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

Case No. ADJ8103143
Regular
Dec 04, 2015

CHUONG VO vs. ZONARE MEDICAL SYSTEMS, INC., ONE BEACON INSURANCE COMPANY

This case involves a defendant seeking reconsideration of an order enforcing an Independent Medical Review (IMR) determination that authorized applicant's requested cervical surgery. The defendant argued a subsequent conflicting IMR determination, the WCJ's lack of jurisdiction, and an improper physician signature on the initial request voided the original IMR. The Appeals Board denied reconsideration, finding that a later IMR does not negate a prior one, the WCJ had jurisdiction to enforce the IMR, and the defendant waived the physician signature argument by proceeding with utilization review.

Independent Medical ReviewUtilization ReviewPetition for ReconsiderationLabor Code section 4610Labor Code section 4610.5anterior cervical decompression and fusionposterior cervical decompression and fusionmedical necessitywaived argumentsecondary treating physician
References
Case No. SAL 0107786
Regular
Oct 16, 2007

MOLLY KIRKPATRICK vs. DOMINICAN SANTA CRUZ HOSPITAL, PSI ADMINISTERED BY OCTAGON RISK SERVICES

This case concerns an injured worker who had cervical spine surgery involving diskectomy, vertebrectomy, decompression, and fusion. The defendant sought reconsideration of an award granting temporary disability benefits beyond the statutory 104-week limit, arguing the surgery was not an amputation. The Appeals Board rescinded the prior award and returned the matter for further proceedings, as the definition of "amputation" in precedent excludes internal body parts like those removed during spinal fusion.

Workers' Compensation Appeals BoardDominican Santa Cruz HospitalOctagon Risk ServicesMolly KirkpatrickIndustrial InjuryCervical Spine SurgeryTemporary Disability IndemnityLabor Code Section 4656(c)AmputationDiskectomy
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. ADJ351902 (OAK 310455) ADJ2725303 (OAK 324531)
Regular
Sep 30, 2008

PHILMORE KING vs. RANEY GEO TECHNICAL, ST. PAUL FIRE & MARINE INSURANCE COMPANY

The WCAB affirmed the WCJ's decision to apply the 1997 disability rating schedule because a treating physician's report indicated permanent disability before January 1, 2005, despite not stating the condition was permanent and stationary.

Workers' Compensation Appeals BoardPhilmore KingRaney Geo TechnicalSt. Paul Fire & Marine Insurance CompanyOpinion and Decision After ReconsiderationFindings Award & OrderWorkers' Compensation Administrative Law JudgeWCJIndustrial InjurySpine Injury
References
Case No. ADJ3843514
Regular
Sep 15, 2008

Ramona J. Ornelas vs. COUNTY OF SACRAMENTO

Reconsideration granted to address errors in permanent disability rating and apportionment. Matter returned for new rating considering walker use and clarifying apportionment.

RAMONA J. ORNELASCOUNTY OF SACRAMENTOADJ3843514SAC 0274104OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONLEFT MINOR SHOULDERLEFT MINOR WRISTBILATERAL KNEESPSYCHE
References
Case No. ADJ1075679
Regular
Oct 14, 2008

AMALIA CARDENAS, CARDENAZ, AMALIA-CARDENAS DE ACOSTA vs. KANSTUL MUSICAL INSTRUMENTS, TRUCK INSURANCE EXCANGE, CLARENDON INSURANCE COMPANY

This case concerns a defendant's petition for reconsideration of a workers' compensation award. The Appeals Board denied the petition, affirming the finding that the applicant sustained industrial injuries and is entitled to temporary total disability (TTD) indemnity from August 1, 2006, to January 27, 2008. The Board found sufficient evidence, including the treating physician's reports and applicant's testimony, to support the need for surgery and the resulting TTD period, despite the Agreed Medical Evaluator's later confirmation of the surgical necessity.

