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

Case No. ADJ8558787
Regular
Apr 11, 2017

Mario Diaz vs. The Gainey Vineyard, Crump & Forster, United States Fire Insurance

This case involves Mario Diaz's workers' compensation claim for a lumbar spine injury. The Appeals Board granted reconsideration to amend the award, finding the agreed medical examiner's apportionment to pre-existing spondylolisthesis was not sufficiently justified. The Board also corrected the permanent disability rating calculation, utilizing the examiner's 34% whole person impairment instead of the initial 45% regional impairment, ultimately awarding 48% permanent disability without apportionment.

WCABapportionmentpermanent disabilityspondylolisthesisdegenerative disc diseaseAgreed Medical ExaminerAMEEscobedoAlmaraz-GuzmanWhole Person Impairment
References
Case No. ADJ1534094 (ANA 0371141), ADJ2039233 (ANA 0370928), ADJ1431772 (ANA 0388738), ADJ3092100 (ANA 0388739)
Regular
Feb 10, 2012

ROLANDO ALVARADO-CRUZ vs. SPRING INDUSTRIES, INC., ZURICH INSURANCE COMPANY

This case involves a workers' compensation applicant seeking reconsideration of a permanent disability award. The applicant argued against the administrative law judge's (WCJ) apportionment of 25% of the disability to pre-existing spondylolisthesis and the method of calculating the final award. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, agreeing that apportionment should be applied after adjustments for age and occupation, but otherwise affirmed the WCJ's findings. Consequently, the applicant's permanent disability award was increased to 21% for both the specific and cumulative trauma injuries.

Workers' Compensation Appeals BoardRolando Alvarado-CruzSpring IndustriesZurich Insurance CompanyFindings and AwardAdministrative Law JudgeMachinistPillow StufferSpecific InjuryCumulative Trauma Injury
References
Case No. ANA 0329574
Regular
Sep 21, 2007

Martina Gonzalez, Ocegueda vs. ST. JOHN KNITS, ARGONAUT INSURANCE COMPANY

The Appeals Board granted reconsideration and overturned the WCJ's decision, finding the WCJ erred in calculating average weekly earnings and relying on an incomplete medical report for apportionment. The case is returned to the trial level to recalculate average weekly earnings and revisit permanent disability and apportionment issues, considering recent legislative changes regarding pre-existing conditions. The Appeals Board noted that the prior medical report failed to address the applicant's spondylolisthesis and that apportionment rules have changed, eliminating the "old rules" regarding pathology.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryLow BackAbdomenRight LegPsycheTotal Permanent DisabilityApportionment
References
Case No. ADJ4523497 (AHM 0062594) ADJ488115 (AHM 0062669)
Regular
Jan 09, 2014

Anthony Becker vs. American Drug Stores, Broadspire

The Workers' Compensation Appeals Board denied reconsideration of a decision that apportioned 25% of the applicant's permanent spinal disability to non-industrial factors. The applicant argued that the Agreed Medical Examiner established his permanent total disability was solely due to surgeries for industrial cumulative trauma. However, the Board found the defendant met its burden of proof for apportionment, as the AME's testimony supported that the applicant's pre-existing spondylolisthesis contributed to the need for two-level spinal surgery. The Board adopted the WCJ's report and affirmed the original award.

WCABPetition for ReconsiderationJoint Findings and AwardCumulative TraumaApportionmentNon-industrial factorsAgreed Medical Examiner (AME)Escobedo v. MarshallsSpondylolisthesisPreexisting developmental anomaly
References
Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ10286078
Regular
Aug 03, 2018

DOROTHY VARELLAS vs. SAN FRANCISCO UNIFIED SCHOOL DISTRICT

This case involves a workers' compensation claim where the defendant sought reconsideration of a prior award concerning the applicant's temporary total disability (TTD) periods. The appeals board granted reconsideration to clarify the TTD periods. Ultimately, the Board affirmed the original award but amended it to establish TTD from May 31, 2016, to July 21, 2016, and again from February 23, 2017, to May 9, 2017, with corresponding permanent and stationary dates. The decision addressed arguments regarding the timeliness and verification of the petition for reconsideration.

Permanent and stationary dateTemporary total disabilityPetition for reconsiderationAgreed Medical Examiner (AME)Treating physicianMedical evidenceDeposition testimonyWCJWorkers' Compensation Appeals Board (WCAB)Low back injury
References
Case No. ADJ2426407 (VEN 0086297)
Regular
Sep 12, 2014

ROCHELLE STOCK vs. CAMARILLO STATE HOSPITAL, STATE COMPENSATION INSURANCE FUND

The applicant challenged the admissibility of a Utilization Review (UR) denial for a hospital bed, arguing that UR is not applicable to requests from an MPN physician. The WCJ admitted the UR denial, finding the applicant's objection lacked merit and that the UR process is mandatory for all treatment requests, even those from MPN physicians. The Appeals Board dismissed the applicant's reconsideration petition as premature. However, treating it as a removal petition, the Board affirmed the WCJ's decision, clarifying that MPN participation does not preclude UR review for treatment authorization.

Workers Compensation Appeals BoardUtilization ReviewMedical Provider NetworkPetition for ReconsiderationRemovalFindings and AwardIndependent Medical ReviewPrimary Treating PhysicianMedical Treatment AuthorizationLabor Code Section 4610
References
Case No. ADJ470132 (GOL 0100305), ADJ1890831 (GOL 0100306)
Regular
Sep 20, 2010

KAREN MCCORMICK vs. PACIFIC CAPITAL BANCORP, STATE COMPENSATION INSURANCE FUND, ST. PAUL TRAVELERS

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied SCIF's petition for reconsideration, affirming the WCJ's findings. The Board found Dr. Scheinberg's medical reports admissible and that applicant sustained an industrial injury to her lumbar spine on October 22, 2001, with permanent disability rated under the 1997 PDRS. The Board also rejected SCIF's Statute of Limitations defense and its claims regarding cumulative trauma and apportionment. SCIF's contentions regarding Dr. Scheinberg's reports, the lumbar spine injury, cumulative trauma, statute of limitations, PDRS application, and apportionment were all denied.

WCABSCIFAMELabor Code section 4628Statute of LimitationsWCAB Rule 104581997 PDRSpermanent disabilityapportionmentcumulative trauma
References
Case No. OAK 294681
Regular
Nov 14, 2007

SCOTT SIMPSON vs. GEO OPTIONS, INC., EARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision regarding permanent disability apportionment, finding substantial medical evidence supported a 50% apportionment to pre-existing conditions. The Board also upheld the WCJ's finding of unreasonable delay in medical treatment, justifying a penalty against the defendant. A minor clerical error in the award regarding penalty references was corrected.

Workers' Compensation Appeals BoardScott SimpsonGeo Options Inc.Hartford Insurance CompanyOAK 294681Opinion and Decision After Reconsiderationpermanent disabilityapportionmentspondylolisthesisqualified medical examiner
References
Case No. ADJ349209 (AHM 0091529)
Regular
Dec 17, 2009

JAMES OZAETA vs. ROYAL CUSTOM DESIGNS, STATE COMPENSATION INSURANCE FUND

The WCAB denied defendant's petition for reconsideration, affirming the WCJ's amended findings and award which found applicant sustained an industrial injury resulting in 93% permanent disability without apportionment.

ApportionmentIndustrial InjuryPsychePermanent DisabilityVocational RehabilitationStipulationLabor Code Section 3208.3(d)Pre-existing ConditionDegenerative Disc DiseaseSpondylolisthesis
References
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