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

Case No. ADJ1232266 (RIV 0075781) ADJ3649405 (RIV 0075782)
Regular
Jan 24, 2017

MARY SAUNDERS vs. SYNERGY THERAPY, INC., TRAVELERS INDEMNITY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address the defendant's challenge to the applicant's insomnia award. The WCAB found that while the applicant's insomnia was industrially caused, the treating physician's report lacked substantial evidence regarding the 10% whole person impairment rating. Therefore, the WCAB amended the award to defer the permanent disability finding for insomnia and returned the case to the WCJ for further development of the record.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardSpecific InjuryCumulative TraumaPermanent DisabilityFuture Medical TreatmentSubstantial EvidenceQualified Medical EvaluatorInsomnia
References
Case No. ADJ1371205 (VNO 0557310)
Regular
Mar 10, 2011

VICTOR LOPEZ vs. GREYSTONE MANAGEMENT, ZENITH INSURANCE COMPANY

This case concerns a lien claimant, Unicare Diagnostic Center, seeking payment for sleep studies related to an applicant's claimed industrial injuries. The applicant settled their primary claim via Compromise and Release, but Unicare's lien remained unresolved. The trial judge ruled against the lien claimant, finding the insomnia claim non-industrial and the sleep studies medically unnecessary. The Appeals Board affirmed this decision after reconsideration, adopting the trial judge's reasoning.

Compromise and ReleaseLien ClaimantUnicare Diagnostic CenterIndustrial InjuryChestEarNoseHandsWristsHeadaches
References
Case No. ADJ1497797 (OAK 0293880)
Regular
Jan 13, 2011

IRWIN FRIEDMAN vs. FRANK ROMBAUER CELLAR, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed the judge's findings regarding industrial injury to the applicant's respiratory system, eyes, throat, psyche, and resulting chronic fatigue and insomnia. The Board agreed the applicant's permanent disability rating of 61% was supported by the evidence and rejected the applicant's argument that he was unable to compete in the open labor market. However, the Board deferred the Employment Development Department's lien and amended the permanent disability indemnity rate to $185.00 per week.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityIndustrial InjuryRespiratory SystemEyesThroatPsycheChronic FatigueInsomnia
References
Case No. ADJ9402316
Regular
Aug 02, 2019

OSCAR SANDOVAL vs. THE STRIP JOINT, INC., STATE COMPENSATION INSURANCE FUND

This case involves applicant Oscar Sandoval seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that denied his claim for injury to his head, jaw/teeth, psyche, and sleep disorder. The WCAB denied reconsideration, affirming the WCJ's finding that the medical reports submitted by applicant's physicians lacked substantial evidence. Specifically, the WCAB found that Dr. Schames' report was based on an inadequate medical history, Dr. Reichwald's report was internally inconsistent and lacked review of sufficient medical records, and Dr. Saeid's report did not sufficiently explain his diagnosis of insomnia.

AOE/COEPetition for ReconsiderationFindings and AwardWCJmedical-legal reportssubstantial evidenceorthopedicpsychologicalinternal medicinecervical spine
References
Case No. ADJ2804761 (LAO0886335)
Regular
Jun 13, 2014

RUBEN PEREZ ARAUJO vs. CENTIMARK CORPORATION, ARCH INSURANCE COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contentions regarding the applicant's Petition to Reopen. The Board found no good cause to reopen the claim for new and further disability related to the applicant's left upper extremity, left lower extremity, insomnia, urological, or internal conditions. This decision was based on the applicant's failure to present substantial evidence of new and further disability beyond what was previously adjudicated or known at the time of the initial award. However, the Board noted that the employer's liability for medical treatment for these conditions may still exist, irrespective of disability findings.