Workers Compensation Appeals BoardKanstul Musical InstrumentsTruck Insurance ExchangeClarendon Insurance CompanyAmalia CardenasReconsiderationFindings and AwardIndustrial InjuryNeck InjuryUpper Extremities Injury
References
Case No. ADJ3582743 (STK 0215397)
Regular
Apr 11, 2014

KERI LARSEN vs. MODESTO IRRIGATION DISTRICT

This case concerns defendant Modesto Irrigation District's petition for reconsideration of a workers' compensation award. The Workers' Compensation Appeals Board granted reconsideration, finding the administrative law judge erred in using an incorrect impairment number for calculating permanent disability. The Board amended the award to reflect an 18% permanent disability rating, based on the agreed medical evaluator's opinion regarding lateral epicondylitis and decreased grip, not nerve entrapment. The Board also corrected the finding for future medical treatment to the right arm and elbow, aligning with the amended disability rating.

Workers' Compensation Appeals BoardModesto Irrigation DistrictKerri Larsenpermanent disability ratingAMA GuidesAlmarez-Guzmanstraight ratingReport And Recommendation On Petition For ReconsiderationAgreed Medical EvaluatorAME
References
Case No. ADJ10958168
Regular
Apr 09, 2019

LYN SAMUEL JEFFERS vs. GLENDALE ADVENTIST MEDICAL CENTER, ADVENTIST HEALTH

This case involves a worker's compensation applicant who claimed her left knee injury occurred when she fainted at work on February 8, 2017. Medical reports from her treating physicians documented acute left knee pain, a torn lateral meniscus, degenerative changes, and temporary total disability following the incident. The Workers' Compensation Appeals Board found the applicant's testimony credible, supported by medical evidence, and determined the injury arose out of and occurred in the course of employment. Therefore, the employer's petition for reconsideration was denied.

AOE/COEPrimary Treating PhysicianTemporary Total DisabilityPreponderance of the EvidenceSubstantial EvidenceWCJ CredibilityPetition for ReconsiderationLateral Meniscus TearDegenerative ChangesChondromalacia
References
Case No. ADJ3692050
Regular
Mar 11, 2011

STEVEN HAULENBECK vs. CITY OF ANAHEIM

This case concerns an applicant seeking reconsideration of a denial for lumbar spinal decompression therapy. The Appeals Board previously reversed a WCJ's award of this treatment, finding the applicant failed to follow proper utilization review (UR) and dispute resolution procedures. Although the applicant argued that the prior decision incorrectly applied a statute not applicable to pre-2005 injuries, the Board denied reconsideration. The Board determined that even under the applicable pre-2005 law, the applicant failed to timely object to the UR denial and initiate the required dispute resolution process. Therefore, the requested medical treatment was not authorized.

Workers' Compensation Appeals BoardPetition for ReconsiderationLumbar spinal decompression therapyIndustrial injuryKnee injuryPolice officerPermanent disabilityCompensable consequenceUtilization reviewLabor Code section 4062.2
References
Case No. ADJ6552734
Regular
Apr 02, 2015

Diane Garibay-Jimenez vs. Santa Barbara Medical Foundation Clinic, Zurich American Insurance

This case concerns a denied request for left ulnar nerve decompression surgery. The Administrative Law Judge (WCJ) upheld the denial, finding the applicant failed to provide necessary Agreed Medical Examiner (AME) reports to the Independent Medical Review (IMR), making a further review unreasonable. However, the Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding the WCJ's order. The WCAB found the defendant failed to comply with Labor Code section 4610.5(l) by not providing all relevant medical records to IMR, thus invalidating the prior IMR determination. The matter was returned for a new IMR application, holding the defendant responsible for submitting complete records.

Workers' Compensation Appeals BoardDiane Garibay-JimenezSanta Barbara Medical Foundation ClinicZurich American InsuranceADJ6552734Opinion and Order Granting Petition for ReconsiderationExpedited Findings of Fact and OrderAdministrative Law JudgeIndependent Medical ReviewUtilization Review
References
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