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

Case No. CV-23-1674
Regular Panel Decision
Nov 14, 2024

In the Matter of the Claim of Juana James

Claimant Juana James, a home health aide, appealed decisions from the Workers' Compensation Board regarding a left shoulder injury sustained in a workplace accident on March 22, 2021. She sought a schedule loss of use (SLU) award. Conflicting medical opinions were presented by her treating orthopedist, Donald Heitman, who found a 30% SLU, and Robert Pae, an orthopedist for the employer's carrier, who concluded claimant manipulated the exam and her SLU was likely between 0% and 30%. The Workers' Compensation Law Judge and the Board found a 0% SLU, discrediting Heitman's methods and crediting Pae's findings. The Appellate Division affirmed the Board's decision, finding it supported by substantial evidence.

Schedule Loss of Use (SLU)Workers' Compensation BoardAppellate DivisionShoulder InjuryMedical ExaminationSymptom MagnificationMaximum Medical Improvement (MMI)OrthopedicsConflicting Medical OpinionsSubstantial Evidence
References
6
Case No. LAO 854789
Regular
Oct 09, 2007

Juana Manriquez vs. KENVIN, INC., dba CORDOVAN & GREY LTD, STATE COMPENSATION INSURANCE FUND

The applicant sought extended temporary disability benefits, claiming a rotator cuff debridement during shoulder arthroscopy constituted an "amputation" under Labor Code section 4656(c)(2)(C). The Board denied reconsideration, affirming the WCJ's finding that "debridement" of an internal body part, like bone, does not meet the statutory definition of amputation. This definition requires the severance or removal of a limb or body appendage, conforming to the common understanding of the term.

Juana ManriquezKenvin IncState Compensation Insurance FundLAO 854789Petition for ReconsiderationAugust 6 2007 Findings and Ordershoulder arthroscopyamputationLabor Code section 4656(c)(2)(C)temporary disability
References
4
Case No. SJO 0258872
Regular
Aug 12, 2008

JUANA MICHEL vs. JACK-IN-THE-BOX, AMERICAN CASUALTY COMPANY OF READING PENNSYLVANIA

The Appeals Board reconsidered a decision regarding Juana Michel's workers' compensation claim and amended the original award. The Board found that medical reports predating January 1, 2005, sufficiently indicated permanent disability, thereby making the 1997 Permanent Disability Rating Schedule applicable. Consequently, the applicant's permanent disability rating was increased from 31% to 53% based on the parties' stipulation and the application of the older rating schedule.

Workers' Compensation Appeals BoardPermanent DisabilityReconsiderationIndustrial InjuryLow Back InjuryPermanent Disability RatingSchedule for Rating Permanent DisabilitiesAmerican Medical Association GuidesAgreed Medical ExaminerTreating Physician
References
6
Case No. ADJ8890512
Regular
Aug 23, 2018

JUANA FLORES vs. MCDONALD'S, UNITED STATES FIDELITY AND GUARANTY COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board (WCAB) dismissed Juana Flores's petition for reconsideration because it was unverified, violating Labor Code section 5902. The WCJ's report provided notice of this defect, yet Ms. Flores failed to cure it by filing a verification or providing a compelling explanation within a reasonable time. Had the petition not been dismissed for procedural defect, the WCAB would have denied it on the merits, adopting the WCJ's findings and giving great weight to their credibility determination.

Petition for ReconsiderationVerifiedLabor Code section 5902Cal. Code Regs.tit. 8§ 10450(e)Lucena v. Diablo Auto BodyUnverified PetitionDismissalWCJ Report
References
2
Case No. ADJ10666000
Regular
Jun 04, 2018

JUANA ALEMAN vs. CITISTAFF SOLUTIONS, OLD REPUBLIC INSURANCE, GALLAGHER BASSETT SERVICES, INC.

The applicant, Juana Aleman, seeks reconsideration of a decision that denied her workers' compensation claim for cumulative injury. The appeals board granted reconsideration because the panel Qualified Medical Examiner's (QME) report lacked substantial evidence. Specifically, the QME's description of the applicant's job duties was inconsistent with testimony from both the applicant and her supervisor. Consequently, the board rescinded the prior decision and returned the matter to the WCJ for further proceedings, recommending the parties provide an accurate job description to the QME.

