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

Case No. ADJ17092437
Regular
Jul 01, 2025

Vince Miller vs. Automobile Club of Southern California, Old Republic Insurance

Defendant sought reconsideration of an Amended Findings of Fact and Order (F&O) that found the applicant had not reached maximum medical improvement (MMI) and was entitled to retroactive temporary disability benefits. The defendant contended a lack of substantial medical evidence for the MMI status and temporary disability, arguing for reliance on the qualified medical evaluator's (QME) report. The Workers' Compensation Appeals Board reviewed the petition and the WCJ's report. The Board ultimately granted the Petition for Reconsideration, rescinded the F&O, and returned the matter to the WCJ for further proceedings to determine if disputed body parts were due to industrial injury before reassessing MMI or temporary disability.

Workers' Compensation Appeals BoardMaximum Medical ImprovementTemporary Total DisabilityPetition for ReconsiderationQualified Medical EvaluatorSubstantial Medical EvidenceFindings of Fact and OrderRescindedReturned to Trial LevelLabor Code Section 5909
References
5
Case No. ADJ926004 (MON 0350313)
Regular
Nov 26, 2012

PAULENE THOMSON vs. SOUTHERN KERN UNIFIED SCHOOL DISTRICT, SELF-INSURED SCHOOLS OF CALIFORNIA

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of a prior award. The original award found the applicant reached maximum medical improvement (MMI) on January 7, 2008, entitling her to increased benefits. The defendant argued this MMI date was incorrect and contradicted by Agreed Medical Evaluator reports. The Board amended the award to defer the MMI date issue, allowing parties to adjust it, and returned the case for further proceedings.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMaximum Medical Improvement (MMI)Labor Code Section 4658Agreed Medical Evaluator (AME)Permanent Disability IndemnityTemporary Disability IndemnityStipulationsPermanent and Stationary Date
References
1
Case No. CV-23-1451
Regular Panel Decision
Nov 07, 2024

Matter of Amato v. Patchogue Supermarkets LLC

Domenico Amato, a claimant, sustained work-related injuries to his bilateral shoulders and biceps in May 2019, leading to two arthroscopic surgeries. Following these, medical evaluations for permanency by two orthopedic specialists, Frank Hudak and Lee Kupersmith, yielded differing schedule loss of use (SLU) percentages for Amato's arms. A Workers' Compensation Law Judge initially found a bilateral 42.5% SLU. However, the Workers' Compensation Board subsequently rejected both physicians' permanency opinions, deeming them unreliable due to inconsistent range of motion (ROM) measurements. Instead, the Board relied on earlier ROM measurements from Dr. Kupersmith, taken before Amato reached maximum medical improvement (MMI), to determine a 20% SLU for each arm. Amato appealed this decision. The Appellate Division, Third Department, modified the Board's decision, finding that it was improper for the Board to determine SLU percentages based on premature medical reports that did not confirm MMI or adhere to proper ROM measurement guidelines. Consequently, the matter was remitted to the Workers' Compensation Board for further consideration.

Workers' CompensationSchedule Loss of UseMaximum Medical ImprovementRange of MotionAppellate DivisionThird DepartmentMedical EvidenceBoard ReviewRemittalOrthopedic Surgery
References
8
Case No. ADJ11409956
Regular
Jun 17, 2019

OSCAR FLORES vs. ETS EXPRESS, INC.

The Workers' Compensation Appeals Board denied ETS Express, Inc.'s petition for reconsideration of an award of temporary disability benefits. The employer argued the applicant was not entitled to benefits because he refused modified work and had reached maximum medical improvement (MMI). The Board found that the medical report relied upon by the defendant was not conclusive on MMI, as it indicated potential future interventional treatment. Therefore, the Board adopted the WCJ's finding that the applicant sustained an industrial injury and is entitled to ongoing temporary disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardTemporary Disability IndemnityMaximal Medical ImprovementPanel Qualified Medical ExaminerPQMEInterventional TreatmentCervical Epidural InjectionsAnterior Cervical Discectomy
References
0
Case No. 2025 NY Slip Op 03610
Regular Panel Decision
Jun 12, 2025

Matter of Quoma v. Bob's Discount Furniture

The Appellate Division, Third Department, heard an appeal from Joseph Quoma challenging decisions by the Workers' Compensation Board regarding credits for temporary disability payments and the application of the safety valve provision under Workers' Compensation Law § 15 (3) (w). The court affirmed that the carrier's credit against maximum benefits for payments beyond 130 weeks from the accident date is a strict time measurement, not dependent on 130 weeks of prior payments. However, the court reversed and remitted the Board's amended decision regarding the safety valve provision, finding that the Board erred by solely considering the absence of a specific form (C-4.3) and failing to consider other medical evidence, such as preauthorized surgery, when determining if the claimant had reached maximum medical improvement (MMI). The case was remitted for a new determination consistent with the court's decision on the safety valve factors.