Workers' Compensation Appeals BoardPetition to ReopenNew and Further DisabilityGood CauseLabor Code Section 5410Agreed Medical ExaminerFindings and AwardInsomniaUrological IssuesInternal Systems
References
Case No. ADJ7927652
Regular
Oct 25, 2016

Bozenna Kasperowicz vs. Metropolitan State Hospital, State Compensation Insurance Fund

This case involves an industrial injury to the applicant, a psychiatric technician, sustained on June 14, 2011, from a patient strike to the head. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over psychiatric impairment and a sleep disorder rating. The WCAB affirmed the original award but reduced the permanent disability rating from 76% to 70% by excluding the sleep dysfunction impairment. The WCAB found Dr. O'Brien's opinion on psychiatric impairment more persuasive than conflicting medical evaluations and determined Dr. Matos's opinion on sleep impairment lacked substantial medical evidence due to staleness.

WCABReconsiderationPsychiatric ImpairmentWhole Person ImpairmentGAF ScoreSleep DisorderSubstantial Medical EvidencePermanent DisabilityQualified Medical EvaluatorInsomnia
References
Case No. ADJ4008604 (LBO 0390525) ADJ7754215
Regular
Dec 12, 2013

JOEL WILLIS vs. CITY OF ANAHEIM, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the City of Anaheim's petition for reconsideration. The Board upheld the administrative law judge's finding that a police officer sustained industrial injury to his psyche, hypertension, GERD, and IBS. Defendant argued the psychiatric injury stemmed from financial difficulties, not work stress, and that the Agreed Medical Evaluator's report was unsubstantiated. The Board found the AME's report constituted substantial evidence and was properly relied upon by the WCJ, despite the defendant's claims.

Workers' Compensation Appeals Boardindustrial injurypsycheinsomniahypertensiongastro-esophageal reflux diseaseirritable bowel syndromepolice officerreconsiderationAgreed Medical Evaluator
References
Case No. ADJ8794924
Regular
Nov 12, 2013

PHILLIP POSTON vs. CALTRANS, STATE COMPENSATION INSURANCE FUND

This case involves a Caltrans road maintenance worker who claimed psychological injury due to alleged workplace harassment. The applicant's claim was denied by the Workers' Compensation Appeals Board (WCAB). The applicant sought reconsideration, arguing the denial was erroneous. The WCAB denied the petition, adopting the WCJ's report which found the applicant failed to prove a compensable injury. The WCJ concluded the matter stemmed from an employment dispute rather than a medical condition, and the applicant did not meet the burden of proof.

Petition for ReconsiderationWCJ ReportDenialCaltransState Compensation Insurance FundPhillip PostonADJ8794924workers' compensationinjurypsyche
References
Case No. ADJ9584702
Regular
May 03, 2019

ROBERTO RUIZ PEREZ vs. DEL RIO WEST PALLETT, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ULLICO CASUALTY COMPANY, INTERCARE INSURANCE SERVICES

The Workers' Compensation Appeals Board granted reconsideration to modify a prior award. The Board found that the applicant was only entitled to two weeks of temporary total disability for his admitted industrial injury to the left hand, based on medical opinions. The Board specifically rejected the applicant's claim for psychological injury and any extended temporary disability beyond the initial two-week period. Therefore, the prior award of temporary total disability from July 2, 2012, to September 11, 2014, was amended to reflect the limited two-week period.

CIGAUllico Casualty CompanyliquidationPetition for ReconsiderationTemporary Total DisabilityLabor Code section 4656(c)(1)Qualified Medical Evaluatorchronic regional pain syndromeanxietyinsomnia
References
Case No. ADJ14669607
Regular
Apr 10, 2023

DOUGLAS HERB vs. COUNTY OF LOS ANGELES, SEDGWICK CLAIMS MANAGEMENT SERVICES, INCORPORATED

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original finding that the applicant sustained industrial injuries to his internal system and head, causing 71% permanent disability. The defendant argued the Agreed Medical Evaluator's (AME) report regarding head injury and sleep issues lacked substantial medical evidence. The Board found the AME's report to be substantial, as it was not speculative, based on adequate examination, and explained its reasoning. Furthermore, the Board found the AME's method of analogizing the applicant's headaches to trigeminal neuralgia for impairment rating was permissible and accurately reflected the applicant's activities of daily living deficits.

GERDirritable bowel syndromehypertensionheadachessleep disturbancepermanent partial disabilityapportionmentmedical treatmentattorney's feeAgreed Medical Evaluator
References
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