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Case Law Database

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

Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
Case No. ADJ9539091
Regular
Sep 23, 2016

MARY RAMSGARD vs. PACIFIC VINEYARD COMPANY, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board denied reconsideration, affirming the WCJ's finding that applicant's L3-4 back injury was not industrially caused, based on Dr. Sharma's opinion. Dr. Sharma's opinion was found to be substantial evidence, utilizing the correct legal standard of reasonable medical probability and supported by the applicant's pre-existing back issues. The Board also upheld the 20% apportionment of permanent disability to non-industrial causes, finding it supported by credible evidence, including prior medical reports and applicant's inconsistent testimony. Applicant's petition failed as her contentions regarding the medical opinion's legal theory and factual basis were not substantiated.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeApplicantDefendantPacific Vineyard CompanyInsurance Company of the WestPermanent DisabilityApportionment
References
10
Case No. ADJ8734628 ADJ9086734
Regular
Aug 12, 2016

PATRICIA CRUZ MALDONADO vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

This case involves White Memorial Medical Center's petition for reconsideration of a Joint Findings and Award finding that applicant Patricia Cruz Maldonado sustained lumbar spine injuries arising out of and occurring in the course of employment as a registered nurse. The defendant argued the findings were erroneous due to alleged inconsistencies in applicant's testimony and a lack of substantial medical evidence for a cumulative injury. The Workers' Compensation Appeals Board denied the petition, upholding the Administrative Law Judge's credibility determinations and finding substantial medical evidence, specifically from Dr. Edwin Haronian, supporting the cumulative trauma injury. The Board emphasized that the WCJ observed the witness and considered all admitted evidence, and that deposition testimony not offered into evidence could not be relied upon.

WCABPetition for ReconsiderationJoint Findings and AwardWCJcredibility determinationsubstantial medical evidencecumulative traumalumbar spineregistered nurseprimary treating physician
References
5
Case No. MISSING
Regular Panel Decision
Apr 14, 2017

Smith v. Berryhill

Ritchie Smith sought judicial review of the Commissioner of the Social Security Administration's decision denying him disability benefits, arguing the decision used incorrect legal standards and lacked substantial evidence regarding his ability to perform substantial gainful activity. The court examined extensive medical evidence from numerous physicians and Smith's own testimony concerning his physical and mental impairments. The hearing officer previously determined that despite severe impairments, Smith retained the residual functional capacity to perform sedentary work. The court affirmed the Commissioner's decision, concluding that the hearing officer applied the correct legal standards, and the findings, including the assessment of Smith's credibility and daily activities, were supported by substantial evidence in the record.

Disability Benefits AppealSocial Security Disability InsuranceSupplemental Security IncomeResidual Functional CapacityMedical OpinionsTreating Physician RuleClaimant CredibilitySedentary Work CapacityPhysical ImpairmentsMental Health Impairments
References
11
Case No. MISSING
Regular Panel Decision

Legal Aid Society v. Association of Legal Aid Attorneys

The Legal Aid Society sought a preliminary injunction against the Association of Legal Aid Attorneys and its officers to prevent the disciplining of striking union members who crossed picket lines. The plaintiff also claimed tortious interference and a civil rights conspiracy under 42 U.S.C. § 1985(3) on behalf of itself, non-striking attorneys, and indigent clients. The District Court denied the injunction, finding several impediments to success on the merits. These included the NLRB's primary jurisdiction, the Norris-LaGuardia Act's prohibitions, and the plaintiff's lack of standing for third-party claims. Furthermore, the court determined that the conspiracy allegations under Section 1985(3) were conclusory and lacked substantial merit.

Labor DisputePreliminary InjunctionUnion DisciplinePicket LinesNational Labor Relations Act (NLRA)Norris-LaGuardia ActStanding (Law)Conspiracy (Law)Civil Rights (42 U.S.C. § 1985(3))Tortious Interference
References
32
Case No. ADJ9556841
Regular
Aug 15, 2016

