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

Case No. ADJ8055062
Regular
May 28, 2013

JAIME CASTANEDA vs. KING DAHL EVENT DESIGN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation applicant seeking reconsideration of a prior award that found a $15\%$ permanent disability and no industrial injury to the psyche. The applicant argues the administrative law judge (WCJ) erred by not including a neurologist's impairment rating for a sleep disorder and by not relying on the primary treating physician's orthopedic assessment. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter for the WCJ to incorporate the neurologist's sleep disorder impairment rating, finding it uncontradicted. However, one commissioner dissented, arguing the sleep disorder was secondary to pain already included in the orthopedic rating and any psychiatric component was noncompensable.

WCABReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityOrthopedistNeurologistSleep DisorderAMA GuidesImpairment Rating
References
Case No. LAO 0778165
Regular
Jul 29, 2008

ROBERTO REYES vs. DRAKE OFFICE OVERLOAD, RELIANCE NATIONAL INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ADVO, INC, ST. PAUL TRAVELERS

This case involved a janitor injured while employed by both a general employer (Drake) and a special employer (Advo). The Workers' Compensation Appeals Board denied Advo's petition for reconsideration, upholding the finding of joint and several liability for the injury. The Board affirmed that Advo's agreement with Drake did not absolve Advo of liability, the statute of limitations did not bar the claim against Advo, and the neurologist's opinion constituted substantial medical evidence.

Workers Compensation Appeals BoardSpecial EmployeeGeneral EmployerJoint and Several LiabilityCIGAInsurance Code section 1063.1Labor Code section 5405Statute of LimitationsLachesSubstantial Medical Evidence
References
Case No. ADJ10737420, ADJ11230735
Regular
May 28, 2019

METHVEN BROWN (Deceased), JANINE BROWN (Widow) vs. COUNTY OF SACRAMENTO, Permissibly Self-Insured, SACRAMENTO COUNTY PROBATION DEPARTMENT

The Workers' Compensation Appeals Board denied reconsideration of a decision finding no industrial injury to the decedent's heart or cerebrovascular system. The widow argued the administrative law judge erred by disallowing further discovery from a cardiologist. However, the Board adopted the judge's report, which noted a neurologist already testified that heart trouble and industrial stress were not medically probable causes of the decedent's stroke and death. The applicants failed to demonstrate why a cardiologist would be more competent to offer such opinions.

Methven BrownJanine BrownCounty of SacramentoSacramento County Probation DepartmentADJ10737420ADJ11230735Petition for ReconsiderationJoint Findings and Orderindustrial injuryheart injury
References
Case No. ADJ7838570
Regular
Dec 10, 2012

MARCO MILLAN vs. WESTOWER COMMUNICATIONS, HARTFORD

The Workers' Compensation Appeals Board dismissed applicant's first petition for reconsideration and denied his second. The applicant sought reconsideration of a finding that his stroke and related injuries were not work-related, arguing a physiatrist's opinion constituted substantial medical evidence. The WCJ and Board found Dr. Schilling lacked the neurological expertise to establish industrial causation, and the consulting neurologist did not confirm it. The Board affirmed the WCJ's decision, finding the applicant failed to meet his burden of proof with substantial evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalIndustrial CausationStrokeCirculatory SystemNegligenceBurden of ProofMedical EvidencePhysiatrist
References
Case No. MON 0316510
Regular
Jul 18, 2008

MIGUEL LOPEZ vs. MV TRANSPORTATION, AMERICAN HOME ASSURANCE, BROADSPIRE CLAIM SERVICES

The Workers' Compensation Appeals Board granted reconsideration of an amended award finding applicant incurred industrial injury causing 78% permanent disability. The Board found the applicant's neurologist's report regarding post-traumatic head syndrome lacked substantial evidence due to contradictions with applicant's testimony. Consequently, the case is returned to the trial level to further address permanent disability and apportionment issues.

