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Case Law Database

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

Case No. ADJ8597474
Regular
Apr 02, 2018

SID AJAZ vs. COLDWELL BANKER, AMERICAN CASUALTY COMPANY

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinding the prior Order that rejected Qualified Medical Evaluator (QME) Dr. Miner's reports. While agreeing Dr. Miner's reports lacked substantial evidence, the Board found the WCJ erred in ordering a new QME panel. Instead, the Board remanded the case to the WCJ to further develop the record, potentially by appointing a regular physician given the applicant's pro per status.

Petition for RemovalOpinion and OrderQualified Medical Evaluator (QME)Substantial EvidenceWorkers' Compensation Appeals Board (WCAB)Administrative Law Judge (WCJ)Supplemental ReportAgreed Medical Evaluator (AME)Develop the RecordPro Per
References
Case No. ADJ7946529
Regular
May 15, 2012

FELICIANO ESPINOZA vs. INTERGEM, ARGONAUT INSURANCE COMPANY

The Appeals Board granted reconsideration because the initial award of temporary disability was based on a chiropractor's report deemed not substantial evidence, due to unclear examination methods including a potential phone-only consultation. The Board found this evidence insufficient to support the temporary disability period awarded. Consequently, the Board rescinded the prior award and returned the case to the WCJ to further develop the medical record. This includes potentially obtaining supplemental reports or deposing the agreed medical examiner regarding the applicant's period of total temporary disability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary DisabilityIndustrial InjurySubstantial EvidenceMedical OpinionFurther Development of RecordWCJEdward Komberg D.C.
References
Case No. EUR 0040718
Regular
Jun 06, 2008

STEVE STACHEL vs. HUMBOLDT FLAKEBOARD, WAUSAU BUSINESS INSURANCE COMPANY

The Board granted reconsideration to address the defendant's due process claim regarding temporary total disability (TTD) benefits. The Board found the applicant's assertion of un-authorized physical therapy was first raised at trial, surprising the defendant. Consequently, the Board struck the TTD award and remanded the matter for further development of the record on that issue.

Petition for ReconsiderationFindings and AwardTemporary Total Disability (TTD)Cumulative Industrial InjuryLeft Arm and WristFraudulent TestimonyDue ProcessNewly Discovered EvidenceReport and RecommendationMedical Treatment Authorization
References
Case No. ADJ3227890
Regular
Jan 25, 2010

TAYLOR POWELL vs. RENAISSANCE RAINGUTTERS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and dismissed their Petition for Removal. The defendant challenged the administrative law judge's finding on the applicant's earning capacity, arguing for a lower weekly earning capacity and requesting further record development. The Board adopted the WCJ's report, which found substantial evidence for the earning capacity calculation based on the applicant's testimony and hourly rate. The Board found the Petition for Removal inappropriate for a final order.

Petition for ReconsiderationPetition for RemovalFindings Award and OrderIndustrial InjuryTemporary DisabilityPermanent DisabilityLabor Code Section 4650(d)Labor Code Section 4453(c)(4)Earning CapacityFurther Development of Record
References
Case No. ADJ11125430
Regular
Sep 30, 2019

Tiffany Merritt vs. CDCR-CALIFORNIA INSTITUTE FOR WOMEN; Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, affirming the WCJ's decision that the applicant did not sustain injury to her psyche arising out of and occurring in the course of employment. The Board found that the applicant's psychological injury was predominantly caused by a lawful, non-discriminatory, good faith personnel action, specifically a transfer to a new department. However, the Board also amended the original order to defer all issues concerning injuries to body parts other than the psyche. These other issues will be returned to the WCJ for further proceedings and decision.

WORKERS' COMPENSATION APPEALS BOARDTIFFANY MERRITTCDCR-CALIFORNIA INSTITUTE FOR WOMENLegally UninsuredSTATE COMPENSATION INSURANCE FUNDADJ11125430Petition for ReconsiderationFindings and OrderWCJHardesty demand
References
Case No. ADJ7264915
Regular
Jul 15, 2013

ANA GONZALES vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

This case involves an applicant who sustained industrial psychiatric injury but whose orthopedic claims were denied due to insufficient medical evidence. The Appeals Board denied the applicant's petition for reconsideration, finding the applicant failed to present substantial medical evidence of industrial causation for her orthopedic complaints. A dissenting commissioner argued that the primary medical evaluator's report was deficient and lacked substantial evidence, warranting further development of the record on orthopedic injuries and other claims. The dissent emphasizes the Board's duty to ensure substantial justice, suggesting it should have ordered further investigation on the denied orthopedic issues.

WCABPetition for ReconsiderationFindings and Orderindustrial injurypsychelow backneckright shoulderright wristright elbow
References
Case No. ADJ9087890
Regular
Jul 03, 2018

SHERLENE WILLIAMS vs. GOLDEN EMPIRE TRANSIT, RISICO CLAIMS MANAGEMENT

This case concerns a lien claimant's claim for reimbursement following applicant Sherlene Williams' industrial injury as a bus driver. The Workers' Compensation Appeals Board affirmed the Administrative Law Judge's decision denying the lien because the medical provider was not within the defendant's Medical Provider Network (MPN). The majority found the WCJ correctly disallowed the lien due to non-compliance with MPN requirements. A dissenting opinion argued the record was incomplete regarding MPN notice to the applicant and recommended further development of evidence.

Medical Provider NetworkMPNLien ClaimantReconsiderationFindings and OrdersCompromise and ReleaseBurden of ProofMPN NoticeLabor Code Section 4616.3Administrative Director's Rule 9767.12
References
Case No. ADJ9904638, ADJ7352002
Regular
Jul 25, 2017

Carmen Caez vs. California Department of Social Services (IHSS), administered by YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration, amending the prior decision to defer the statute of limitations issue for the applicant's low back and other injuries sustained on November 1, 2008. The Board found the initial determination barring benefits lacked substantial evidence, particularly regarding the timeliness of the claim under Labor Code section 5405. Further development of the record is required to address potential tolling of the statute of limitations due to the employer's failure to provide proper workers' compensation notification. The case is returned for further proceedings to resolve these issues.

ADJ9904638ADJ7352002IHSS caregiverLabor Code sections 35503551statute of limitations tolledclaim formHoneywell v. Workers' Comp. Appeals Bd.denial letterApplication for Adjudication
References
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