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

Case No. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
Case No. MISSING
Regular Panel Decision
Sep 04, 2013

Matter of Madigan v. ARR ELS

In 1994, the claimant sustained a low back injury during employment as a machinist, leading to workers' compensation benefits. Liability for the case was transferred to the Special Fund for Reopened Cases in 2003. Due to poor surgical outcomes, the claimant has been on pain medication, including oxycontin, since at least 2007, with doses escalating. A consultant for the Special Fund questioned the necessity of the increased medication, prompting a hearing. A Workers’ Compensation Law Judge ruled that the pain medications should continue, with the Special Fund covering the costs, until new Board guidelines or physician recommendations advised otherwise. The Workers’ Compensation Board affirmed this decision, citing that their Medical Treatment Guidelines for chronic pain were still in draft form at the time. The appellate court subsequently affirmed the Board's decision, noting that the guidelines were not yet in effect at the time of the Board's ruling and that the Board's interim guidance was rational.

Workers' CompensationPain ManagementOpioid PrescriptionsMedical Treatment GuidelinesSpecial FundReopened CasesLumbar InjuryOxycontinAppellate ReviewAdministrative Law
References
4
Case No. MISSING
Regular Panel Decision

Claim of Stewart v. P & C Food Markets, Inc.

A claimant, who worked as a cashier, developed persistent leg and hip pain diagnosed as a slipped femoral epiphysis requiring surgery in August 1990. Following surgery, he allegedly developed chronic low back pain and filed for workers' compensation benefits. While surgeons opined that neither the slipped hip nor back pain were work-related, chiropractors testified otherwise. The Workers’ Compensation Board ruled in the claimant's favor, finding a causal relationship for both conditions. The employer and its insurer appealed, raising an issue about the chiropractors' qualifications which was deemed not properly preserved. The Appellate Division affirmed the Board's decision, finding substantial evidence for the causal relationship.

Workers' CompensationCausal RelationshipSlipped Femoral EpiphysisBack PainChiropractor TestimonyMedical Expert QualificationSubstantial EvidenceAppellate ReviewEmployer AppealInsurance Carrier
References
4
Case No. ADJ9176582
Regular
Feb 21, 2020

MARIA MORENO vs. GARROUTTE FARMS, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding applicant sustained industrial injury to her left shoulder, left wrist, left hip, and low back, causing temporary and permanent disability. While the Board denied the defendant's petition regarding the low back injury and temporary disability, it deferred the issue of the permanent disability rating. This deferral includes a potential increase to the whole person impairment for pain, which will be determined at the trial level after further hearing. The Board confirmed an award for additional temporary total disability and further medical treatment.

ADJ9176582Petition for ReconsiderationFindings Award and OrderIndustrial InjuryLeft ShoulderLeft WristLeft HipLow BackTemporary DisabilityPermanent Disability
References
2
Case No. MISSING
Regular Panel Decision

Claim of Di Simone v. Underwriters Adjusting Co.

The claimant, an insurance adjustor, sustained a low back injury in 1971. After initial recovery, he experienced recurrent pain, culminating in 1977 with severe back pain requiring laminectomy and fusion surgery. The Workers’ Compensation Board determined a direct causal link between the 1971 accident and the 1977 disability, rejecting a referee’s finding of a new accident in 1977. The Board’s decision relied on Dr. Wilson’s testimony, which characterized the 1977 issues as recurrences of the 1971 injury. The appellate court affirmed the Board's decision, finding it supported by substantial evidence and noting the Board’s authority to resolve conflicts in medical testimony.

Recurrent injuryPrior injury exacerbationWorkers' compensation claimLow back injuryLaminectomy and fusionCausation disputeMedical opinion conflictSubstantial evidenceAppellate reviewBoard decision affirmed
References
2
Case No. 533203
Regular Panel Decision
Oct 06, 2022

Matter of Cotterell v. Trinity Health Corp.

Claimant, Meggan Cotterell, sustained a lower back injury in 2015 while working for Trinity Health Corporation. Later, a right hip injury was found to be causally-related to the original work injury. The employer and carrier argued the hip injury claim was untimely under Workers' Compensation Law § 28, which mandates claims be filed within two years of the accident. The Workers' Compensation Board affirmed the claim amendment, crediting the treating orthopedist's testimony that initial hip pain was confused with low back symptoms and the hip labral tear was diagnosed later. The Appellate Division affirmed the Board's decision, finding that medical reports indicating hip pain filed within two years, coupled with the delayed diagnosis, provided substantial evidence to support the Board's determination that the amendment was not time-barred.

