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

Case No. ADJ10339693
Regular
Mar 16, 2019

CATHERINE WILSON vs. STOCKTON UNIFIED SCHOOL DISTRICT, YORK RISK SERVICES

The Workers' Compensation Appeals Board granted reconsideration to address the WCJ's decision regarding the applicant's industrial injury. The Board affirmed the finding of injury to the lumbar spine and the need for further medical treatment for that injury. However, all other issues, including injury to the shoulders and thoracic spine and the determination of permanent disability, were deferred due to the WCJ's inadequate explanation and analysis. Further proceedings are required to develop the record and clarify disputed medical opinions before a final decision on all issues can be made.

WCABPetition for ReconsiderationFindings of FactAward and OrdersIndustrial InjuryLumbar SpineThoracic SpineShouldersTemporary DisabilityPermanent Disability
References
Case No. ADJ7558401
Regular
May 28, 2013

ROBERT RICE vs. PROCUT, LLC, ZENITH INSURANCE COMPANY

The WCAB granted reconsideration to address the defendant's challenge to the 45% permanent disability award. The defendant argued the Qualified Medical Evaluator's (PQME) opinion was unsubstantiated, particularly regarding the lumbar spine rating and the inclusion of pain impairment. The WCAB found the PQME's reports lacked sufficient rationale and explanation, failing to adequately justify the Almaraz-Guzman rating. Consequently, the WCAB rescinded the award and returned the case for further medical record development.

Workers' Compensation Appeals BoardProCut LLCZenith Insurance CompanyRobert Ricepermanent disabilityqualified medical evaluatorPQMEDr. Sanjay Chauhanwhole person impairmentAMA Guides
References
Case No. ADJ450513 (GOL 0098571)
Regular
Mar 11, 2011

MONICA LEDESMA vs. FIRESTONE VINEYARD, STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration of the WCJ's award, finding the physician's permanent disability opinion lacked substantial evidence. Specifically, Dr. Scheinberg failed to adequately explain his shift in impairment rating from Category II to Table 6-9, which addresses herniation, without providing sufficient justification. Consequently, the Board rescinded the award and returned the case to the trial level for further proceedings to ensure the decision is based on substantial medical evidence. The WCJ may also address the defendant's other contentions, including temporary disability offset.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLumbar SpineSleep DisorderTemporary DisabilityPermanent DisabilitySubstantial EvidenceAMA Guides
References
Case No. AD10769216
Regular
Dec 13, 2019

Richard Hovannisian vs. UCLA, Permissibly Self-Insured, Administered By SEDGWICK CMS

The WCAB granted reconsideration and deferred issues of lumbar spine injury and permanent disability from a prior award. The WCJ's decision relied on a QME report that failed to establish industrial causation for the lumbar spine injury and lacked sufficient explanation for departing from AMA Guides methodology for permanent disability ratings. The Board found these deficiencies meant the decision was not based on substantial medical evidence. Further proceedings are required for the QME to adequately address causation, rating methodology, and lumbar spine classification.

WCABPetition for ReconsiderationFindings of Fact & Awardindustrial injurylumbar spinepermanent disabilitysubstantial medical evidencedue processDisability Evaluation Unitpanel qualified medical evaluator
References
Case No. ADJ10551600
Regular
Mar 02, 2018

JOSE TORRES vs. COUNTY OF STANISLAUS, YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration because the primary treating physician's opinion, which formed the basis of the award, was not supported by substantial evidence. The physician's impairment ratings for the applicant's neck and back were based on outdated strength testing results from 1.5 years prior to his report and conflicted with more recent findings. The Board found the physician's examination inadequate, thus rescinding the award and remanding the case for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Award OpinionPermanent Disability RatingSubstantial EvidencePrimary Treating PhysicianQualified Medical EvaluatorJamar TestingOutdated Testing ResultsInadequate Examination
References
Case No. ADJ7669411
Regular
Jul 23, 2013

OSCAR HUERTA vs. HIGGINS & LOVETT CONSTRUCTION, TOWER SELECT INSURANCE CO.

