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

Case No. ADJ8611746
Regular
Feb 27, 2017

VILMA AGUILAR vs. SLATKIN RESIDENCE, STATE FARM INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The defendant argued the administrative law judge erred in awarding 17% permanent disability by relying on the applicant's treating physician over a qualified medical evaluator. The Board found the treating physician's opinion was well-supported by objective clinical findings and consistent with the diagnosis of lumbar radiculopathy. Therefore, the Board gave significant weight to the administrative law judge's findings and denied the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityPrimary Treating PhysicianQualified Medical EvaluatorMedical OpinionCredibility DeterminationsSubstantial EvidenceLumbar Radiculopathy
References
8
Case No. MISSING
Regular Panel Decision
Nov 19, 1998

Claim of Escala v. Cecilware Corp.

The Workers’ Compensation Board's decision, filed November 19, 1998, which ruled that the claimant had a continuing causally related disability resulting from a work altercation on August 23, 1994, and was entitled to benefits post-February 12, 1996, was affirmed. Substantial evidence, including the treating physician Peta Carrera's diagnosis of lumbar radiculopathy and conclusion of total disability, supported the Board's finding. The Court found no abuse of discretion in precluding the testimony of the employer's physician, Robert Koval, due to his repeated non-appearances, despite the Board improperly considering Carrera’s recent medical reports. Conflicts in medical evidence were for the Board to resolve, and the argument concerning the claimant's prior unemployment benefits was rejected as they were received before the period at issue.

Causally Related DisabilityLumbar RadiculopathyCervical HerniationDisc BulgesMuscle SpasmsTreating Physician TestimonyMedical Evidence ConflictPreclusion of TestimonyUnemployment Insurance BenefitsAppellate Review
References
5
Case No. MISSING
Regular Panel Decision

Zenith Insurance Co. v. Ayala

Carmen Ayala sustained a lower back injury at work on January 28, 2006. Her initial diagnosis was later augmented to include lumbar radicular syndrome and L5-S1 spondylolisthesis (collectively, the "Lumbar Condition"). Zenith Insurance Company (Carrier) was notified of the injury on March 1, 2006, and despite having medical records of the Lumbar Condition by April 27, 2006, it did not dispute its compensability until July 28, 2006, 62 days after initial notice. A TWC hearing officer and appeals panel found that the Carrier waived its right to contest the compensability of the Lumbar Condition under Texas Labor Code Section 409.021 for failing to timely dispute it. The trial court granted summary judgment for Ayala, concluding the Carrier waived its right. The appellate court affirmed the trial court's judgment, rejecting the Carrier's argument that the Texas Administrative Code abrogates the waiver period for extent-of-injury disputes.

Workers' Compensation LawWaiver DoctrineCompensability DisputeLumbar SpondylolisthesisLumbar Radicular SyndromeTexas Labor CodeSummary Judgment AppealExtent of InjuryInsurance Carrier ObligationsTimely Dispute
References
7
Case No. ADJ11027267
Regular
Feb 03, 2023

LUIS ROSALES vs. IRELAND TILE AND STONE INC., SEDGWICK 14779 SAN DIEGO

This case involves an injured tile setter, Luis Rosales, who claimed lumbar radiculopathy stemming from an admitted industrial lumbar contusion. The Workers' Compensation Appeals Board denied reconsideration of a prior order, upholding a finding of 0% permanent disability. This decision was based on the Qualified Medical Examiner's (QME) reports, which the Board found to be substantial evidence. The Board specifically rejected the applicant's argument that the QME's opinions were inconsistent, clarifying that the QME found the sacral cyst unrelated to the lumbar contusion, not that the symptoms were unrelated to the cyst.

Petition for ReconsiderationQualified Medical ExaminerPQMEDr. Sonusupplemental reportsubstantial evidencelumbar contusionsacral cystradiculopathypermanent disability
References
2
Case No. 2019-03-0262
Regular Panel Decision
Mar 11, 2021

Mays, April v. Fast Pace Medical Clinic, PLLC

April Mays, an employee, fell at work and initially received treatment for her neck and cervical spine. She sought additional treatment for her lumbar and thoracic spine, which Fast Pace Medical Clinic, PLLC, denied. The Court reviewed conflicting medical opinions from Dr. Paul Johnson, the panel-selected physician, and Dr. C.M. Salekin, an independent medical examiner. Dr. Salekin diagnosed lumbosacral radiculopathy and probable rod displacement related to the fall, recommending further evaluation. The Court found Ms. Mays presented sufficient proof to rebut Dr. Johnson's causation opinion, which stated the lumbar and thoracic pain was unrelated to the work injury without detailed explanation. Therefore, the Court granted Ms. Mays's claim for the requested lumbar and thoracic MRIs and an orthopedic evaluation.

