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Reconsideration granted to address errors in permanent disability rating and apportionment. Matter returned for new rating considering walker use and clarifying apportionment.
The applicant sought reconsideration of a denied authorization for Synvisc knee injections. The original Independent Medical Review (IMR) denied the request, finding no documentation of the applicant's osteoarthritis failing to respond to conservative treatment. The Appeals Board found this IMR determination was based on a plainly erroneous finding of fact, as medical records in the file directly contradicted this assertion. Therefore, the Board granted the applicant's appeal, rescinded the WCJ's decision, and remanded the case for a new IMR.
Applicant sought reconsideration of a $23\%$ permanent disability award, arguing the $40\%$ apportionment to non-industrial factors lacked substantial medical evidence. The Workers' Compensation Appeals Board denied reconsideration, adopting the trial judge's report. The Board found the Qualified Medical Evaluator's apportionment was based on substantial medical evidence, including applicant's pre-existing osteoarthritis and a prior knee replacement, which explained the causation for the permanent disability. The Board also confirmed timely action on the petition within the statutory 60-day period.
The Appeals Board rescinded the original award due to an insufficient apportionment of permanent disability. The Board found that the QME's opinion, which attributed 75% of the applicant's left knee disability to pre-existing osteoarthritis, lacked adequate reasoning and was not substantial evidence. Therefore, the case was returned for further development of the record regarding apportionment, specifically concerning the QME's rationale. The Board clarified that while the applicant sustained an admitted injury to her left knee, the extent of permanent disability and its causation require further medical evaluation.
The Appeals Board affirmed the WCJ's decision, finding applicant reached permanent and stationary status on October 3, 2008, based on Agreed Medical Evaluator (AME) Dr. Chun's substantial evidence. The Board also upheld the 90% apportionment of permanent disability to applicant's pre-existing degenerative osteoarthritis, finding Dr. Chun's opinion supported by Dr. Rimoldi's report. The applicant's arguments regarding the P&S date and apportionment were rejected as misplaced or not supported by substantial evidence.
This case concerns a petition for reconsideration of a finding that applicant sustained industrial injury to his right knee on October 2, 2009. The defendant argued that the Agreed Medical Evaluator's (AME) opinion did not support industrial injury and that the applicant's attorney engaged in ex parte communication. The Board denied the petition, finding the AME's opinion regarding the right knee injury insufficient. The Board adopted the WCJ's reasoning that the mechanism of injury, as reported by the applicant and corroborated by other physicians, along with the presence of a new tear on MRI, supported the industrial causation finding.
The Appeals Board granted reconsideration and reversed the WCJ's finding that the applicant was permanent and stationary on June 1, 2009. The Board found the Agreed Medical Evaluator's (AME) opinion more persuasive, concluding the applicant was not yet permanent and stationary due to ongoing recovery from knee surgery. Consequently, temporary disability benefits are awarded through October 26, 2009, with further proceedings to determine benefits thereafter.
The Workers' Compensation Appeals Board granted reconsideration to amend a previous award. The Board found that the applicant's primary treating physician's apportionment of 15% of the hip disability to non-industrial factors was based on substantial medical evidence, and should have been incorporated. This amendment reduced the applicant's permanent disability rating from 72% to 66%. The dissenting opinion argued that the physician's apportionment lacked sufficient detail to constitute substantial evidence.
This case involves a workers' compensation appeal where the defendants seek reconsideration of a prior award. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The primary grounds for this decision were that the defendants were denied due process by not being given an opportunity to cross-examine the rating rater and that the award relied on outdated medical reports. The WCAB also suggested obtaining current medical evaluations due to the time elapsed since the original reports.
The WCAB granted reconsideration, rescinded the prior decision, and returned the matter for further proceedings due to issues with the date of injury and apportionment of disability.
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