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

Case No. ADJ1279352
Regular
Nov 18, 2010

WARREN BARNA vs. PACIFIC TUBE, ST. PAUL TRAVELERS, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of an award finding them liable for an applicant's psychiatric injury. The applicant had previously settled orthopedic claims and a cumulative trauma claim. The Appeals Board granted reconsideration to amend the original decision, adding specific findings required by Labor Code section 4751 regarding the applicant's pre-existing psychiatric disability and the compensable industrial psychiatric injury. The Board affirmed the original finding of liability against the SIBTF, while clarifying the applicant's eligibility for SIBTF benefits and addressing the issue of potential offsets.

Subsequent Injuries Benefits Trust Fundpsychiatric disabilitypre-existing disabilityindustrial injurypermanent partial disabilityLabor Code section 4751Workers' Compensation Appeals Boardreconsiderationcumulative traumaspecific injury
References
0
Case No. ADJ1315350 (VNO 0557111)
Regular
Apr 20, 2012

LINDA KAMBOW vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, VALLEY STATE PRISON FOR WOMEN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by an inmate laborer for orthopedic and psychiatric injuries. The Workers' Compensation Appeals Board denied reimbursement to Hepps Pharmacy for medications, as no prescription was provided. The Board also reversed an award to Southern California Mental Health Associates for psychiatric treatment, ruling that inmate psychiatric injuries are not compensable under Labor Code section 3208.3(j). The Board found that the psychiatric injury was a consequence of the industrial orthopedic injury, and thus not a compensable independent non-industrial condition requiring treatment to relieve orthopedic effects.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code 3208.3(j)Inmate laborerIndustrial orthopedic injuryNon-industrial psychiatric treatmentPrimary treating physicianSubstantial medical evidenceCompromise and Release AgreementLien trial
References
4
Case No. ADJ8418862
Regular
Aug 26, 2018

CARMEN MEJIA vs. COUNTY OF ORANGE

This case involves an applicant seeking workers' compensation for a psychiatric injury and orthopedic issues against the County of Orange. The Appeals Board denied the defendant's petition for reconsideration regarding the psychiatric injury, finding the defendant failed to prove the injury was substantially caused by good faith personnel actions. The Board granted the applicant's petition, deferring orthopedic injury issues to the trial level due to insufficient medical evidence and contradictory expert opinions. The matter is returned for further development of the record regarding back, chest, and other orthopedic claims, as well as permanent disability and future medical treatment.

Labor Code section 3208.3psychiatric injurypredominant as to all causesactual events of employmentlawful nondiscriminatory good faith personnel actionsubstantial causetotality of circumstancesqualified medical evaluator (QME)panel qualified medical evaluator (PQME)cumulative trauma
References
15
Case No. ADJ9674255
Regular
Jul 10, 2017

YAN LIU vs. HAWAIIAN GARDENS CASINO, INSURANCE COMPANY OF THE WEST

This case concerns an applicant who alleges both orthopedic and psychiatric injuries from her employment as a casino dealer. While the Board affirmed the finding of orthopedic injury, it deferred the issue of psychiatric injury. The Board clarified that Labor Code § 4660.1(c) does not bar psychiatric claims arising directly from employment events, but it requires a medical apportionment of causation between direct psychiatric injury and injury as a consequence of physical injury. The matter was returned to the trial level for further development of the record regarding the psychiatric injury and its apportionment.

AOE/COELabor Code Section 4660.1(c)psychiatric injurycompensable consequenceviolent actsubstantial medical evidencetreating physicianQMEcontinuous traumaharassment
References
10
Case No. ADJ9041984 ADJ9040577
Regular
Dec 21, 2018

ISABEL VALENCIA vs. FIFTH AND PACIFIC COMPANIES, HARTFORD CASUALTY INSURANCE COMPANY, BROADSPIRE SERVICES, INC.

This case involves applicant Isabel Valencia's claim for psychiatric injury stemming from a previously stipulated orthopedic injury. The defendant contended the psychiatric injury was not work-related, arguing it was a consequence of the physical injury. The Appeals Board denied reconsideration, affirming that a "compensable consequence" injury, like a psychiatric condition resulting from an industrial orthopedic injury, is industrially related. The Board also found it appropriate to further develop the record regarding applicant's disability, as the current psychiatric condition prevents accurate assessment.

