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

Case No. ADJ8269895
Regular
Jan 31, 2018

FERMIN SANDOVAL vs. WATERPROOFING ASSOCIATES, CYPRESS INSURANCE, BERKSHIRE HATHAWAY

This case involves an applicant seeking reconsideration of a workers' compensation award finding a 50% permanent disability from a back and right knee injury. The applicant argued he was permanently and totally disabled, that the WCJ erred by considering non-industrial factors, and that his average weekly wage was miscalculated. The Board affirmed the original award, finding that while an applicant can rebut a scheduled rating by showing impairment of rehabilitation due to the industrial injury, this applicant's vocational limitations stemmed from non-industrial factors like illiteracy and language barriers. Therefore, the Board concluded the applicant did not meet his burden to prove a greater loss of earning capacity due solely to the industrial injury as required by *Ogilvie*.

Workers' Compensation Appeals BoardSecond Petition for ReconsiderationFindings and AwardPermanent DisabilityLabor Code Section 4662(b)Average Weekly WageLabor Code Section 4453(C)(1)Labor Code Section 4453(C)(3)Ogilvie v. Workers' Comp. Appeals Bd.Scheduled Rating
References
2
Case No. ADJ7037475
Regular
Oct 04, 2018

JESUS ROJAS vs. GAY AND LESBIAN COMMUNITY CENTER, INC.; STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Jesus Rojas's petition for reconsideration, affirming the administrative law judge's award of 81% permanent disability for his admitted industrial spine injury. Rojas argued for 100% permanent disability based on an Agreed Medical Examiner's opinion of inability to return to the labor market and contended apportionment to non-industrial factors was unsubstantiated. The Board found the apportionment to pre-existing congenital stenosis was supported by medical evidence and that the *Hikida* case did not apply as Rojas's disability was not directly caused by the effects of medical treatment necessitated by both industrial and non-industrial factors. Furthermore, the Board held that Labor Code section 4662(b) does not create an independent pathway to permanent total disability.

Petition for ReconsiderationFindings of Fact and AwardPermanent DisabilityApportionmentAgreed Medical Examiner (AME)Labor Code section 4656Labor Code section 4658Labor Code section 4662(b)Hikida v. Workers' Comp. Appeals. Bd.non-industrial factors
References
2
Case No. ADJ2570690 (BAK 0136703) ADJ2091641 (BAK 0136704) ADJ2368957 (BAK 0136705)
Regular
Feb 01, 2016

WESLEY CHAMBERS vs. SCHLUMBERGER DOWELL, TRAVELERS INDEMNITY COMPANY OF ILLINOIS, TRAVELERS INSURANCE COMPANY

In this Workers' Compensation Appeals Board decision, the applicant sustained a 100% permanent disability award due to orthopedic and psychiatric injuries. The Board granted reconsideration, agreeing with the applicant's total permanent disability but finding the prior apportionment to non-industrial factors was insufficient. The Board amended the award to incorporate a 15% apportionment to non-industrial factors based on medical opinion, reducing the compensable permanent disability to 85%, and returned the case for a new rating. This adjustment stems from the applicant's pre-existing "family problems" which contributed to his psychiatric condition, independent of his industrial injuries.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityApportionmentCumulative TraumaPsychiatric InjuryOrthopedic InjuryAgreed Medical ExaminerQualified Medical EvaluatorMedical Evidence
References
1
Case No. MON 0240201
Regular
Apr 09, 2008

CAROL CHARON vs. RALPHS GROCERY COMPANY, SEDGWICK CLAIMS SERVICES

This case involves an applicant seeking reconsideration of a workers' compensation award concerning psychiatric injury. The Appeals Board granted reconsideration, rescinding the prior decision because the judge's apportionment of permanent disability to non-industrial factors was not adequately supported by medical evidence. The Board requires further medical clarification on what specific non-industrial factors occurring *after* a prior award are responsible for the increased disability, consistent with evolving apportionment laws.

ReconsiderationApportionmentIndustrial InjuryPsychePermanent DisabilityAgreed Medical EvaluatorVargasLabor Code Section 4663SB 899Marsh
References
2
Case No. ADJ3925996 (FRE 0180480) ADJ360469 (FRE 0198851)
Regular
Oct 01, 2012

MICHAEL AKINS vs. THE SALVATION ARMY, Permissibly Self-Insured

In this workers' compensation case, the defendant, The Salvation Army, seeks to deny liability for applicant Michael Akins' recommended spinal surgery. While Akins sustained industrial injuries to his neck and back in 1998 and 2001, a subsequent non-industrial car accident in 2008 displaced hardware from his prior industrial surgery. The Board found that the industrial injury was a substantial contributing factor to the need for the current surgery, even though the non-industrial accident was the "most proximate cause." Therefore, the defendant remains liable for the recommended surgical intervention.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderIndustrial InjurySpinal SurgeryPrimary Treating PhysicianNon-Industrial Motor Vehicle CollisionIntervening EventAgreed Medical ExaminerCausation
References
1
Case No. ADJ3026623
Regular
Jun 28, 2010

