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

Case No. ADJ10419700 (MF) ADJ10543011
Regular
May 09, 2019

CHERIE BATES vs. PRIDE INDUSTRIES, UNITED STATES FIRE INS. CO., BROADSPIRE

This case involves an applicant's claim for a head injury allegedly sustained at work after losing balance and hitting her head. While her testimony and initial claim documentation suggest a work-related incident occurred, the Workers' Compensation Appeals Board (WCAB) found insufficient medical evidence to confirm the injury's industrial nature due to the applicant's history of seizures and conflicting medical reports. Consequently, the WCAB rescinded the previous award and returned the case to the trial level for further development of expert medical opinion on the industrial causation of the head injury. The applicant's knee injury claim from a separate date was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryHead InjuryCredibilityFraudMedical EvidenceLay TestimonyExpert Medical OpinionOccult Injury
References
3
Case No. ADJ8835979
Regular
Aug 27, 2015

Antonio Vera Munoz vs. Parkwood Landscape Maintenance, AMTRUST

This case concerns a worker who sustained a fall and claimed injury to his head, brain, back, and knee. The defendant failed to deny the claim within 90 days, triggering a presumption of compensability. While the defendant presented medical evidence suggesting the applicant's seizure was non-industrial, the Appeals Board found insufficient evidence to rebut the presumption for all claimed injuries. Consequently, the Board amended the findings to include head injury as presumed industrial, affirmed the back and knee injuries, and ordered further development on the wrist injury claim, while denying removal.

WCABDWC-190-day presumptionLabor Code section 5402Petition for ReconsiderationPetition for Removalindustrial injuryorthopedic injuryseizurecysticercosis
References
8
Case No. ADJ1955186
Regular
Apr 14, 2023

ROBERT JELENIC vs. LOS ANGELES DEPARTMENT OF WATER AND POWER

This case involves a dispute over permanent and total disability following a 1997 industrial injury. The Appeals Board affirmed the finding of permanent and total disability, including the applicant's upper and lower back in the industrial injury. However, the Board rescinded the original finding that apportionment to non-industrial factors was inapplicable, stating apportionment under Labor Code section 4663 should be considered. The majority found Dr. Richman's apportionment opinions did not provide substantial evidence for apportionment, while the dissenting opinion argued for further development of the record regarding apportionment to a 1992 non-industrial injury.

Permanent Total DisabilityApportionmentLabor Code Section 4662(a)(4)Agreed Medical Examiner (AME)Vocational FeasibilityCognitive ImpairmentSub Rosa Videos1997 PDRSPermanent Impairment RatingPre-existing Condition
References
10
Case No. ADJ8269895
Regular
Jan 31, 2018

FERMIN SANDOVAL vs. WATERPROOFING ASSOCIATES, CYPRESS INSURANCE, BERKSHIRE HATHAWAY

This case involves an applicant seeking reconsideration of a workers' compensation award finding a 50% permanent disability from a back and right knee injury. The applicant argued he was permanently and totally disabled, that the WCJ erred by considering non-industrial factors, and that his average weekly wage was miscalculated. The Board affirmed the original award, finding that while an applicant can rebut a scheduled rating by showing impairment of rehabilitation due to the industrial injury, this applicant's vocational limitations stemmed from non-industrial factors like illiteracy and language barriers. Therefore, the Board concluded the applicant did not meet his burden to prove a greater loss of earning capacity due solely to the industrial injury as required by *Ogilvie*.

Workers' Compensation Appeals BoardSecond Petition for ReconsiderationFindings and AwardPermanent DisabilityLabor Code Section 4662(b)Average Weekly WageLabor Code Section 4453(C)(1)Labor Code Section 4453(C)(3)Ogilvie v. Workers' Comp. Appeals Bd.Scheduled Rating
References
2
Case No. 03-cv-4134
Regular Panel Decision

Infantolino v. Joint Industry Board of the Electrical Industry

Anthony Infantolino sued the Joint Industry Board of the Electrical Industry (JIB) and Thomas Bush, alleging unlawful retaliation under the Americans with Disabilities Act (ADA) and New York State/City laws. JIB moved for summary judgment, arguing procedural defects and substantive failures, including that it was not Infantolino's employer. The court found JIB to be a 'joint labor-management committee' and thus a 'covered entity' under the ADA, refuting the employer argument. The court denied summary judgment regarding the retaliation claims, finding genuine issues of fact as to whether JIB's stated reasons for its actions were pretexts for impermissible retaliation. However, the motion for summary judgment was granted in part, denying punitive and compensatory damages for the ADA retaliation claim and punitive damages for the New York State Human Rights Law claim, but allowing punitive damages for the New York City Human Rights Law claim.

