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

Case No. ADJ1455856
Regular
Aug 24, 2012

GUILLERMO HERNANDEZ vs. SPIESS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a finding of 79% permanent disability. The Board found the applicant's vocational expert's opinions regarding diminished future earning capacity unsubstantiated. Consequently, the Board amended the award to reflect 37% permanent disability based on a prior stipulation, and removed any apportionment to non-industrial factors due to lack of substantial medical evidence from the defendant.

WCABSpiess ConstructionState Compensation Insurance FundGuillermo HernandezADJ1455856GRO 0032468ReconsiderationPermanent DisabilityDiminished Future Earning CapacityDFEC
References
Case No. ADJ3625445 (AHM 0123968)
Regular
Mar 01, 2010

DAVID ROMAN vs. REGENTS, UNIVERSITY OF CALIFORNIA, Permissibly Self-Insured, Adjusted By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn a finding of 5% permanent disability after apportionment for a neck injury, arguing the medical examiner's opinion was not substantial evidence and that treatment couldn't be apportioned. The Board found the administrative law judge's reliance on the medical examiner's opinion, which attributed the worsening condition to pre-existing degenerative arthritis, was supported by substantial evidence. The Board also clarified that further medical treatment was awarded, but surgery specifically would be considered non-industrial due to the apportionment finding.

Workers Compensation Appeals BoardPermanent DisabilityApportionmentQualified Medical ExaminerSubstantial EvidenceIndustrial InjuryNeck InjuryReconsiderationWCJMMI
References
Case No. ADJ7084863, ADJ7380456
Regular
Aug 05, 2011

JAMES LAMB vs. THE KENAN ADVANTAGE GROUP, AMERICAN ZURICH INSURANCE CO.

This case involves a truck driver, James Lamb, who sustained a lumbar spine injury with radicular pain during his employment. The defendant sought reconsideration of the prior award finding injury only to his lumbar spine. Subsequently, the applicant and defendant reached a settlement via a Compromise and Release agreement. The Appeals Board granted reconsideration, rescinded the prior award, and returned the matter to the trial level for review of the settlement.

Workers' Compensation Appeals BoardKenan Advantage GroupAmerican Zurich Insurance Co.Gallagher BassettJoint Findings Award and Ordertruck drivercumulative periodlumbar spineradicular painlower extremities
References
Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ1119129 (GOL 099292)
Regular
Dec 22, 2008

TIM GILLES vs. SANTA BARBARA COMMUNITY COLLEGE DISTRICT, ACE INSURANCE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding a prior award of 25% permanent disability and future medical treatment for the applicant's neck and back injuries. The Board affirmed the finding that the cumulative trauma period ended with the applicant's January 2003 neck surgery. The Board found that apportionment issues were properly addressed by the medical evidence and that the defendant's arguments did not warrant disturbing the original award.

Workers Compensation Appeals BoardTim GillesSanta Barbara Community College DistrictACE InsuranceKeenan & AssociatesADJ1119129GOL 099292Findings and Awardpermanent disabilityapportionment
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. ADJ1833781 (VNO 0506228)
Regular
Jan 19, 2012

LESLIE OSBORNE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS - CSP - LAC; legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board affirmed the WCJ's decision denying an applicant's claim for psychiatric injury. The applicant, a former correctional officer, argued that actual employment events predominantly caused her injury and that she was unable to file a claim prior to termination. The Appeals Board found that the applicant failed to meet her burden of proof. Substantial evidence supported the WCJ's finding that no industrial psychiatric injury occurred.

Workers' Compensation Appeals BoardPsychiatric InjuryCorrectional OfficerActual Events of EmploymentPredominant CauseMental CapacityFindings and OrderPetition for ReconsiderationReport and RecommendationBurden of Proof
References
Case No. ADJ4015470
Regular
Feb 08, 2010

ROBIN JORDEN vs. WARNER BROTHERS INC., Self-Administered

This case involves an employer seeking reconsideration of a workers' compensation award for an employee's industrial hip injury. The employer argued the employee was not entitled to temporary disability indemnity (TDI) prior to her surgery. However, the Workers' Compensation Appeals Board denied the petition, upholding the judge's finding that the period leading up to surgery constituted active medical treatment. The Board found the judge's decision supported by substantial evidence, viewing the entire process as a single course of events.

Petition for ReconsiderationFindings and AwardTemporary Disability IndemnityIndustrial InjuryRight HipAssistant DirectorDate of SurgeryActive Medical TreatmentTreating PhysicianEvaluating Doctor
References
Case No. ADJ9725074
Regular
May 25, 2016

RAFAEL GIL vs. WEBCOR BUILDERS, ZURICH INSURANCE

The Workers' Compensation Appeals Board affirmed a prior decision finding the applicant sustained an industrial injury to his head, neck, back, and right shoulder. The Board upheld the award of temporary disability, finding the applicant's testimony credible, supported by medical evidence. Defendants argued insufficient evidence for temporary disability, but the Board found no contrary evidence of substantial weight. The WCJ's findings on credibility and factual determinations were given great weight and were affirmed.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary Disability IndemnityWCJCredibility DeterminationsIndustrial InjuryContrary EvidenceAffirm DecisionScott Co. v. Workers' Comp. Appeals Bd.
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
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