or relieve the effects of the industrial injury, even if the tear itself wasn't solely industrially caused.

Rotator cuff repairIndustrial injuryNon-industrial accidentUtilization reviewPanel Qualified Medical EvaluatorPQMEApportionmentPermanent disabilityInextricably linkedFurther development of medical record
References
Case No. ADJ6774605
Regular
Sep 02, 2016

Tammy Tran vs. PROFESSIONAL SERVICE INDUSTRY, ZURICH LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration of the Administrative Law Judge's (ALJ) decision, which limited reimbursement for self-procured medical treatment. The Board found that the ALJ erred by only allowing reimbursement for treatment from the claim date until the denial date. Citing *McCoy v. Industrial Accident Commission*, the Board determined that the employer is liable for all reasonably necessary self-procured medical expenses incurred after the employer denied the claim, as this denial effectively refused to provide treatment. Consequently, the Board rescinded the ALJ's award and remanded the case for further proceedings to determine the reasonableness of all self-procured medical expenses.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardSelf-Procured Medical TreatmentLabor Code Section 4600McCoy v. Industrial Accident CommissionDenial of ClaimReimbursementIndustrial InjuryReasonably Necessary Treatment
References
Case No. ADJ7418888 ADJ6523182
Regular
May 07, 2014

Frances Evans vs. San Joaquin Regional Transit District, York Risk Services Group, Inc.

This case involves Frances Evans' claim for workers' compensation benefits due to cumulative trauma to her back and spine and a subsequent motor vehicle accident. The Appeals Board denied reconsideration, affirming its prior decision that Evans failed to prove her cumulative trauma injury arose from her employment. Because no industrial injury was established, the motor vehicle accident sustained while en route to a medical evaluation was also deemed non-compensable. The Board found the Agreed Medical Examiner's conflicting opinions on causation insufficient to meet the applicant's burden of proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationCumulative Trauma InjuryIndustrial InjuryCompensable Consequence InjuryAgreed Medical Examiner (AME)Substantial Medical EvidenceIndustrial CausationBurden of ProofPermanent Disability
References
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