Workers' CompensationExpedited HearingMedical Treatment DenialCausation DisputeIndependent Medical Examination (IME)Pre-existing Condition AggravationLumbar Spine InjuryThoracic Spine InjuryCervical RadiculopathyOrthopedic Evaluation
References
1
Case No. ADJ10489999
Regular
Feb 01, 2019

Sean Lawson vs. Zenith Insurance Company

This case involves a dispute over the permanent disability rating for applicant Sean Lawson's low back injury. The defendant, Zenith Insurance Company, argues that the Range of Motion (ROM) method used by the Qualified Medical Evaluator (QME) was inappropriate, and the Diagnosis-Related Estimates (DRE) method should have been applied as there was only one level of radiculopathy. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's finding that the ROM method was appropriate based on the QME's expert opinion and the AMA Guides' provision for its use with multi-level involvement. However, one Commissioner dissented, believing the DRE method was mandated given the lack of evidence for multi-level radiculopathy.

WCABPetition for ReconsiderationPermanent DisabilityApportionmentNon-industrial factorsDiagnosis-Related Estimates (DRE) methodRange of Motion (ROM) methodQualified Medical Evaluator (QME)AMA GuidesMultilevel radiculopathy
References
1
Case No. 2018-06-0018
Regular Panel Decision
Jul 26, 2018

Coon, Gerald v. Commercial Warehouse and Cartage, Inc.

Gerald C. Coon, an employee, filed a request for temporary disability and medical benefits after an alleged back injury on September 22, 2017, due to a malfunctioning safety lanyard at Commercial Warehouse and Cartage, Inc. (CWC). Mr. Coon claimed continuous pain and denial of medical treatment by CWC. However, CWC witnesses testified Mr. Coon did not exhibit pain or request medical care until November 19, 2017. The Court found Mr. Coon's testimony not credible. Medical opinions varied, with Dr. Robert Carver, a panel physician, determining Mr. Coon's conditions (degenerative disc disease and lumbosacral radiculopathy) were not work-related. Dr. William M. Gavigan diagnosed a work-related lumbar strain but a non-work-related disc herniation. The Court credited Dr. Gavigan's opinion as most persuasive, confining the compensable injury to a lumbar strain, and found Mr. Coon unlikely to prevail on entitlement to additional medical treatment or temporary disability benefits, as no doctor took him off work for the strain. The Court, therefore, denied Mr. Coon's request for benefits.

Workers' CompensationBack InjuryLumbar StrainDegenerative Disc DiseaseLumbosacral RadiculopathyMedical CausationCredibility AssessmentExpedited HearingTemporary Disability BenefitsMedical Benefits
References
4
Case No. ADJ9506185
Regular
Jul 13, 2016

JIM NEWELL vs. COUNTY OF KERN

The Workers' Compensation Appeals Board denied the County of Kern's petition for reconsideration of an award to Jim Newell. The award was based on industrial cumulative trauma to the lumbar spine and hypertensive cardiovascular disease, including left ventricular hypertrophy (LVH). The County argued there was insufficient evidence of LVH and sought further medical development, specifically a cardiac MRI. The Board found that the existing medical evidence, including echocardiograms and expert testimony, constituted substantial evidence to support the LVH diagnosis, making further testing unnecessary.

Workers' Compensation Appeals BoardCounty of KernJim NewellSheriff's Sergeantcumulative traumalumbar spinecirculatory systemhypertensionhypertensive cardiovascular diseaseleft ventricular hypertrophy
References
2
Case No. ADJ14216452
Regular
Sep 12, 2025

JAIME VILLANUEVA vs. DALEY'S DRYWALL & TAPING, INC.; ARCH INSURANCE

Applicant Jaime Villanueva sought reconsideration of a June 16, 2025 decision that found 0% permanent disability based on a Qualified Medical Examiner's report. The Appeals Board found the QME's report by Dr. Bruce Huffer to be unsubstantial due to its conclusory nature, lack of reasoning, and failure to discuss pertinent medical records from other physicians. Consequently, the Board granted the petition, rescinded the original decision, and returned the matter for further proceedings to properly develop the medical record regarding the applicant's lumbar spine injury and claimed radiculopathy.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPanel Qualified Medical ExaminerPQMERadiculopathyPermanent DisabilityDRE Lumbar Category IIAMA GuidesSubstantial Evidence
References
9
Case No. MISSING
Regular Panel Decision

Claim of Reddien v. Joseph Davis Inc.

Claimant suffered work-related injuries to his back and left wrist in July 1999, with a schedule loss of use of his left hand determined in 2001. In 2011, claimant sought treatment for lumbar radiculopathy. The employer’s workers’ compensation carrier filed a request to transfer liability for the claim to the Special Fund for Reopened Cases pursuant to Workers’ Compensation Law § 25-a. The Workers’ Compensation Board denied the transfer, ruling the case was never truly closed because the issue of permanency for the back injury had not been addressed. The Appellate Division affirmed the Board's decision, finding substantial evidence that the case was not truly closed and thus Workers’ Compensation Law § 25-a was inapplicable.

Workers' CompensationSpecial FundReopened CasesSchedule Loss of UseLumbar RadiculopathyPermanent Partial DisabilityBoard DecisionAppellate ReviewCausally Related InjuryMedical Opinion
References
5
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