ROBERTO PICENO vs. KLUNE INDUSTRIES, INC.; CIGA, administered by CAMBRIDGE for FREMONT, in liquidation

This case involves a defendant's petition for reconsideration of an award of permanent disability for an applicant's industrial injuries sustained on January 22, 1997. The defendant argued for apportionment of the permanent disability to non-industrial factors and to a cumulative trauma injury. The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition because it was unverified, a mandatory requirement. The WCAB found the defendant failed to cure this defect within a reasonable time after it was pointed out. Therefore, the defendant's contentions regarding apportionment were not addressed on their merits by the WCAB.

Workers' Compensation Appeals BoardPetition for ReconsiderationUnverified PetitionLabor Code Section 5902ApportionmentCumulative TraumaSpecific InjuryAgreed Medical ExaminerQualified Medical EvaluatorSubstantial Evidence
References
1
Case No. ADJ8008859
Regular
Nov 05, 2020

MADELINE CASACCA vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS and REHABILITATION, CTF SOLEDAD, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of a prior award. The Board found that the defendant failed to provide substantial evidence for apportionment of applicant's disability, as the QME's opinion lacked sufficient explanation of how non-industrial factors caused the disability. Additionally, the Board determined that the Labor Code section 4658(d)(3)(A) reduction in indemnity was inapplicable because the applicant had already returned to work in her regular position. Commissioner Lowe dissented, arguing that the QME's apportionment of 10% disability to non-industrial factors constituted substantial evidence.

Workers' Compensation Appeals BoardAdjudication NumberFindings and AwardPetition for ReconsiderationInjury AOE/COEPermanent Partial DisabilityLabor Code section 4658(d)(3)(A)Fifteen Percent ReductionOrthopedic Qualified Medical ExaminerApportionment
References
5
Case No. ADJ1955186
Regular
Apr 14, 2023

ROBERT JELENIC vs. LOS ANGELES DEPARTMENT OF WATER AND POWER

This case involves a dispute over permanent and total disability following a 1997 industrial injury. The Appeals Board affirmed the finding of permanent and total disability, including the applicant's upper and lower back in the industrial injury. However, the Board rescinded the original finding that apportionment to non-industrial factors was inapplicable, stating apportionment under Labor Code section 4663 should be considered. The majority found Dr. Richman's apportionment opinions did not provide substantial evidence for apportionment, while the dissenting opinion argued for further development of the record regarding apportionment to a 1992 non-industrial injury.

Permanent Total DisabilityApportionmentLabor Code Section 4662(a)(4)Agreed Medical Examiner (AME)Vocational FeasibilityCognitive ImpairmentSub Rosa Videos1997 PDRSPermanent Impairment RatingPre-existing Condition
References
10
Case No. ADJ3265478 (POM 0249587) ADJ8008455 ADJ8008457
Regular
Jun 11, 2012

Marva Thomas vs. Long Beach Unified Schools, Tristar Los Angeles

Applicant Marva Thomas sought reconsideration of three permanent disability awards, arguing the Agreed Medical Examiner's (AME) apportionment to non-industrial factors was unsubstantiated. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding the AME's reports and deposition testimony lacked sufficient reasoning and did not establish a clear basis for the apportioned percentages. The WCAB rescinded the original awards and returned the matter for further development of the medical record. This ensures the AME's apportionment is adequately explained, demonstrating how and why specific percentages are attributed to industrial versus non-industrial causes.

ApportionmentAgreed Medical ExaminerPermanent DisabilityCumulative TraumaDegenerative ArthritisSubstantial Medical EvidenceReasonable Medical ProbabilityCausationLabor Code Section 4663Findings and Awards
References
1
Case No. ADJ1861602 (NOR 0180537) ADJ509009 (NOR 0190111)
Regular
Aug 23, 2010

MARIO VAZQUEZ vs. SOUTHERN CALIFORNIA GAS COMPANY, ALEXIS RISK MANAGEMENT SERVICES, INC.

The defendant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) award of 100% permanent disability and lifetime benefits to the applicant for psychological and physical injuries. The defendant argued for apportionment to non-industrial factors, citing a medical evaluator's opinion that the applicant had pre-existing personality disorders. However, the WCAB denied reconsideration, finding the defendant failed to meet its burden of proof on apportionment, as the medical expert could not medically quantify the non-industrial contribution to the disability. Furthermore, the WCAB upheld the finding that the applicant's two industrial injuries were intertwined, preventing separate apportionment between them.

Petition for ReconsiderationJoint Findings of Fact and AwardIndustrial InjuryPsycheHeadachesSeizuresPermanent DisabilityApportionmentNon-Industrial FactorsSubstantial Evidence
References
12
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