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

Case No. ADJ10749554
Regular
Nov 06, 2018

APRIL SIMMONS COOK vs. DESERT OASIS HEALTHCARE, GALLAGHER BASSETT SERVICES, INC.

This case involves a dispute over whether defendant's communication with a Qualified Medical Evaluator (QME) violated Labor Code section 4062.3. The Workers' Compensation Appeals Board (WCAB) granted reconsideration and removal, rescinding the original Findings and Award. The WCAB will return the matter to the trial level for further proceedings and a new decision by the WCJ. This action is taken to align the decision with the recent en banc opinion in *Suon v. California Dairies* regarding violations of section 4062.3.

Workers' Compensation Appeals BoardPetition for RemovalEx Parte CommunicationLabor Code Section 4062.3Qualified Medical EvaluatorAttorney's FeesFindings and AwardEn Banc DecisionSuon v. California DairiesRescinded
References
1
Case No. ADJ3844537 (ANA 0379640)
Regular
Apr 21, 2016

RAUL MERCADO CHAVEZ vs. PC INDUSTRIES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded the WCJ's decision and returned the case for further proceedings. The Board found the WCJ's decision was procedurally flawed for failing to resolve all issues and substantively deficient because the finding of 100% permanent disability was not supported by substantial evidence. Specifically, the vocational expert's opinion was found unreliable as it did not adequately consider the AMEs' medical restrictions. The Board ordered updated medical opinions and further development of the record before a new decision is rendered.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityVocational RehabilitationSubstantial EvidenceBifurcated DecisionDue ProcessLabor CodeMedical OpinionsApportionment
References
8
Case No. ADJ1124701 (OAK 0304697)
Regular
Jan 25, 2010

GENE THOMAS vs. SLEEP TRAIN MATTRESS CENTER, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision favoring the applicant's spinal surgery, finding that proper procedural steps were not followed. The employer's utilization review (UR) had denied the surgery, but neither party followed the required second-opinion process under Labor Code section 4062(b). The WCAB returned the case to the trial level, allowing the employer ten days from receipt of the decision to object to the surgery and initiate the second-opinion process. This decision aligns with the WCAB's en banc ruling in *Cervantes*, which clarified the procedures for handling spinal surgery disputes after UR denials.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code section 4062(b)Spinal SurgerySecond OpinionCervantes v. El Aguila Food ProductsACOEM GuidelinesExperimental TreatmentEn Banc DecisionAdministrative Director Rules
References
4
Case No. ADJ2530222 (MON 0304365)
Regular
Jun 06, 2013

DIANE DAVIS vs. LOS ANGELES COUNTY METROPOLITAN TRANSPORTATION AUTHORITY, TRAVELERS INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a WCJ's decision awarding applicant 58% permanent disability for injuries to her wrists and psyche. The WCAB found that the WCJ's decision lacked substantial evidence because the medical opinions on apportionment and permanent disability were insufficient, particularly Dr. Gilberg's unclear apportionment and the failure to consider Drs. Richman and Furst's opinions. The case is returned to the trial level for further proceedings to obtain clearer medical evidence and address specific contentions from the Subsequent Injuries Benefits Fund regarding apportionment and overall permanent disability.

Subsequent Injuries Benefits Trust FundPermanent Total DisabilityApportionmentCumulative TraumaCognitive DisorderPseudo-dementiaChronic Pain SyndromeNeuropathic Pain SyndromeSubstantial EvidenceMedical Probability
References
8
Case No. ADJ7348149
Regular
Mar 18, 2019

CELINE ROUYA vs. SAVE MART SUPERMARKETS, CORVEL CORPORATION

The applicant appeals the WCJ's decision denying injury to psyche and other body parts, arguing the WCJ erred by not addressing her harassment claim and finding the personnel actions were in good faith. The Appeals Board granted reconsideration to further study the issues, noting discrepancies in witness testimony and insufficient medical opinions on causation. The case is returned to the WCJ for further proceedings to develop the record, including obtaining clarified medical opinions on causation and further testimony. The dissenting commissioner would affirm the WCJ's decision, finding the personnel actions were legal and non-discriminatory, and applicant's harassment claims were not supported by objective evidence.