WORKERS' COMPENSATION APPEALS BOARDFIFTH AND PACIFIC COMPANIESHARTFORD CASUALTY INSURANCE COMPANYBROADSPIRE SERVICESINC.ADJ9041984ADJ9040577Findings Award and Orderstipulationpsychiatric injury
References
1
Case No. ADJ7558173
Regular
Oct 28, 2014

JESSIE MOORE vs. PASADENA AREA COMMUNITY COLLEGE DISTRICT

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and found the applicant was not temporarily totally disabled after her retirement. The Board determined that while the applicant stated her retirement was reluctant, the primary reasons cited were hostile work environment and emotional stress, not solely orthopedic injuries. Medical evidence did not substantially support the claim that the admitted orthopedic injuries alone rendered her temporarily totally disabled. Consequently, temporary disability benefits were not awarded for the orthopedic injuries.

Workers' Compensation Appeals BoardJessie MoorePasadena Area Community College DistrictKeenan & Associatesstatute of limitationstemporary disabilitycumulative traumacervical spinelumbar spineleft wrist
References
7
Case No. ADJ2610987 (SBR 0304298)
Regular
Feb 11, 2011

ELSIE SMITH vs. LAIDLAW, BROADSPIRE, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The applicant sought reconsideration of a decision denying Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, upholding the finding that the applicant failed to prove a disabling pre-existing condition before her 2001 injury or a combined permanent disability of at least 70%. The WCAB found the administrative law judge properly relied on the AME's orthopedic opinion and disregarded an older report, also noting the applicant's attorney improperly submitted deposition testimony not in evidence. The attorney was admonished for improper evidence submission and potentially sanctionable conduct.

Subsequent Injuries Benefits Trust FundSIBTFPreexisting permanent disabilityLabor Code section 4751Agreed Medical EvaluatorAMEMedical reportsWCJPetition for ReconsiderationCompromise and Release
References
6
Case No. ADJ9944770
Regular
Oct 19, 2018

Sam Zavalata vs. Conifer Value Based Care, LLC

This case involves applicant Sam Zavaleta's workers' compensation claim for psychiatric and orthopedic injuries against Conifer Value Based Care, LLC. The Workers' Compensation Appeals Board (WCAB) rescinded the trial judge's decision, finding that the medical opinions from both the orthopedic and psychiatric evaluators required further development. Specifically, issues exist regarding the orthopedic causation of cumulative trauma injury to the applicant's psyche, back, neck, and wrist, as well as the substantial causation of the psychiatric injury in relation to the defendant's good faith personnel action defense. The matter is returned to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPsychiatric InjuryCumulative TraumaPersonnel Action DefenseGood FaithCausationMedical OpinionApportionment
References
12
Case No. ADJ3015781 (VNO 0511310) ADJ3473132 (VNO 0544088)
Regular
Oct 25, 2011

WANDA ROYBAL vs. BARRETT BUSINESS SERVICES, INC., PINNACLE RISK MANAGEMENT

The applicant sought reconsideration of findings that her psychiatric injury from a 2004 robbery was not presumed compensable and that further medical treatment was not needed for a 2005 orthopedic injury. The Board denied reconsideration, finding insufficient evidence the employer was notified of a claimed psychological injury from the robbery within the timeframes required for a Labor Code §5402 presumption. Regarding the orthopedic injury, the Board found that while the injury was industrial, the applicant's own deposition testimony and medical records indicated no further need for treatment. The applicant's credibility regarding her knowledge of the claims process was also questioned.

ADJ3015781ADJ3473132WANDA ROYBALBARRETT BUSINESS SERVICESPINNACLE RISK MANAGEMENTRECONSIDERATIONLABOR CODE 5402PSYCHE INJURYORTHOPEDIC INJURYJANUARY 5 2005
References
1
Case No. ADJ9068768 (MF)
Regular
Sep 15, 2017

CHEILITA LANE vs. SAN BERNARDINO COUNTY

This case involves an applicant alleging cumulative trauma injury to her neck, shoulders, lower extremities, and a psychiatric injury due to her employment as a probation officer. The defendant sought reconsideration of the original award, challenging the applicant's credibility and the compensability of the psychiatric injury, arguing it stemmed from subjective perceptions rather than actual events. The Appeals Board granted reconsideration, affirming the psychiatric injury finding based on substantial evidence and the WCJ's report. However, they amended the award to defer issues related to the orthopedic injury, medical treatment for it, and permanent disability, remanding the matter for further proceedings to develop the medical record regarding the orthopedic claim.

Workers' Compensation Appeals BoardCumulative TraumaPsychiatric InjuryOrthopedic InjuryQualified Medical EvaluatorSubstantial EvidencePermanent DisabilityMedical TreatmentPermanent and Stationary DateVocational Rehabilitation
References
0
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