WCABMV TransportationAmerican Home AssuranceBroadsire Claim ServicesMIGUEL LOPEZBus DriverIndustrial InjuryNeck InjuryBack InjuryRight Shoulder Injury
References
Case No. ADJ11025609
Regular
Apr 30, 2018

DONNA IVES vs. DR MYERS DISTRIBUTING COMPANY, PREFERRED EMPLOYERS INSURANCE COMPANY

In this workers' compensation case, the Appeals Board rescinded the WCJ's decision and returned the matter for further proceedings. The Board found that the defendant improperly modified the applicant's Request for Authorization (RFA) for treatment by a chiropractic neurologist. Instead of referring the request for medical utilization review, the claims administrator authorized treatment with a general chiropractor. The Board emphasized that claims adjusters cannot modify RFAs and that medical necessity decisions must be made by physicians.

WCABPetition for ReconsiderationFindings of FactWCJindustrial injurychiropractic neurologistMedical Provider Network (MPN)Request for Authorization (RFA)Utilization Review (UR)Medical Treatment Utilization Schedule (MTUS)
References
Case No. ADJ4518619
Regular
Aug 17, 2011

XIOMARA LEMUS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The Workers' Compensation Appeals Board denied the defendant's (Los Angeles Unified School District) Petition for Removal. The defendant sought to rescind an order continuing the case for trial, arguing it was deprived of due process by not obtaining a Qualified Medical Evaluation (QME) to rebut the applicant's treating neurologist. The Board found that removal is an extraordinary remedy, and the defendant failed to demonstrate substantial prejudice or irreparable harm, nor that reconsideration would be inadequate. The case was returned to the trial level for rescheduling.

Petition for RemovalQualified Medical EvaluationRebuttalTreating NeurologistDue ProcessExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationAdequacy of Remedy
References
Case No. ADJ8700541
Regular
Oct 17, 2019

ZAHRA STEPHENS vs. COX ENTERPRISES, INC.

The Appeals Board granted reconsideration to review the WCJ's finding of permanent and total disability based on the opinions of a psychologist, Dr. Windman, and a vocational expert, Mr. Wilkinson. The Board found that Dr. Windman's opinion lacked substantial evidence due to inconsistencies, inadequate record review, and conflicts with other medical opinions. Consequently, Mr. Wilkinson's vocational opinion, which relied heavily on Dr. Windman's findings, was also deemed not substantial evidence. The case is remanded to the trial level for further proceedings and a new determination of permanent disability.

Workers' Compensation Appeals BoardReconsiderationPermanent Total DisabilityMedical OpinionVocational ExpertSubstantial EvidencePQMENeurologistPsychologistOrthopedist
References
Case No. ADJ4664471
Regular
Jul 14, 2010

WILLIAM ROBERTS vs. WESTEN ENVIRONMENMTAL ENGINEERS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a decision that denied his claim for psychiatric injury. The Board found the petition was skeletal and failed to cite legal principles or evidence. Furthermore, the applicant failed to meet his burden of proving work events were the predominant cause of his alleged psychiatric disorder due to credibility issues and an inaccurate history provided to medical evaluators. The Board adopted the Workers' Compensation Judge's report and recommendation in its entirety.

Workers' Compensation Appeals BoardReconsideration DeniedPsychiatric InjuryPredominant CauseCredibility DeterminationInaccurate HistoryBurden of ProofIntoxication DefenseNeurologistPsychiatrist
References
Case No. ADJ4225526 (GOL 0092072)
Regular
Apr 20, 2017

JESUS ARROYO vs. JOHN CRAVENS PLASTERING, STATE COMPENSATION INSURANCE FUND

This case involves Jesus Arroyo's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, adopting the reasoning of the workers' compensation administrative law judge. Medical evidence from Dr. Markovitz established that Arroyo suffered a total and permanent disability resulting from industrial injuries, including an aortic aneurysm repair and subsequent strokes. The Board found Dr. Markovitz's opinions constituted substantial medical evidence, despite conflicting defense opinions, and affirmed that all necessary medical care and permanent disability were industrially caused.

Workers' Compensation Appeals BoardJesus ArroyoJohn Cravens PlasteringState Compensation Insurance FundPetition for ReconsiderationAgreed Medical ExaminerGerald Markovitzechocardiogramaortic root dilationexpanding aortic aneurysm
References
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