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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ9379623
Regular
May 18, 2018

ETHERY AMARI vs. CHILDREN'S HOSPITAL OF LOS ANGELES

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied her request for an additional neurology Qualified Medical Evaluator (QME). The applicant sustained admitted injuries including to her spine and shoulder, and also claimed headaches. Her treating physician recommended a neurology consult twice, and the applicant testified about worsening headaches post-injury. The Board found that these factors constituted good cause and demonstrated significant prejudice, warranting the appointment of a neurology QME panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology QMEWCABFindings and OrderIndustrial InjuryCervical SpineLumbar SpineHeadachesPrimary Treating Physician
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
Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
Case No. ADJ3403193 (RIV 0072531)
Regular
Sep 08, 2009

PERRY NICKLE vs. MESA CONTRACTING CORPORATION, SEABRIGHT INSURANCE

The Appeals Board granted reconsideration, rescinding the original award and substituting a new one. The Board found that the applicant did not sustain a hearing loss injury but did sustain neurological and orthopedic permanent disability. They determined that 60% of the orthopedic disability and 50% of the neurological disability were non-industrial, resulting in a revised permanent disability award of 31%. The Board also confirmed the applicant's entitlement to a cane and further medical treatment based on expert medical opinions.

Workers' Compensation Appeals BoardReconsiderationApportionmentAgreed Medical EvaluatorQualified Medical EvaluatorPermanent DisabilityNeurological DisabilityOrthopedic DisabilityHearing LossDegenerative Disease
References
Case No. ADJ8967872
Regular
Jan 31, 2018

FERNANDO FERNANDEZ vs. HALEX CORPORATION, EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal, rescinding a prior finding that denied a neurology PQME. The Board found that there was ample evidence, including a treater's recommendation and the applicant's medical history of a stroke, to support the request. The WCAB determined that denial of the PQME would cause significant prejudice and irreparable harm to the applicant. Therefore, an order was issued granting the applicant's request for an additional neurology Qualified Medical Evaluator panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology PQMEIndustrial InjuryIntracranial HemorrhageAnticoagulationPulmonary EmbolismsDeep Venous ThrombosisStrokePrimary Treating Physician
References
Case No. ADJ6820021, ADJ6820115, ADJ6820640, ADJ6820664
Regular
May 11, 2012

GENOVEVA AYALA vs. WARNER BROTHERS

This case involves Genoveva Ayala's workers' compensation claims against Warner Brothers for multiple injuries. The Administrative Law Judge (WCJ) found some injuries to be established but excluded applicant's medical evidence regarding neurological and internal injuries due to alleged procedural violations. The Appeals Board granted reconsideration, finding that the applicant should have an opportunity to obtain admissible medical reports through the Qualified Medical Evaluator (QME) process, as defendants allegedly interfered with this process. Consequently, the issue of neurological and internal injuries is deferred for further evaluation.

Workers' Compensation Appeals BoardGenoveva AyalaWarner BrothersPermissibly Self-InsuredJoint Partial Findings of FactOrders and Notice of Intention to Appoint Regular PhysicianWorkers' Compensation Administrative Law Judge (WCJ)orthopedic injurycumulative traumaneurological system
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. ADJ4018708 (SBA 0079160)
Regular
Apr 23, 2010

KATHY KELLERMANN vs. REGENTS OF UCSB, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves Kathy Kellermann's claim for workers' compensation benefits, where the administrative law judge initially found a cumulative trauma injury to her psyche but not to her dental, neurological, or internal systems, awarding 8% permanent disability. Ms. Kellermann sought reconsideration, arguing the judge erred by excluding dental, neurological, and internal injuries, acting in excess of powers regarding an independent medical exam, and improperly relying on certain medical reports for disability assessment. The Appeals Board granted reconsideration to clarify the scope of injury, affirming the finding of psyche injury but not other systems as a compensable consequence. The Board also upheld the 8% permanent disability award, citing precedent allowing reliance on a single physician's relevant and considered opinion even if inconsistent with others.

ADJ4018708SBA 0079160Kathy KellermannRegents of UCSBSedgwick Claims Management ServicesOpinion and Order Granting ReconsiderationDecision After Reconsiderationindustrial cumulative trauma injurypsyche injurydental injury
References
Case No. ADJ2834861 (GRO 00349120) ADJ3453107 (GRO 0031731) ADJ405168 (GRO 0034913)
Regular
Nov 14, 2019

TOM JANISE vs. DSH ATASCADERO, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted applicant's Petition for Removal, rescinding an order that closed discovery and set a trial date. This was because a court-ordered neurology panel Qualified Medical Evaluator (QME) was not selected until after discovery was closed, despite delays from the Medical Unit. The Board agreed that applicant should not be prejudiced by this delay and allowed for the QME evaluation to proceed. Consequently, the trial was converted to a status conference.

Petition for RemovalAppeals BoardWCJQualified Medical EvaluatorDWC Medical Unitneurologydiscovery closureproof of serviceStatus Conferencerescinded order
References
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