ADA RetaliationDisability DiscriminationSummary JudgmentBurden-Shifting FrameworkCausal ConnectionPretextPunitive DamagesCompensatory DamagesNew York City Human Rights LawNew York State Human Rights Law
References
36
Case No. ADJ10170331
Regular
Sep 23, 2019

ROBIN WITHERS vs. ALLIED BARTON SECURITY SERVICES, ARCH INSURANCE COMPANY

This case concerns Robin Withers' petition for reconsideration of a workers' compensation ruling denying her claim for psychiatric injury. The administrative law judge found that Withers sustained industrial injury in the form of headaches but not to her psyche. Withers argued she proved a work-related psychiatric injury, citing symptoms that predated significant non-industrial stressors. However, the evidence, including expert opinion, indicated that non-industrial stressors were the predominant cause of her psychiatric condition. Therefore, the petition for reconsideration was denied.

Workers Compensation Appeals BoardADJ10170331Findings of FactPetition for ReconsiderationWCJpsychiatric injuryPQMEpredominant causenon-industrial stressorssexual harassment
References
2
Case No. ADJ3026623
Regular
Jun 28, 2010

ROBERTO PICENO vs. KLUNE INDUSTRIES, INC.; CIGA, administered by CAMBRIDGE for FREMONT, in liquidation

This case involves a defendant's petition for reconsideration of an award of permanent disability for an applicant's industrial injuries sustained on January 22, 1997. The defendant argued for apportionment of the permanent disability to non-industrial factors and to a cumulative trauma injury. The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition because it was unverified, a mandatory requirement. The WCAB found the defendant failed to cure this defect within a reasonable time after it was pointed out. Therefore, the defendant's contentions regarding apportionment were not addressed on their merits by the WCAB.

Workers' Compensation Appeals BoardPetition for ReconsiderationUnverified PetitionLabor Code Section 5902ApportionmentCumulative TraumaSpecific InjuryAgreed Medical ExaminerQualified Medical EvaluatorSubstantial Evidence
References
1
Case No. ADJ556317 (VNO 0560264) ADJ6957841
Regular
Oct 05, 2010

DALE HENGEN vs. WILLIAM FRANKEL PLUMBING, STATE COMPENSATION INSURANCE FUND

This case involves a worker who sustained an industrial head injury and subsequent seizure, followed by death approximately 1.5 years later. While the initial injury and temporary disability were found to be industrial, the cause of death was contested, with potential contributing factors including binge drinking and the prior head trauma. The Appeals Board found insufficient medical evidence to definitively link the death to the industrial injury and therefore rescinded the prior decision. The matter is remanded for further development of the medical record to determine the causal factors of death, possibly through a neurology AME or QME.

Workers Compensation Appeals BoardRobert HengenDale HengenWilliam Frankel PlumbingState Compensation Insurance FundADJ556317ADJ6957841Opinion and Decision After ReconsiderationAmended Findings Order and AwardWorkers' compensation judge
References
5
Case No. ADJ3925996 (FRE 0180480) ADJ360469 (FRE 0198851)
Regular
Oct 01, 2012

MICHAEL AKINS vs. THE SALVATION ARMY, Permissibly Self-Insured

In this workers' compensation case, the defendant, The Salvation Army, seeks to deny liability for applicant Michael Akins' recommended spinal surgery. While Akins sustained industrial injuries to his neck and back in 1998 and 2001, a subsequent non-industrial car accident in 2008 displaced hardware from his prior industrial surgery. The Board found that the industrial injury was a substantial contributing factor to the need for the current surgery, even though the non-industrial accident was the "most proximate cause." Therefore, the defendant remains liable for the recommended surgical intervention.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderIndustrial InjurySpinal SurgeryPrimary Treating PhysicianNon-Industrial Motor Vehicle CollisionIntervening EventAgreed Medical ExaminerCausation
References
1
Case No. ADJ2126841 (LAO 0848423)
Regular
Oct 23, 2014

ESPERANZA LUCIA MELENDEZ vs. KELLERMEYER BUILDING SERVICES LLC, ZURICH AMERICA INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

The Board reconsidered a WCJ's award of home health care for an applicant injured in 2004, finding the defendants' arguments regarding IMR and authorization rules inapplicable due to the injury date. While affirming the need for home health care supported by medical opinions, the Board remanded the case to determine the specific scope and amount of such services, distinguishing them from non-industrial conditions. The Board reversed the WCJ's finding that the applicant's right ankle injury was industrially related due to a lack of substantial medical evidence and applicant testimony. Therefore, the award is affirmed in part, with the home health care scope deferred and the ankle injury deemed non-industrial.

Independent Medical ReviewLabor Code section 4610.5home health caremedical treatmentsection 4600prescriptionqualified medical evaluatoradmissiblehearsaycompensable consequence
References
2
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