SOFIA RIOS vs. TULARE REGIONAL MEDICAL CENTER, ALPHA FUND

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of an award to Sofia Rios. The Board found that the Qualified Medical Evaluator did not engage in ex parte communication by sending a questionnaire and that his reports constituted substantial medical evidence. The employer's arguments that the doctor relied on personal anecdotes and an inaccurate assessment of lift team availability were rejected. The Board affirmed the original award based on the substantial evidence in the medical reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorEx Parte CommunicationSubstantial Medical EvidenceLabor Code Section 5909TollingReasonable Medical ProbabilityInadequate Medical HistoriesCausation Analysis
References
5
Case No. ADJ2337190 (LAO 0829672) ADJ3193895 (LAO 0829673) ADJ187762 (LAO 0829674)
Regular
Apr 21, 2009

OLIVIA HUERTA vs. GMP LABORATORIES, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, Dr. Elena Konstat, seeking reconsideration of a Workers' Compensation Appeals Board decision that limited reimbursement for her medical-legal reports. The Board found that the original decision erred in disallowing two of Dr. Konstat's three medical-legal reports. The Board clarified that the Official Medical Fee Schedule for treatment rates does not apply to medical-legal expenses, and the testimony of the defendant's lien negotiator was not substantial evidence. Consequently, the Board granted reconsideration, rescinded the original finding, and substituted a new finding allowing reimbursement for all three of Dr. Konstat's medical-legal reports, with the exact amounts, penalties, and interest to be determined.

Medical-legal lienReconsiderationFindings and AwardIndustrial injuryNervous system injuryPsycheLicensed clinical psychologistMedical-legal expensesOfficial Medical Fee Schedule (OMFS)Compromise and Release (C&R)
References
1
Case No. ADJ11645837
Regular
Dec 07, 2020

NAVIN RAZO vs. STATE OF CALIFORNIA, DEPARTMENT OF INSURANCE, Legally Uninsured, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant temporarily totally disabled. The defendant argued that the medical reports relied upon were not substantial evidence. The Board adopted the judge's report, which found the opinions of Drs. Hannani and Levine to be substantial evidence based on reasonable medical probability. These doctors were new treating physicians who assessed the applicant as temporarily totally disabled and in need of further treatment.

Petition for ReconsiderationDeniedSubstantial Medical EvidenceReasonable Medical ProbabilityTemporary Total DisabilityExpedited HearingQMEPrimary Treating PhysicianFibromyalgiaEczema
References
8
Case No. ADJ9073697
Regular
Aug 02, 2017

JOHN BRINER JR. vs. STATE OF CALIFORNIA, PELICAN BAY STATE PRISON, legally uninsured, STATE COMPENSATION INSURANCE FUND

This Workers' Compensation Appeals Board decision affirms a prior award finding applicant sustained injury to his right shoulder, left knee, and low back. The Board found the defendant failed to meet its burden of proof for apportionment of permanent disability, as the Agreed Medical Evaluator's opinions were not substantially supported by evidence and improperly addressed medical treatment rather than permanent disability. The Board also affirmed the finding that occupational group number 481 applied, based on substantial evidence of the applicant's diverse and physically demanding duties. Therefore, the original Findings and Award are affirmed in their entirety.

ApportionmentAgreed Medical EvaluatorPermanent DisabilityStationary EngineerOccupational Group NumberSubstantial EvidenceRight Shoulder InjuryLow Back InjuryLeft Knee InjuryReconsideration
References
13
Case No. ADJ18498378
Regular
Oct 27, 2025

MARIA VENEGAS vs. MARATHON PETROLEUM COMPANY, ACE AMERICAN INSURANCE

Lien claimant, Premier Psychological Services, sought reconsideration of a Findings and Order from July 30, 2025, which denied its lien for medical-legal and medical treatment expenses. The Workers' Compensation Appeals Board (WCAB) granted the petition for reconsideration, rescinded the original F&O, and returned the matter to the trial level for further proceedings. The Board found that the medical-legal expenses were incurred for a contested claim and that the medical report from Dr. Mark Michaels constituted substantial medical evidence for an injury arising out of and in the course of employment, despite some curable deficiencies regarding interpreter information. The WCAB ordered further consideration of the medical treatment expenses and a potential updated utilization review.

Premier Psychological ServicesAdjudication Number ADJ18498378Opinion and Order Granting Petition for ReconsiderationDecision After ReconsiderationLien ClaimantPrimary Treating Physician (PTP)Dr. Mark MichaelsInjury Arising Out of and In the Course of Employment (AOE/COE)PsycheMedical-Legal Report
References
21
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