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

Case No. ADJ6972640
Regular
Jul 25, 2016

JAVIER VENTURA vs. AMERICAN COPAK CORPORATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and returned the case to the trial level for further proceedings. The WCAB found the original decision lacked sufficient explanation for its findings, particularly regarding the occupational group number and the chosen method for rating lumbar spine impairment. Furthermore, the WCAB requires a specific medical opinion on the appropriate method to assess the applicant's lumbar spine disability under the AMA Guides. The WCAB also directed further development of the record concerning the applicant's claimed lung injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityDRE MethodROM MethodOccupational Group NumberAMA GuidesLumbar Spine Impairment
References
Case No. ADJ8181938; ADJ8702275
Regular
Apr 10, 2023

KAREN MILLER vs. STATE OF CALIFORNIA, VENTURA YOUTH CORRECTIONAL FACILITY, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued against the statutory 15% increase, the method of evaluating spine impairment, and the inclusion of a sleep disorder. The Board adopted the WCJ's report, finding no error in the application of the 15% increase or the evaluation of the spine impairment using the ROM method as deemed appropriate by the agreed medical examiner. Furthermore, the Board upheld the finding of an industrially caused sleep disorder, noting that formal sleep studies are not always required for diagnosis and that the physician's rating falls within the AMA Guides.

WCABPetition for ReconsiderationDeniedVentura Youth Correctional FacilityAdjudication NumbersOccupational Group 214Cervical SpineLumbar SpineBilateral ShouldersGastrointestinal System
References
Case No. ADJ9344211
Regular
Dec 01, 2017

Patricia Preston vs. Los Angeles Unified School District, SEDGWICK CLAIMS MANAGEMENT SERVICES

The applicant sought reconsideration of a workers' compensation award, challenging the permanent disability rating primarily based on the chosen medical evaluation method. The applicant argued the Range-of-Motion (ROM) method, favored by her treating physician, should have been used instead of the Diagnosis-Related Estimates (DRE) method employed by a Qualified Medical Evaluator (QME). Additionally, she contended that her vocational expert's opinion supported a finding of total permanent disability. The Board denied reconsideration, affirming the administrative law judge's decision, finding the QME's DRE rating supported by substantial evidence and the applicant's vocational evidence insufficient to prove total disability. A dissenting opinion argued that findings of multi-level spinal involvement supported the use of the ROM method for a potentially higher rating and questioned the QME's justification for choosing DRE.

Workers' Compensation Appeals BoardPatricia PrestonLos Angeles Unified School DistrictSedgwick Claims Management ServicesADJ9344211Permanent Disability RatingRange-of-Motion MethodDiagnosis-Related Estimates MethodApportionmentDr. Fenton
References
Case No. MON 0339411
Regular
Jul 21, 2008

Dionisio Jimenez vs. NUPAC APARTMENTS, STATE COMPENSATION INSURANCE FUND

This case involves a dispute over the proper method used to rate the applicant's permanent disability following a back and leg injury. The defendant contends the Agreed Medical Examiner improperly used the Range of Motion (ROM) method instead of the Diagnosis-Related Estimate (DRE) method per the AMA Guides. The Appeals Board rescinded the prior award and returned the case to the trial level for further development of the record. This development will address why the ROM method was used and clarify the appropriate rating methodology.

Workers' Compensation Appeals BoardDionisio JimenezNupac ApartmentsState Compensation Insurance FundMON 0339411Opinion and Decision After ReconsiderationFindings and AwardIndustrial InjuryBack InjuryRight Leg Injury
References
Case No. ADJ2894653
Regular
Jan 17, 2012

LENA WILSON vs. PIEDMONT LUMBER AND NURSERY, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address the reasonableness of the attorney's fee and its commutation method. The Board found the original fee of $\$ 41,522.43$ was unreasonably low because it did not properly account for the applicant's Cost of Living Allowance (COLA). Consequently, the Board rescinded the prior order and awarded an attorney's fee of $\$ 84,814.30$, to be commuted using the "uniformly increasing reduction method," finding this latter method to be in the applicant's best interest.

