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

Case No. ADJ10443669
Regular
Oct 04, 2017

Donna Carter vs. Rose International Group, OneBeacon Insurance Group

The Appeals Board affirmed the Workers' Compensation Judge's finding that Donna Carter sustained an industrial injury to her right knee and left wrist on May 18, 2016. Despite inconsistencies in the applicant's testimony regarding a slip and fall incident, her account was corroborated by a witness who found her on the floor. Medical records from the day of the incident also supported the applicant's claim, establishing a clear mechanism of injury. The Board found that the common sense nature of a slip and fall does not require expert medical opinion to establish industrial causation for the incident itself.

ADJ10443669Rose International GroupOneBeacon Insurance GroupDonna CarterWorkers' Compensation Appeals BoardOpinion and Decision After Reconsiderationslip and fallindustrial injuryright kneeleft wrist
References
Case No. ADJ4 227596 (POM 0281890) MF ADJ3 720208 (POM 0281889)
Regular
Apr 06, 2016

MARISSA GONZALEZ-ORNELAS vs. COUNTY OF RIVERSIDE

The applicant sought reconsideration of a denied authorization for Synvisc knee injections. The original Independent Medical Review (IMR) denied the request, finding no documentation of the applicant's osteoarthritis failing to respond to conservative treatment. The Appeals Board found this IMR determination was based on a plainly erroneous finding of fact, as medical records in the file directly contradicted this assertion. Therefore, the Board granted the applicant's appeal, rescinded the WCJ's decision, and remanded the case for a new IMR.

Workers' Compensation Appeals BoardIndependent Medical ReviewSynvisc injectionsOsteoarthritisLabor Code section 4610.6(h)Plainly erroneous finding of factOrdinary knowledgeExcess of powersUtilization reviewTreating physician
References
Case No. ADJ3566472 (SFO 04633189)
Regular
Apr 05, 2010

MAURICE EDWARDS vs. CALIFORNIA PACIFIC MEDICAL CENTER

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued the judge erred by combining work restrictions for the left knee and subjective pain for the right knee. The Board found the rating justified, noting the Agreed Medical Examiner stated the applicant was more disabled due to right knee pain. The Board concluded the rater's testimony supported the combined rating without improper addition of disability percentages.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLeft KneeRight KneePsycheApportioned Permanent Partial DisabilityBilateral Knee DisabilityWork Restrictions
References
Case No. ADJ9126926
Regular
May 09, 2014

TERESA GREGORY vs. CONTRA COSTA COUNTY

Defendant Contra Costa County petitioned for removal to compel a UR physician's testimony regarding a disputed knee injection. The WCJ had ordered the physician to appear for live testimony over defendant's objection. However, at the scheduled hearing, the WCJ removed the case from the calendar, stating the knee injection had already occurred and no pending issues remained. Consequently, the petition for removal was dismissed as moot because the UR physician's testimony was no longer necessary.

Petition for RemovalUtilization ReviewExpedited HearingLive TestimonyWCJMOOTDismissedWorkers' Compensation Appeals BoardRescind OrderGood Cause
References
Case No. OAK 0334678, OAK 0334680
Regular
Jul 21, 2008

KENNY AUBREY vs. COLOR TECH CORPORATION

This case involves an applicant who sustained industrial injuries to both knees, resulting in concurrent temporary total disability. The Workers' Compensation Appeals Board (WCAB) affirmed a prior award of temporary disability indemnity, applying the 104-week/two-year limitation under Labor Code section 4656(c)(1). This application was justified by the AME's finding that both injuries contributed to the applicant's concurrent temporary disability, aligning with precedent established in *Foster v. Workers' Comp. Appeals Bd.*.

Workers' Compensation Appeals BoardColor Tech Corporationindustrial injuriesboth kneesarthroscopic surgeriesleft kneeright kneejoint replacementtemporarily totally disabledaggregate disability payments
References
Case No. ADJ3023725 (STK 0186210) ADJ 6853419
Regular
Mar 03, 2016

IGNACIO ROA vs. ROHRER BROTHERS/GENERAL PRODUCE; FREMONT COMPENSATION INSURANCE COMPANY, in liquidation CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by SEDGWICK; XL SPECIALTY/BROADSPIRE; STATE COMPENSATION INSURANCE FUND

This case concerns applicant Ignacio Roa's petition for reconsideration of a workers' compensation award finding 20% permanent disability for a right knee injury with 50% apportionment to nonindustrial factors. Roa also sought to establish an industrial injury to his left knee as a consequence of the right knee injury and a cumulative trauma injury to both knees, which the Workers' Compensation Appeals Board denied. The Board affirmed the judge's findings, relying on Dr. Henrichsen's opinion that Roa's left knee symptoms were due to the natural progression of prior surgery and wear, not industrial factors. A dissenting opinion argued for further medical development, finding persuasive evidence of industrial contribution to the left knee condition.

