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

Case No. ADJ237483
Regular
Nov 13, 2012

RAYEK J. FAHOUM vs. KAISER FOUNDATION HOSPITAL

The Workers' Compensation Appeals Board denied Rayek J. Fahoum's petition for reconsideration, upholding the findings of the Workers' Compensation Judge. The Judge's report found Fahoum sustained industrial injury to his neck and low back with secondary chronic pain syndrome, awarding 41% permanent disability. This decision relied on the opinions of the Agreed Medical Examiner and Dr. Renee Rinaldi, who concluded Fahoum experienced symptom magnification and that his condition was chronic pain syndrome, not fibromyalgia as claimed by Dr. Allen Salick. The Board extended great weight to the Judge's credibility findings regarding the medical opinions.

Workers' Compensation Appeals BoardReconsideration DeniedAgreed Medical ExaminerSubstantial Medical EvidenceFibromyalgiaChronic Pain SyndromeSymptom MagnificationOrthopedic InjuryLumbosacral StrainCervical Strain
References
Case No. FRE 0219842
Regular
Mar 11, 2008

ELBEY LONERO vs. MERCED TRANSPORTATION, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) reversed an administrative law judge's decision regarding the applicant's temporary disability end date, finding it should be March 24, 2005, based on an agreed medical evaluator's opinion. The WCAB affirmed the use of the 1997 Permanent Disability Rating Schedule, finding that a treating physician's pre-2005 report indicated permanent disability. Finally, despite the adjusted temporary disability period, the defendant was denied credit for overpayments, as the applicant acted in good faith and the payments were continued after receiving the AME's report.

WORKERS' COMPENSATION APPEALS BOARDELBEY LONEROMERCED TRANSPORTATIONINC.STATE COMPENSATION INSURANCE FUNDCase No. FRE 0219842OPINION AND DECISION AFTER RECONSIDERATIONbus driverindustrial injurylow back
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ12182074
Regular
Jan 30, 2023

JUSTIN HAMILTON vs. SACRAMENTO REGIONAL TRANSIT

The Appeals Board rescinded a WCJ's take-nothing order and returned the case to the trial level for further proceedings. The Board found that the Agreed Medical Evaluator (AME), Dr. Campbell, needs to supplement his opinion on industrial injury causation given the WCJ's credibility finding against the applicant. Additionally, the WCJ must consider the applicant's alleged criminal conviction for workers' compensation fraud, if proven, and provide the AME with any conviction details for review. The Board emphasized that it expresses no final opinion on the injury's existence or compensability.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuryAgreed Medical EvaluatorCriminal ConvictionWorkers' Compensation FraudMedical OpinionCredibilityDiscoveryRescinded
References
Case No. ADJ3776077 (ANA 0409837) ADJ1854171 (ANA 0409862) ADJ310640 (ANA 0409836)
Regular
Sep 08, 2009

MARIA O'CAMPO vs. MICHAEL D. COOPER, D.D.S., INC.; STATE FARM FIRE AND CASUALTY COMPANY

This case involves applicant Maria O'Campo's petition for reconsideration of findings regarding industrial injuries to her knee, spine, and upper extremities. The Workers' Compensation Appeals Board denied reconsideration, affirming the WCJ's decision that applicant sustained industrial injuries but awarding only 2% permanent disability for upper extremity injuries, finding no permanent disability for the knee and spine. The WCJ properly relied on substantial medical evidence, particularly Dr. Mandel's reports, and found Dr. Einbund's report to be unreliable due to an apparent misinterpretation of an MRI. The Appeals Board found no requirement to further develop the record, as applicant failed to request it and the existing evidence supported the WCJ's findings.

Workers' Compensation Appeals BoardIndustrial InjuryFindings and AwardsPetition for ReconsiderationQualified Medical ExaminerCumulative TraumaSpecific InjuryPermanent DisabilityMedical EvidenceRecord Development
References
Case No. ADJ1997686 (MON 0358806)
Regular
May 24, 2011

JAVIER GUTIERREZ vs. COOPER INDUSTRIES, INC., ACE AMERICAN INSURANCE COMPANY

The Appeals Board reversed the WCJ's award of 16% permanent disability for a neck injury. Dr. Brickman's report, which supported the award, was deemed unsubstantial as it relied on an incorrect medical history and erroneous legal theory regarding the cause of the applicant's sleep disturbance. The Board found that the applicant's sleep issues stemmed from a non-compensable psychological condition, not neck pain. Consequently, the Board adopted the opinion of PQME Dr. Portnoff, who concluded the applicant sustained a cervical strain with no resulting permanent disability.

Workers' Compensation Appeals BoardEAMS processing delayFindings and Awardindustrial injuryneck injuryassemblertemporary disabilitypermanent disabilityself-procured careAMA Guides
References
Case No. ADJ8217072
Regular
Nov 06, 2013

SANDRA MILLER vs. ABC UNIFIED SCHOOL DISTRICT, KEENAN \& ASSOCIATES

The applicant, Sandra Miller, sought temporary disability benefits following a bus accident. The defendants contested her entitlement, arguing insufficient medical evidence of disability and lack of lost wages. The Appeals Board modified the original award, finding that based on her primary treating physician's reports, Miller was entitled to temporary disability indemnity benefits only from March 26, 2012, to June 20, 2012. The Board rejected entitlement for earlier periods due to a lack of substantial medical evidence supporting disability claims prior to Dr. Barri's reports. The case was returned to the trial level with this amended finding.

Workers' Compensation Appeals BoardReconsiderationTemporary Disability IndemnityPrimary Treating PhysicianMedical OpinionSubstantial EvidenceLost WagesSummer MonthsRetirementMotor Vehicle Accident
References
Case No. ADJ3740744
Regular
Oct 01, 2008

VREG MATEVOSIAN vs. DELUXE LABORATORIES, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns the denial of a petition for reconsideration by Deluxe Laboratories and Liberty Mutual Insurance Company, who sought to dismiss an applicant's petition to reopen for new and further disability. The Appeals Board affirmed the WCJ's decision, finding the applicant's petition adequately pleaded new and further disability based on medical evidence of increased permanent disability due to the progression of his industrial injury. The Board emphasized that their focus was on the sufficiency of the pleadings, not the ultimate merits of the applicant's claim for additional benefits.

Petition to ReopenNew and Further DisabilityWCAB Rule 10458Stipulated AwardAgreed Medical ExaminerPermanent DisabilityLumbosacral SpineIndustrial InjuryFive Year Limitation PeriodPetition to Dismiss
References
Case No. ADJ3622683 (EUR 0039238)
Regular
Aug 08, 2011

JOSEPH VASSEL vs. SUNSHINE GARDENING SERVICE, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn a prior award concerning his 2003 back and neck injury. The Board adopted the Administrative Law Judge's report, which found that the applicant's neck complaints were unrelated to the injury and that the apportionment of disability was consistent with current law. The denial also addressed the applicant's arguments regarding the necessity of chiropractic treatment and medical evidence.

Workers' Compensation Appeals BoardSunshine Gardening ServiceZenith Insurance CompanyJoseph VasselPetition for ReconsiderationOrder Denying ReconsiderationLabor Code § 5909Due ProcessFindings and AwardPermanent Partial Disability
References
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