This case involves a workers' compensation claim for a laborer injured on November 2, 2010, to his neck and back. The defendant disputes the finding of 51% permanent disability, primarily arguing that the panel qualified medical evaluator's (PQME) report was not substantial evidence. The Appeals Board has granted reconsideration to further review the PQME's lumbar impairment rating, specifically questioning whether "non-verifiable radicular complaints" sufficiently supported the DRE Category III rating. The Board has rescinded the prior award and returned the case for further development of the record.

Occupational Group 480Panel Qualified Medical Evaluator (PQME)Dr. DawdyDRE Category IIIRadiculopathyLumbar ImpairmentSubstantial Medical EvidenceFurther Development of the RecordAmended Findings and AwardLumbar Spine
References
Case No. ADJ10679103
Regular
Dec 14, 2017

LARRY SYKES vs. THE ANSCHUTZ CORPORATION, STARR INDEMNITY & LIABILITY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior finding of industrial injury to the applicant's lumbar spine. The Board found that the existing medical reporting from Dr. Hong, Dr. Jamasbi, and the PQME Dr. Schofferman did not constitute substantial evidence to support this lumbar spine injury finding. Therefore, the case is returned to the trial level to develop the record further on the lumbar spine injury issue.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryCervical SpineThoracic SpineLumbar SpineStagehandSecurity OfficerMedical Treatment RecordsSubstantial Evidence
References
Case No. ADJ10612927
Regular
Jul 30, 2018

ROBERT O'NEAL vs. MARTEN TRANSPORT LIMITED, ACE AMERICAN INSURANCE COMPANY, CANNON COCHRAN MANAGEMENT SERVICES, INCORPORATED

The Workers' Compensation Appeals Board denied Marten Transport's petition for reconsideration. The Board affirmed the finding of industrial injury to the applicant's neck and lumbar spine, based on medical evidence of immediate complaints and the doctor's opinion of causation. The Board also upheld the denial of apportionment, as no reporting physician found a basis for it and the defendant failed to prove apportionment despite opportunities. The original award included temporary and permanent disability, plus further medical treatment.

Workers' Compensation Appeals BoardMarten Transport LimitedAce American Insurance CompanyCannon Cochran Management Servicesindustrial injuryneck injurylumbar spine injurytemporary disabilitypermanent disabilityapportionment
References
Case No. ADJ8413521
Regular
Apr 13, 2020

STEVEN KING vs. COUNTY OF SAN BERNARDINO

This Workers' Compensation Appeals Board case involves applicant Steven King's claims for injury arising out of and occurring in the course of employment, including bilateral shoulders, lumbar spine, cardiac system, hernia, skin disorder, hearing loss, and hypertension. The Board affirmed the finding of injury AOE/COE and the hypertension rating but remanded the case for further development of the record regarding the applicant's lumbar spine impairment. The administrative law judge's prior rejection of the Agreed Medical Examiner's (AME) supplemental opinion on lumbar spine disability was deemed an improper disregard of substantial medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings and Awardinjury arising out of and occurring in the course of employmentbilateral shoulderslumbar spinecardiac systemherniaskin disorderhearing loss
References
Case No. ADJ11065177
Regular
Apr 09, 2019

FRANK ROMANO vs. PROVIDENCE HEALTH AND SERVICES, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior award that found 4% permanent disability. The Board found the orthopedist's apportionment of lumbar spine impairment to nonindustrial daily activities to be unsubstantiated. Specifically, the doctor could not identify specific nonindustrial activities causing impairment or link them to the found impairment. Therefore, the Board awarded an unapportioned 7% permanent disability for the applicant's industrial lumbar spine injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanent DisabilityApportionmentSubstantial Medical EvidenceMedical OpinionLumbar Spine DRE Category IIWhole Person ImpairmentAMA GuidesMuscle Spasm
References
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