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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Fernandez v. North Shore Orthopedic Surgery & Sports Medicine, P.C.

Frank Fernandez, an x-ray technician, sued his former employer, North Shore Orthopedic Surgery & Sports Medicine, P.C., for retaliation under Title VII after filing a national origin discrimination complaint. A jury found in favor of Fernandez, awarding back pay, front pay, and punitive damages. North Shore subsequently moved for judgment as a matter of law, a new trial, and to modify the damage awards. The court denied North Shore's motions for judgment and a new trial, affirmed the jury's back pay award, but vacated and reduced the front pay award from $160,000 to $50,000, and the punitive damages award from $100,000 to $50,000.

RetaliationTitle VIIEmployment DiscriminationBack PayFront PayPunitive DamagesMitigation of DamagesFederal Rules of Civil ProcedureJudicial DiscretionEquitable Relief
References
27
Case No. 2017 NY Slip Op 03580 [150 AD3d 1349]
Regular Panel Decision
May 04, 2017

Claim of Richards v. Massena Central Schools

Mary Ann Richards, a cleaner, sustained neck injuries in March 2010 while working for Massena Central Schools, leading to an established workers' compensation claim and cervical surgery. In June 2013, she sought to amend her claim to include consequential neurological injuries, specifically scapulothoracic crepitation and mandibular dysesthesia. Both the Workers' Compensation Law Judge and the Workers' Compensation Board denied this amendment, concluding that Richards failed to demonstrate a causal relationship between her established work injury and the alleged consequential conditions. The Appellate Division, Third Department, affirmed the Board's decision, finding it supported by substantial evidence. Multiple medical professionals, including orthopedic surgeons and neurologists, provided opinions that either could not determine the etiology of Richards' symptoms or found no objective evidence linking them to her work injury or subsequent surgery.

Workers' CompensationNeurological InjuryCausationMedical EvidenceAppellate ReviewScapulothoracic CrepitationMandibular DysesthesiaCervical SurgeryIndependent Medical ExaminationBurden of Proof
References
5
Case No. ADJ10917207
Regular
Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute
References
9
Case No. ADJ7264915
Regular
Jul 15, 2013

ANA GONZALES vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

This case involves an applicant who sustained industrial psychiatric injury but whose orthopedic claims were denied due to insufficient medical evidence. The Appeals Board denied the applicant's petition for reconsideration, finding the applicant failed to present substantial medical evidence of industrial causation for her orthopedic complaints. A dissenting commissioner argued that the primary medical evaluator's report was deficient and lacked substantial evidence, warranting further development of the record on orthopedic injuries and other claims. The dissent emphasizes the Board's duty to ensure substantial justice, suggesting it should have ordered further investigation on the denied orthopedic issues.

WCABPetition for ReconsiderationFindings and Orderindustrial injurypsychelow backneckright shoulderright wristright elbow
References
11
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. ADJ2434971 (OAK 0238163)
Regular
Dec 02, 2010

ANA RODRIGUEZ vs. SHERATON PALACE HOTEL, TOKIO MARINE

The Workers' Compensation Appeals Board denied reconsideration of a finding that the applicant, Ana Rodriguez, did not sustain new and further permanent disability subsequent to a 1997 stipulated award. The judge found her testimony regarding increased orthopedic and psychiatric symptoms to be not credible. Medical evidence from Dr. Edington indicated no orthopedic increase in disability since the award, and the psychiatric disability became permanent and stationary concurrently with the orthopedic condition. Therefore, the judge concluded there was no "new and further" disability as defined by Labor Code Section 5410.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedCredibility FindingGarza v. Workers' Comp. Appeals Bd.Stipulated AwardPetition to ReopenNew and Further DisabilityOrthopedic DisabilityPsychiatric Disability
References
2
Case No. ADJ9975590; ADJ9976116
Regular
Feb 25, 2016

Ana Nieto vs. Avitus, Inc., American Zurich Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the appealed order was interlocutory and not subject to reconsideration. The WCAB treated the petition as one for removal and denied it, as the defendant failed to demonstrate substantial prejudice or irreparable harm. The defendant's contention that their trial exhibits and an orthopedic QME panel were erroneously stricken was rejected, as was their claim that the orthopedic QME panel was improperly denied. The defendant failed to provide sufficient evidence to support their request for an orthopedic QME panel over a chiropractic one.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings of Fact & OrdersQualified Medical Evaluator (QME)Orthopedic Surgery QMEChiropractic QMETrial ExhibitsAdministrative Law Judge (WCJ)Labor Code § 4062.2
References
6
Case No. ADJ11913752
Regular
Nov 19, 2019

LAURA DOW vs. UCSF, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns a dispute over the proper procedure for requesting a Qualified Medical Evaluator (QME) panel after a workers' compensation claim was denied. The Workers' Compensation Appeals Board (WCAB) granted removal, reversing a WCJ's decision. The WCAB found that the defendant's request for an orthopedic surgery QME panel was valid, initiated after the denial notice and statutory waiting period. They also determined that orthopedic surgery was an appropriate specialty, overriding the WCJ's order for a pain medicine panel. The parties are now directed to proceed with the orthopedic surgery QME panel.

QME panelPetition for RemovalOpinion and OrderFindings and OrdersMedical UnitPain MedicineOrthopedic SurgeryDenial NoticeQualified Medical EvaluatorLabor Code Section 4060
References
4
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
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