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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. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ10265190
Regular
Jun 12, 2017

HANAN MEGALLA vs. COUNTY OF SAN BERNARDINO

This case involves a worker who sustained severe injuries from gunshot wounds and sought additional physical therapy. The defendant employer argued that the request was untimely and beyond the post-surgical treatment period, and that the applicant failed to establish medical necessity. The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding the finding that the employer failed to timely and effectively serve the Utilization Review denial. The Board found the additional physical therapy was reasonable and necessary, and that the request fell within the permissible 24-visit limitation after the post-surgical period concluded.

Workers' Compensation Appeals BoardUtilization ReviewService of DeterminationReconsiderationMedical TreatmentFindings and AwardWCJApplicantDefendantSan Bernardino County
References
Case No. ADJ9857146
Regular
Apr 10, 2017

JOSHUA HARNER vs. RUSSELL MECHANICAL, INC., ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The applicant sustained an industrial elbow injury on his first day of employment as a laborer. While the Board affirmed the finding of industrial injury and temporary disability period, it deferred the calculation of the temporary disability rate. This deferral is to allow for further development of the record regarding the applicant's earning capacity under Labor Code section 4453(c)(4), given his lack of prior work history.

Workers' Compensation Appeals BoardIndustrial InjuryLeft Elbow InjuryLaborerMachine Shop WorkerDecember 11 2014Temporary DisabilityPetition for ReconsiderationAgreed Medical ExaminerComminuted Fracture
References
Case No. ADJ10443669
Regular
Oct 04, 2017

Donna Carter vs. Rose International Group, OneBeacon Insurance Group

The Appeals Board affirmed the Workers' Compensation Judge's finding that Donna Carter sustained an industrial injury to her right knee and left wrist on May 18, 2016. Despite inconsistencies in the applicant's testimony regarding a slip and fall incident, her account was corroborated by a witness who found her on the floor. Medical records from the day of the incident also supported the applicant's claim, establishing a clear mechanism of injury. The Board found that the common sense nature of a slip and fall does not require expert medical opinion to establish industrial causation for the incident itself.

ADJ10443669Rose International GroupOneBeacon Insurance GroupDonna CarterWorkers' Compensation Appeals BoardOpinion and Decision After Reconsiderationslip and fallindustrial injuryright kneeleft wrist
References
Case No. ADJ 4200496 (GRO 0030688)
Regular
Jan 19, 2010

FRANCISCO MARTINEZ-REYES vs. SOLAMAR FARMS, INC., STATE COMPENSATION INSURANCE FUND

This case concerns the proper method for calculating permanent disability award commutations for a farm laborer with 100% disability sustained on February 10, 2004. The applicant appeals the administrative law judge's decision favoring the Uniformed Reduction (UR) method, arguing the Uniformed Increasing Reduction (UIR) method better accounts for state average weekly wage (SAWW) increases mandated by Labor Code section 4659. The Appeals Board granted reconsideration, rescinded the prior decision, and remanded the case for a new decision. The Board found the UIR method better serves the goal of consistent periodic payments, and the SAWW increase commencement date was not moot.

Workers' Compensation Appeals BoardUniformed Reduction (UR)Uniformed Increasing Reduction (UIR)State Average Weekly Wage (SAWW)Permanent Disability AwardCommutationLabor Code Section 4659Life PensionTotal Permanent DisabilityCost of Living Adjustment (COLA)
References
Case No. ADJ8857482
Regular
Jan 28, 2014

RENE QUINTANA vs. NEW ALBERTSONS, INC.; SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involved a petition for reconsideration that was denied by the Workers' Compensation Appeals Board. The Board adopted the findings of the workers' compensation administrative law judge, also denying reconsideration. The applicant's complaints regarding the Agreed Medical Evaluator's (AME) review of medical records, consideration of MRI films, and comments on an "internal injury/hernia" were rejected. The Board found no error in the AME's report or the approval of the compromise and release agreement given the applicant's claimed injuries and representation by counsel.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorOrthopedicsMedical Records ReviewMRI FilmInternal InjuryHerniaCompromise and Release AgreementWCJ Report
References
Case No. ADJ1353365
Regular
Sep 16, 2008

MARIA GUILLEN vs. LE MERIGOT HOTEL; ARROWPOINT CAPITAL CORPORATION; MARRIOTT INTERNATIONAL/HOLLYWOOD RENAISSANCE HOTEL

The WCAB granted reconsideration, affirming the June 25, 2008 Findings and Award but amending it to be a Joint and Several Findings and Award and appointing Le Merigot as administrator.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardJoint and SeveralLe Merigot HotelArrowpoint Capital CorporationMarriott InternationalHousekeeperIndustrial InjuryNeck Injury
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ7166686
Regular
Jul 24, 2012

RICHARD ANDERSON vs. JAGUAR/LANDROVER OF VENTURA, COMPWEST INSURANCE COMPANY

This case involves an applicant who suffered a stroke and subsequent 100% permanent disability following surgery for an industrial shoulder injury. The defendant sought reconsideration, arguing for apportionment to pre-existing conditions and challenging the attorney's fee calculation. The Appeals Board affirmed the 100% permanent disability finding, finding no basis for apportionment as the applicant's pre-existing conditions did not cause the disability itself. However, the Board modified the attorney's fee award, requiring commutation using a specific method and a 3% cost of living adjustment, finding the previously assumed 4.6% to be speculative.

Workers Compensation Appeals BoardRichard AndersonJaguar/Landrover of VenturaCompwest Insurance CompanyADJ7166686ReconsiderationFindings and AwardIndustrial InjuryBrain InjuryNeurological System
References
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