Petition for ReconsiderationPanel Qualified Medical Examiner (QME)Substantial EvidenceJob Description InaccuracyCumulative InjuryWorkers' Compensation Appeals Board (WCAB)Medical OpinionLabor CodeRestored to CalendarFindings Order Opinion
References
5
Case No. ADJ7158302
Regular
Jun 27, 2013

JUANA ZAVALA PEREZ vs. VIRGINIA SMITH, dba ZIP SORT SUPPORT, ACE AMERICAN INSURANCE, administered by ESIS

The Workers' Compensation Appeals Board dismissed Juana Zavala Perez's petition for reconsideration because it was not filed from a "final" order that determined substantive rights. The Board also denied the petition for removal, finding that the applicant failed to demonstrate substantial prejudice or irreparable harm. The case involved an appeal against Virginia Smith, dba Zip Sort Support, and Ace American Insurance.

Petition for ReconsiderationRemovalFinal OrderSubstantive RightInterlocutory OrderProcedural DecisionEvidentiary DecisionSubstantive QuestionPre-trial OrderEvidence
References
6
Case No. ADJ2574910 (ANA 0328189) ADJ7188791
Regular
Jul 28, 2011

MARIO MANRIQUEZ, JR. vs. JAMES LINEBACK M.D., STATE COMPENSATION INSURANCE FUND; BREDFELDT, CORSON & ODUKOYA; and FARMINGTON CASUALTY

The applicant, Mario Manriquez, Jr., filed a Petition for Removal seeking authorization for medical-legal testing from Farmington Casualty. The Appeals Board denied this petition, finding it premature as the applicant should have filed a Declaration of Readiness. However, the Board granted removal on its own motion to address multiple outstanding issues across two case numbers. These include the applicant's entitlement to medical treatment, the pending petition for an order compelling authorization for medical-legal expenses, and the applicant's prior no-shows at hearings. The Board redesignated the upcoming hearing as a status conference to allow the WCJ to address these matters.

Petition for RemovalPetition for Order CompellingPanel Qualified Medical EvaluatorPQMEMedical-Legal ProceduresFarmington CasualtyState Compensation Insurance FundCumulative InjuryCirculatory SystemExpedited Hearing
References
1
Case No. ADJ3533713
Regular
Nov 07, 2011

JUANA LOPEZ vs. THE MERCHANT OF TENNIS, HARTFORD INSURANCE

The Workers' Compensation Appeals Board (WCAB) removed this matter for the purpose of imposing sanctions. The WCAB found that the petition for reconsideration filed by SIR Practice Solutions, LLC on behalf of several lien claimants was skeletal, unintelligible, and violated multiple WCAB rules regarding evidentiary and legal support. The lien claimants and SIR Practice Solutions, LLC failed to object to the Notice of Intention to Impose Sanctions within the allotted time. Therefore, the WCAB imposed sanctions of $250.00 against each individual lien claimant and found SIR Practice Solutions, LLC jointly and severally liable for these sanctions.

Workers' Compensation Appeals BoardRemovalSanctionsLien ClaimantsSIR Practice SolutionsPetition for ReconsiderationSkeletal PetitionAppeals Board Rule 10846Labor Code Section 5813Notice of Intention to Impose Sanctions
References
6
Case No. ADJ7775170
Regular
Jul 16, 2012

JUANA NEGRETE vs. SHURFLO, HAMPSHIRE INSURANCE COMPANY

This case involves an applicant's workers' compensation claim filed after layoff, triggering Labor Code Section 3600(a)(10). The Appeals Board granted reconsideration, finding the applicant met her burden of proof that she notified her employer of her injury prior to her layoff. The applicant's unrebutted testimony and supporting medical evidence demonstrated employer notice, thus overcoming the statutory bar to compensation. The case was remanded for further proceedings on the merits of the applicant's claim.

Workers' Compensation Appeals BoardJuana NegreteShurfloHampshire Insurance CompanyADJ7775170Opinion and Order Granting ReconsiderationDecision After Reconsiderationbilateral armsbilateral elbowssleep problems
References
4
Case No. RIV 0069711
Regular
Apr 04, 2008

JUANA CASTANEDA vs. BRAWLEY BEEF, AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board dismissed the lien claimant's petition for reconsideration because it was filed untimely. The lien claimant failed to object within the allowed ten days to the Notice of Intention to Dismiss Lien and then filed the petition for reconsideration 20 days after the statutory deadline. The Board found that the lien claimant did not adequately overcome the defendant's proof of service for a prior hearing notice.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationDismissalUntimely filingBoard Rule 10770Compromise and ReleaseLabor Code section 5903JurisdictionProof of Service
References
4
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