Workers Compensation Appeals BoardAttorney's FeeReconsiderationJoint Findings and OrderWorkers' Compensation JudgeUniform Reduction MethodUniformly Increasing Reduction MethodCommutationPermanent Total DisabilityCost of Living Allowance (COLA)
References
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
Case No. ADJ6820630
Regular
Mar 19, 2018

MARK COLLINS vs. ENTERTAINMENT PARTNERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The WCAB dismissed the Defendant's Petition for Reconsideration because it was not filed from a final order. The Board granted the Defendant's Petition for Removal to rescind the WCJ's order vacating submission and appointing a new physician. The WCJ erred by refusing to accept the AME's rating based on the Diagnosis-Related Estimate (DRE) method, as physicians have discretion to use the most accurate method. However, the AME's own deposition testimony indicated that the Range of Motion (ROM) method, mandated by the WCJ, would yield a higher impairment rating. Therefore, the matter is returned to the trial level for the WCJ to obtain a permanent disability rating using the existing record and potentially consulting a DEU rater.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAgreed Medical Examiner (AME)Range of Motion (ROM) methodDiagnosis-Related Estimates (DRE) methodAmerican Medical Association's Guides (AMA Guides)Whole Person Impairment (WPI)cumulative traumaspinal injury
References
Case No. ADJ2234332 (OAK 0325654)
Regular
Apr 25, 2016

WAYNE LA COSSE vs. CARONE & COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address defendant's objections regarding the application of the 1997 Permanent Disability Rating Schedule and the calculation of attorney's fees. The Board affirmed the WCJ's findings on the industrial injury and permanent disability, finding no error in applying the 1997 schedule or the amount of the attorney's fee. However, the Board rescinded the specific award and orders concerning attorney's fees to allow the WCJ to re-determine the method of commutation based on the applicant's best interests, potentially using a Uniformly Increasing Reduction Method. The case is returned to the trial level for further proceedings and a new determination on attorney's fees.

Workers Compensation Appeals BoardFindings and AwardPermanent Disability Rating ScheduleIndustrial InjuryPermanent DisabilityAttorney's FeesCommutationUniform Reduction MethodUniformly Increasing Reduction MethodState Average Weekly Wage
References
Case No. ADJ9890148
Regular
Feb 02, 2017

Timothy Bedford vs. CITY OF LOS ANGELES

This Workers' Compensation Appeals Board case denies reconsideration of a permanent disability rating. The Board affirmed the use of Figure 15-19 of the AMA Guides, finding it permissible to use any chapter or method within the Guides that most accurately reflects impairment. The Agreed Medical Evaluator's opinion was deemed substantial, as he explained how Figure 15-19 was used to derive a more accurate rating based on the applicant's specific spinal condition. The decision also distinguished the current case from prior panel decisions regarding the application of the AMA Guides and work limitations.

AMA Guidespermanent disability ratingrebuttable presumptionwhole person impairmentAlmaraz/Guzman IIclinical judgmentagreed medical evaluator (AME)Figure 15-19functional losssurgical-grade disc herniations
References
Case No. ADJ7873101
Regular
Apr 11, 2017

SHERY FRANKLIN vs. STATE OF CALIFORNIA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award, finding that the administrative law judge erred in several permanent disability ratings. Specifically, the WCAB will allow for further proceedings to re-rate permanent disability, incorporating the agreed medical examiner's findings for hypertension and sleep disorder, and rating psyche disability without apportionment. Issues regarding the method of rating cervical spine disability, industrial injury to the upper digestive tract, and entitlement to a Labor Code section 4658(d) increase will also be further developed and decided. The WCAB affirmed the findings on temporary disability and further medical treatment.

WCA BReconsiderationIndustrial InjuryPermanent DisabilityApportionmentAgreed Medical EvaluatorAMEWhole Person ImpairmentWPISleep Disorder
References
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