Workers' Compensation Appeals BoardCeline RouyaSave Mart SupermarketsCorvel CorporationADJ7348149ReconsiderationPsychiatric InjuryPharmacy TechnicianHarassmentNational Origin
References
5
Case No. ADJ2653468 (LBO 0389795), ADJ7229862, ADJ9578758, ADJ10137164
Regular
Apr 28, 2017

MUKESH SINGH vs. STATE OF CALIFORNIA

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision awarding high permanent disability ratings to Mukesh Singh based on a vocational expert's opinion that he couldn't compete in the labor market. The WCAB found the expert's opinion insufficient because it failed to adequately address the impact of non-industrial factors and the applicant's ability to participate in vocational rehabilitation. Consequently, the WCAB amended the decision to use scheduled permanent disability ratings for each of the applicant's three injuries, allowing for apportionment among them. This adjustment corrects an improper use of the Combined Values Chart for combining distinct injuries and aligns the award with existing legal precedent on rebutting scheduled ratings.

Workers' Compensation Appeals BoardLegally UninsuredJoint Findings and AwardPetition for ReconsiderationPermanent DisabilityScheduled RatingsApportionmentVocational ExpertSubstantial EvidenceLeBoeuf Rule
References
6
Case No. ADJ1225282 (VNO 0377064) ADJ3069813 (VNO 0377062)
Regular
May 05, 2015

CHERYL CASTRILLO vs. CATHOLIC HEALTH CENTER WEST dba. MARIAN MEDICAL CENTER

The Workers' Compensation Appeals Board affirmed a prior decision finding that the defendant properly completed and communicated utilization review decisions, and that the applicant failed to prove the Independent Medical Review (IMR) process was biased. The Board held that delays in IMR decisions do not invalidate them, citing a relevant appellate court opinion. Furthermore, the Board lacks the authority to rule on the constitutionality of the relevant Labor Code sections. Therefore, the original decision was upheld.

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewAdministrative DirectorPetition for ReconsiderationFindings of Fact and OrderWCJLabor Codeconstitutionalitytimeliness
References
3
Case No. ADJ7159953
Regular
Feb 17, 2012

ANTONIO CORONA vs. RANDSTAD NORTH AMERICA, ACE AMERICAN INSURANCE COMPANY

Lien claimants sought reconsideration of an administrative law judge's order disallowing their liens and imposing sanctions. The Appeals Board granted reconsideration, rescinded the order, and returned the matter for a decision on the merits. The Board found the sanctions unjustified due to unclear orders regarding trial briefs and lack of proper notice, and further noted the judge failed to issue a required opinion explaining the basis for disallowing the liens. The case is remanded for a proper decision with an explanatory opinion.

Workers' Compensation Appeals BoardLien ClaimantsReconsiderationWCJ OrderSanctionsTrial BriefsBurden of ProofCompromise and ReleaseIndustrial InjuryUtilization Review
References
2
Case No. ADJ1242432 (LAO 0810317) ADJ1936406 (LAO 0857303)
Regular
Feb 01, 2011

REYNA MEZA vs. PACPRO MANAGEMENT, Dba COAST SPORTSWEAR, AMERICAN CLAIMS MANAGEMENT for EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, By Its Facilitating Agent, INTERCARE INS. SERVICES, for PAULA INSURANCE COMPANY, In Liquidation

Everest National Insurance Company seeks reconsideration of an arbitrator's decision awarding CIGA $\$95,245.36$ in reimbursement for cumulative trauma benefits. Everest argues the arbitrator erred by finding the cumulative trauma extended over the applicant's entire employment, contrary to the Agreed Medical Examiner's (AME) opinion. The Appeals Board granted reconsideration, finding the AME's opinion legally flawed and lacking substantial evidence for the extended cumulative trauma period. The matter is remanded to the arbitrator for further proceedings to develop the medical record and render a new decision.

Workers' Compensation Appeals BoardIndustrial InjuryCumulative TraumaSpecific InjuryAgreed Medical ExaminerPetition for ReimbursementCalifornia Insurance Guarantee AssociationInsurance Coverage PeriodInjurious ExposureSubstantial Evidence
References
9
Case No. ADJ1137286
Regular
Mar 03, 2009

PINAZ KOLAHI vs. GENERAL MOTORS CORP., SEDGWICK CLAIMS MANAGEMENT

Defendant General Motors seeks reconsideration of a Workers' Compensation Appeals Board decision awarding temporary disability, permanent disability, and future medical treatment to applicant Pinaz Kolahi. Defendant argues the cumulative trauma period ending date is unsupported, temporary disability is unsubstantiated, and permanent disability indemnity was calculated at an incorrect rate. The Board granted reconsideration, rescinded the original and amended findings, and remanded the case for further proceedings due to an apparent inconsistency between the amended findings and opinion on decision. The Board expressed no opinion on the merits of the underlying contentions.

WCABADJ1137286VNO 0490167Pinaz KolahiGeneral Motors Corp.Sedgwick Claims ManagementFindings and AwardAmended Findings and AwardPetition for ReconsiderationReport and Recommendation
References
2
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