Workers' Compensation Appeals BoardIgnacio RoaRohrer BrothersFremont Compensation Insurance CompanyCIGAXL SpecialtyState Compensation Insurance Fundpermanent disabilityapportionmentnonindustrial factors
References
Case No. ANA 394929
Regular
Aug 23, 2007

JOSE LUIS SILVA vs. EL MODENO GARDENS, INC., STATE COMPENSATION INSURANCE FUND, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied SCIF's petition for reconsideration regarding the cumulative injury award and exposure percentages. However, the Board granted Redwood's petition and amended the original award to include an additional two weeks of temporary disability for the applicant in May 2005 due to knee injections. The original findings regarding the cumulative injury to the stomach, extremities, and eyes, as well as the need for future medical care, were otherwise affirmed.

Workers' Compensation Appeals BoardCumulative InjuryLower ExtremitiesEyesStomachTemporary DisabilityFuture Medical CareExposureLiability ApportionmentPetition for Reconsideration
References
Case No. ADJ9070770
Regular
Jun 10, 2014

OSCAR GARCIA-PICEN vs. TIGHT QUARTERS, INC., CALIFORNIA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a prior ruling ordering viscosupplementation injections for an applicant's knee injury. The WCAB found the prior ruling, which deemed the defendant's utilization review (UR) denial defective due to a missing signature, to be based on an incorrect premise as the UR physician did sign the report. However, the WCAB noted the UR physician may not have been aware of the applicant's second surgery, potentially rendering the UR defective for other reasons. The case was returned to the trial level for further consideration, with a dissenting opinion arguing the UR was demonstrably defective for omitting key medical history and the treatment should have been affirmed.

Workers' Compensation Appeals BoardOscar Garcia-PicenTight QuartersInc.California Insurance CompanyADJ9070770Opinion and Decision After ReconsiderationViscosupplementation injectionsUtilization Review (UR) denialDefective UR
References
Case No. ADJ3727929
Regular
Jul 17, 2013

JOE GAGNE vs. FRU CON CONSTRUCTION, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board adopted the WCJ's report, which found that the applicant was only temporarily disabled from June 1, 2007, to July 23, 2007, and was not entitled to further travel expense reimbursement. The WCJ determined that while one physician's opinion could constitute substantial evidence, that opinion lacked sufficient clarity and consistency to support the applicant's broader claims of temporary disability and cumulative trauma to the left knee and back. The Board affirmed that a single physician's considered opinion can be substantial evidence, even if inconsistent with other medical opinions.

Petition for ReconsiderationDeniedSubstantial EvidencePlace v. Workmen's Comp. Appeals Bd.Fru Con ConstructionZurich North AmericaADJ3727929SAC 0315536ApplicantTemporarily Disabled
References
Case No. ADJ2073428 (VNO 0465400) ADJ1610465 (VNO 0540972) ADJ3247765 (VNO 00384869)
Regular
Apr 04, 2011

JAY ZAVERI vs. STATE COMPENSATION INSURANCE FUND; Legally Uninsured

The applicant sought reconsideration of a workers' compensation award, arguing for a 100% permanent disability rating and challenging the permanent disability start date used for attorney fee commutation. The Appeals Board denied the petition, finding insufficient evidence to establish total permanent disability, as the applicant was currently employed and medical opinions did not definitively support such a rating. The Board also ruled that the applicant waived arguments regarding the rating of specific injuries by failing to properly object, and that even if considered, separate ratings for back, knee, and plantar fasciitis conditions would not result in a higher award due to fibromyalgia being the primary cause and rating higher. Finally, the Board clarified that the July 2, 2000 date was only relevant to the attorney fee commutation calculation and not to the determination of permanent disability indemnity payments.

WCABPetition for ReconsiderationJoint Findings and AwardWorkers' Compensation Judge (WCJ)Industrial InjuryBack InjuryHip InjuryBilateral Knee InjuryBilateral Foot InjuryBilateral Plantar Fasciitis
References
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