Workers' Compensation LawTemporary Disability BenefitsPermanent Partial DisabilityStatutory CapSafety Valve ProvisionMaximum Medical ImprovementJudicial ReviewAdministrative BurdenAppellate DivisionRemittal
References
7
Case No. WCB G074 4160
Regular Panel Decision
Dec 12, 2013

Matter of Qualls v. Bronx District Attorney's Office

Claimant William Sanchez sustained a work-related injury to his left knee and was awarded workers' compensation benefits. After two surgeries, his treating physician determined he reached maximum medical improvement and released him to return to work with restrictions. Sanchez then obtained an order of preclusion due to the employer/carrier's failure to provide medical evidence. The Workers' Compensation Board reversed this order and rescinded the preclusion order because the employer/carrier provided the required medical evidence before the preclusion order was issued. The employer/carrier appeals the finding that the claimant's period of temporary total disability extends beyond the date of maximum medical improvement.

Workers' Compensation BenefitsKnee InjuryMaximum Medical ImprovementPreclusion OrderAppellate DivisionMedical EvidenceTemporary Total DisabilityWork-Related InjurySedgwick CMS
References
0
Case No. CV-22-1999
Regular Panel Decision
Mar 21, 2024

Matter of Schuette v. Consolidated Edison Co. of N.Y.

Claimant Dennis Schuette appealed a Workers' Compensation Board decision which denied a schedule loss of use (SLU) award for a right wrist injury sustained in a workplace accident in 2019 while working for Consolidated Edison. Medical examiners initially opined that claimant had reached maximum medical improvement and sustained a 73⅓% SLU to his right wrist. However, the Board found these medical opinions not credible, as the examiners were unaware of claimant's concurrent diagnosis and treatment for bilateral carpal tunnel syndrome and his ongoing work activities. The Board concluded that maximum medical improvement was not clearly established, making the SLU determination premature. The Appellate Division affirmed the Board's decision, finding it supported by substantial evidence.

Workers' Compensation LawSchedule Loss of UsePermanent ImpairmentMaximum Medical ImprovementCarpal Tunnel SyndromeIndependent Medical ExaminationFraudCredibilityAppellate ReviewMedical Treatment Guidelines
References
6
Case No. ADJ7056858
Regular
Mar 26, 2012

JISIFRIDO CHAVEZ vs. MENASHA CORPORATION, SENTRY INSURANCE COMPANY

This case involves an applicant who sustained a shoulder injury and underwent two surgeries. The defendant sought reconsideration of an award of temporary disability, arguing the applicant had reached maximum medical improvement and was subject to the 104-week statutory cap. The Workers' Compensation Appeals Board denied reconsideration, adopting the WCJ's report. The WCJ found the applicant had not reached maximum medical improvement, supported by medical evidence indicating continued pain and failed surgical repair, and the defendant's arguments regarding the cap were already addressed.

Workers' Compensation Appeals BoardReconsideration DeniedLabor Code Section 4656Temporary DisabilityPermanent and StationaryAgreed Medical ExaminerRotator Cuff RepairMaximum Medical ImprovementModified DutyShoulder Injury
References
1
Case No. ADJ7925931, ADJ7925917
Regular
Sep 27, 2017

LUISA SEQUEIRA vs. RANDSTAD PLACEMENT PROS, ACE AMERICAN

This case involved an applicant seeking reconsideration of a workers' compensation award, arguing that the declaration of readiness to proceed was defective due to a lack of a primary treating physician's report on permanent disability. The Appeals Board affirmed the original award, finding that Labor Code section 4061(i) does not require all treating physicians to find maximum medical improvement before proceeding to trial. The Board reasoned that the applicant's Panel Qualified Medical Evaluator (PQME) provided substantial medical evidence sufficient to support the permanent disability award, even though primary treating physicians had not yet found MMI. Therefore, the WCJ correctly relied on the PQME's report.

Declaration of readinessPermanent disabilityPrimary treating physicianQualified Medical EvaluatorMaximum medical improvementLabor Code section 4061(i)Substantial medical evidenceFindings Award and OrderReconsiderationIndustrial injury
References
3
Case No. ADJ19947925
Regular
May 19, 2025

Andres De Jesus Garcia vs. Slater's 50/50, Security National Insurance Company

Applicant, Andres De Jesus Garcia, sought reconsideration of a March 12, 2025 Findings and Award (F&A) which denied his request for a new primary treating physician (PTP) or a second opinion. The workers' compensation administrative law judge (WCJ) had found that the applicant reached maximum medical improvement (MMI) based on reports from his PTP and a panel qualified medical evaluator (PQME). Applicant contended he is entitled to a change of PTP or a second opinion within the medical provider network (MPN) under various Labor Code sections and WCAB Rules. The Appeals Board granted the Petition for Reconsideration, deferring a final decision after reconsideration to allow for further review of the factual and legal issues.

Petition for ReconsiderationMedical Provider Network (MPN)Primary Treating Physician (PTP)Maximum Medical Improvement (MMI)Qualified Medical Evaluator (PQME)Labor Code sections 4616.3 and 4616.4WCAB Rules 9767.6(e) and 9767.7Tenet/Centinela Hospital Medical Center v. Workers' Comp. Appeals Bd. (Rushing)Labor Code section 5909Electronic Adjudication Management System (EAMS)
References
12
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