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

Case No. ADJ9166524
Regular
Feb 24, 2015

MICHAEL GORBEA vs. LIMBACH COMPANY, LP, ARCH INSURANCE, GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board adopted and incorporated the WCJ's report, giving great weight to the WCJ's credibility determinations due to observing the witnesses' demeanor. The WCJ found the applicant's testimony regarding the alleged injury was not credible and was rebutted by defense witnesses. Furthermore, the WCJ determined the post-termination defense was applicable as the applicant's notice of injury was not timely or contemporaneous with his layoff.

AOE/COEPetition for ReconsiderationWCJ credibility determinationpost-termination defenseDover v. Fresh Start Bakeriescontemporaneous notification exceptionpreponderance of the evidenceindustrial clinic diagnosislumbar sprainmuscle spasm
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
Case No. VNO 0365922
Regular
Mar 03, 2008

NANCY COULTER vs. SULPHUR SPRINGS UNION SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The applicant sought reconsideration of a WCJ's award, arguing injury to her psyche, neck, shoulders, and cardiovascular system, in addition to her teeth. The Appeals Board granted reconsideration to amend the finding of injury to specifically include "teeth (bruxism) resulting in myofascial pain to her jaw and muscle tenderness." Ultimately, the Board affirmed the original award, finding no industrial injury to the psyche, neck, shoulders, or cardiovascular system, relying on the credibility of a witness and substantial medical evidence.

Workers' Compensation Appeals BoardSulphur Springs Union School DistrictCalifornia Insurance Guarantee AssociationFindings and Awardpermanent disabilitypsychiatric injurygood faith personnel action defensePetition for Reconsiderationbruxismmyofascial pain
References
Case No. VNO 0456809
Regular
Oct 02, 2007

JAVAD BASSIRY, vs. AMERICAN RESIDENTIAL SERVICES; ZURICH NORTH AMERICA

This case involves Javad Bassiry's workers' compensation claim for injuries sustained as a plumber tech. The Appeals Board granted reconsideration to amend a finding of fact regarding the specific body parts injured. Ultimately, the Board affirmed the original decision but with the clarified finding of injury to the applicant's left shoulder, neck, left arm, left wrist, and lower abdominal muscle.

Javad BassiryAmerican Residential ServicesZurich North AmericaVNO 0456809ReconsiderationJuly 30 2007Plumber techOccupational Group No. 481March 8 2002Left shoulder
References
Case No. FRE 0191984
Regular
Aug 11, 2008

MARIA ROMERO vs. FOSTER POULTRY FARMS

This Workers' Compensation Appeals Board case involves a dispute over lien claimant Schroeder Chiropractic North's payment for services rendered to applicant Maria Romero. Both the defendant and the lien claimant petitioned for reconsideration of an amended findings and award. The Board granted reconsideration, amending the award to allow payment for chiropractic treatment from January 6, 2005, to October 18, 2006, while disallowing payment for specific services like manual muscle testing and radiography.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantChiropractic TreatmentManual Muscle TestingRadiography TestsOrthoticsKnee BraceQualified Medical EvaluatorStipulations
References
Case No. SFO 0490700
Regular
Mar 26, 2008

Mercedes Abarca vs. RITZ CARLTON HALF MOON BAY

The Board granted reconsideration, amending the original award to limit the payment for the interferential muscle stimulator (IMS) device and supplies. Initially, the Administrative Law Judge found the device necessary for the entire period claimed, but upon reviewing Dr. Wolfer's note, the Board limited coverage to November 19, 2005, to January 30, 2006. This amendment reflects that the IMS device was deemed necessary for the industrial injury only during this specific timeframe.

Workers' Compensation Appeals BoardSupplemental Findings & Awardinterferential muscle stimulator (IMS device)lien claimantRS Medicalself-procured medical expenseutilization reviewsubstantial evidencePetition for ReconsiderationWCJ report and recommendation
References
Case No. ADJ916227 (VNO 0474238)
Regular
Jun 11, 2009

JOANNA LEE FRADY vs. MAGIC FORD AUTO NATIONS, ZURICH, Adjusted By UNIVERSAL UNDERWRITERS GROUP

This case concerns an applicant's entitlement to further medical treatment for an admitted industrial injury to her back, neck, and right hand. The defendant sought reconsideration of a prior award finding the applicant entitled to treatment recommended by her treating physician, Dr. Caro, specifically a brain MRI, muscle and skin biopsies, and a neurological evaluation. The Appeals Board granted reconsideration, finding Dr. Caro's report conclusory and not substantial evidence, and instead amended the award to grant treatment as recommended by panel Qualified Medical Examiner Dr. Yousefi. Dr. Yousefi's reports, based on thorough examination and testing, concluded that invasive procedures like muscle and skin biopsies were not indicated and recommended an independent neurological evaluation for further clarification.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgeFuture Medical TreatmentIndustrial InjuryPermanent DisabilityTreating PhysicianQualified Medical ExaminerSubstantial Evidence
References
Case No. ADJ7033642
Regular
Jul 24, 2013

JOHNNY REVELS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT; SEDGWICK

The Workers' Compensation Appeals Board denied the Los Angeles Unified School District's petition for reconsideration. The Board adopted the administrative law judge's report, finding that a single physician's opinion can constitute substantial evidence, even if it contradicts other medical opinions. The Board also noted the defendant's violation of procedural rules regarding single-spacing. The petition was denied based on the established medical evidence and procedural issues.

Petition for ReconsiderationWorkers' Compensation Appeals BoardWCJ ReportSubstantial EvidencePhysician OpinionRegulation ViolationsRules 10232(a)(11)Rule 10845(a)Single SpacingPetition Denial
References
Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ9023782
Regular
Sep 20, 2019

REFUGIO PACAS vs. BARON HR. LLC, ZURICH AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration of a decision that denied new and further disability for the applicant's November 25, 2012 injury. While the Board found no new disability for the left wrist and lumbar spine, it identified potential new and further disability in the applicant's left knee. The matter is returned for further development of the record, specifically to clarify the applicant's left knee impairment with the agreed medical evaluator. The Board requires clarification on the rating methodology used for the left knee and whether it deviates from the AMA Guides.

Petition to ReopenNew and Further DisabilityStipulated AwardAgreed Medical EvaluatorRange of MotionWhole Person ImpairmentDiagnosis Related EstimateGait DerangementMuscle AtrophyArthritis
References
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