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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. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ8415183
Regular
Apr 27, 2015

TIM HAGER vs. COUNTY OF SANTA CLARA CENTRAL FIRE DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to correct a technical rating error in the applicant's permanent disability award. The Board affirmed the original finding that the applicant, a firefighter, sustained industrial injuries to his bilateral upper extremities and heart. However, the permanent disability rating was adjusted from 71% to 70% due to the correction of a specific rating modifier. The Board also found that the orthopedic Agreed Medical Evaluator's use of grip loss to rate the applicant's upper extremity impairment was supported by substantial evidence.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityFirefighterBilateral Upper ExtremitiesHeart HypertensionAgreed Medical Evaluator (AME)Orthopedic AMEInternal Medicine AME
References
Case No. ADJ4552593 (MON 0258406) ADJ6674320
Regular
Jun 21, 2011

KIMBERLY DeNOVA-JOY vs. SANTA PAULA ELEMENTARY SCHOOL DISTRICT, CIGA On Behalf of FREMONT INSURANCE COMPANY In Liquidation, As Administered By CAMBRIDGE INTERGRATED SERVICES

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, remanding the case for further proceedings. The Board found the WCJ failed to fully address apportionment, a mandated issue. Specifically, the WCJ neglected to consider apportionment of orthopedic and psychiatric disability as determined by AMEs, beyond the rheumatologist's opinion on fibromyalgia. The Board also noted that existing medical reports may be stale, necessitating potential new evaluations.

Workers' Compensation Appeals BoardReconsiderationApportionmentPermanent DisabilityFibromyalgiaCumulative TraumaMedical EvidenceExpert Medical OpinionOrthopedicsPsychiatry
References
Case No. ADJ4653074 (BAK 0152415)
Regular
Oct 11, 2013

ROBERT HUFF vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to review the administrative law judge's decision regarding applicant Robert Huff's workers' compensation claim against the California Department of Corrections. The Board amended the findings to deny temporary total disability benefits for the period December 9, 2009, to March 7, 2011, as the applicant had exhausted his 104-week limit. The Board also deferred the issues of permanent disability and attorney's fees, remanding the matter for a new rating based on the orthopedic Agreed Medical Evaluator's March 5, 2012 report, while affirming the rejection of the psychiatric AME's apportionment. Finally, the Board corrected a clerical error regarding the weekly rate for permanent disability benefits.

WORKERS' COMPENSATION APPEALS BOARDROBERT HUFFCALIFORNIA DEPARTMENT OF CORRECTIONSPermissibly UninsuredSTATE COMPENSATION INSURANCE FUNDOpinion and Decision After ReconsiderationFindings of Fact Award and OpinionWCJAgreed Medical EvaluatorsAME
References
Case No. ADJ3824814 (AGO 0012776), ADJ2299798 (VNO 0327881)
Regular
Mar 06, 2012

PHILIP DAVIS vs. ROCKWELL INTERNATIONAL, now THE BOEING COMPANY, permissibly self-insured, adjusted by SEDGWICK CMS

The Appeals Board granted reconsideration and amended the award to include "Viagra" as a stipulated injured body part, based on the parties' prior agreement. The Board affirmed the denial of reimbursement for home care services from January 5, 1995, to November 22, 2000, as this issue was not clearly withdrawn from litigation. Furthermore, the Board upheld the denial of 24/7 home health care services from July 2, 2002, onward, as medical evaluations did not support such a need for orthopedic or pulmonary conditions. Finally, the applicant was admonished for exceeding the page limit for their reconsideration petition.

Viagranuclear waste workerhome care assistancepulmonary agreed medical examinerAMECompromise and ReleasestipulationsWorkers' Compensation Appeals BoardWCJFindings of Fact
References
Case No. ADJ7785251
Regular
Nov 14, 2014

Jon Brothers vs. STATE OF CALIFORNIA, DEPARTMENT OF FORESTRY AND FIRE PROTECTION, COASTAL/NORTH REGION; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to clarify that the applicant's cumulative trauma orthopedic injury claim is still under development. The Board agreed with the WCJ that the defense's medical expert, Dr. Baldwin, failed to provide substantial medical evidence due to a misunderstanding of cumulative trauma principles. Dr. Baldwin improperly required documented prior specific injuries to opine on cumulative trauma, thereby failing to adequately assess the applicant's extensive work history. Therefore, the case is affirmed except for the amendment of a finding of fact to reflect that the orthopedic injury claim is contested and requires further medical evaluation.

Cumulative traumaQualified Medical EvaluatorIndependent Medical Evaluatorsubstantial medical evidenceorthopedic injurybinaural hearing losscardiovascular systemBattalion Chiefretired annuitantorthopedic cumulative trauma
References
Case No. ADJ1023653 (MON 0331335)
Regular
Feb 05, 2009

BARBARA ARANA vs. THE HOME DEPOT, SEDGWICK CMS

The Workers' Compensation Appeals Board affirmed a prior decision regarding applicant Barbara Arana's industrial injury at The Home Depot, which caused back and psyche injuries. The Board found that the Agreed Medical Evaluator's (AME) report provided substantial evidence for apportioning 33 1/3% of the applicant's lumbar disability to pre-existing conditions. While one commissioner dissented, arguing the AME's apportionment report lacked clarity on the causal link between prior conditions and current disability, the majority adopted the WCJ's findings. This decision upholds the original award of 39% permanent disability after apportionment.

Agreed Medical Evaluator (AME)ApportionmentIndustrial InjuryLumbar DisabilityPsychiatric DisabilityPermanent DisabilityReconsiderationFindings and AwardSubstantial EvidencePre-existing Conditions
References
Case No. ADJ10187704, ADJ10924724
Regular
May 17, 2018

STEVEN CASE vs. GOLDEN GATE BRIDGE HIGHWAY AND TRANSPORTATION DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to increase applicant's permanent disability rating for bilateral shoulder injury from 9% to 38%. The Board found the Agreed Medical Evaluator's (AME) alternative rating, based on strength loss, was substantial medical evidence and properly considered within the AMA Guides. The WCJ erred in applying an overly restrictive interpretation of "complex or extraordinary" cases for deviating from strict AMA Guides ratings. The AME's use of strength loss data from the AMA Guides, even for an age outside the specified range, was permissible under the *Almaraz-Guzman* line of cases when justified by clinical judgment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationAgreed Medical Evaluator (AME)permanent disability ratingbilateral shouldersorthopedic AMEAMA GuidesAlmaraz-Guzmanstrength loss index
References
Case No. ADJ7867551; ADJ7867528
Regular
Feb 11, 2014

MARK MAYNE vs. INTEL CORPORATION

In *Mayne v. Intel Corporation*, the Appeals Board granted Defendant Intel's Petition for Removal. The Board agreed that an Agreed Medical Evaluator (AME) agreement cannot be unilaterally cancelled by one party for an untimely report, as the WCJ had found. Consequently, the Board amended the prior order to specify that any subsequent Qualified Medical Evaluator (QME) panel, if needed, must be in orthopedic surgery, the same specialty as the original AME. The Board also noted potential issues of ex parte communication and sanctions that the WCJ may address on remand.

Petition for RemovalAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Panel of QMEsJoint Findings of Fact and OrdersWCJAppeals BoardSupplemental ReportEx Parte CommunicationLabor Code section 5813
References
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