Workers' CompensationHip InjuryLabral TearTimelinessWorkers' Compensation Law § 28CausationMedical EvidenceOrthopedist TestimonyAppellate ReviewBoard Decision
References
7
Case No. SAC 0342537, SAC 0365636
Regular
Aug 04, 2008

JUDY HAMILTON vs. PLACER COUNTY WATER AGENCY, DISCOVER PROPERTY & CASUALTY, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, finding the WCJ inadvertently omitted a finding of industrial injury to the applicant's low back within the cumulative trauma. While upholding the denial of a specific low back injury claim, the Board corrected the cumulative trauma finding to include the low back. Furthermore, the Board removed the 50% apportionment of permanent disability for the low back due to insufficient medical evidence, ultimately increasing the applicant's permanent disability award.

Cumulative TraumaApportionmentCausationPermanent DisabilityLabor Code Section 4663Dr. YashrutiDr. GlanczWCJPetition for ReconsiderationFindings and Award
References
4
Case No. MISSING
Regular Panel Decision

Claim of Wiltsie v. Owens Corning Fiberglass

Claimant suffered a compensable low back injury in 1995, continuing work with restrictions and ADA accommodations. In 2003, the employer's decision to change his shift caused claimant stress, leading his primary physician to diagnose chest pain syndrome, agoraphobia, and depression, and advise him to stop working. Initially awarded benefits for a period, the Workers’ Compensation Board subsequently denied further benefits, concluding that claimant's departure from work was for reasons unrelated to his back disability. Claimant appealed, contending his back injury prevented him from the new shift, but the Board's determination, supported by other evidence, found he left due to stress from the shift dispute rather than his back condition. The Board's decision, which included an assessment of claimant's testimony and medical evidence, was affirmed, as it was supported by credible evidence.

Low Back InjuryAmericans with Disabilities Act (ADA)Workplace AccommodationShift Schedule ChangeStress-Related IllnessChest Pain SyndromeAgoraphobiaDepression DiagnosisCredibility of Medical OpinionPermanent Partial Disability
References
5
Case No. MISSING
Regular Panel Decision
Aug 16, 2000

Thompson v. Port Authority of New York & New Jersey

The Supreme Court, New York County, affirmed a judgment denying damages for future pain and suffering and loss of consortium to a construction worker and his wife following a personal injury suit. The jury found insufficient persuasive medical evidence to corroborate the plaintiff's subjective complaints of persistent headaches, low back pain, and sexual dysfunction. Evidence showed the plaintiff had not maintained a continuous course of treatment and had a pre-existing degenerative spinal disease. While the plaintiff was awarded damages for future loss of earnings due to disability from strenuous work, his claims for ongoing pain and sexual dysfunction were deemed incredible or unrelated to the accident. The court also upheld the trial court's charge on the plaintiff's duty to mitigate damages by seeking vocational rehabilitation, given the credibility issues surrounding his ability to work.

Personal InjuryConstruction AccidentFuture Pain and SufferingLoss of ConsortiumMedical EvidenceCredibility AssessmentMitigation of DamagesVocational RehabilitationPre-existing ConditionJury Verdict
References
3
Case No. MISSING
Regular Panel Decision

Gibson v. Barnhart

Plaintiff Bonnie L. Gibson sought Social Security Disability Insurance (SSDI) benefits after injuring her back in 1993, alleging various disabling conditions like cervical cancer, osteoarthritis, low back pain, and degenerative disc disease. Her applications were denied both initially and on reconsideration, and subsequently by an Administrative Law Judge (ALJ). Following the Appeals Council's denial of her request for review, Gibson commenced this action to challenge the Commissioner of Social Security's final determination. The court found that the ALJ failed in his affirmative obligation to develop the administrative record, noting significant gaps in the plaintiff's medical treatment records from 1994 to 1998 and the absence of her workers' compensation files. Due to this incomplete record, the court could not make a determination regarding her disability status. Therefore, the court denied the Commissioner's motion for judgment on the pleadings and granted the plaintiff's motion for remand, sending the case back for further development of the administrative record.

SSDISocial SecurityDisability BenefitsAdministrative RecordRemandALJMedical EvidenceWorkers' CompensationBack InjuryOsteoarthritis
References
8
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