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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
Case No. ADJ6408456
Regular
May 17, 2010

KENNETH M. HOOVER vs. CITY OF POMONA

The Appeals Board granted reconsideration of the WCJ's award of 100% permanent total disability. The Board found that the WCJ's decision was not supported by substantial evidence, primarily due to deficiencies in Dr. Grodan's medical reporting regarding the applicant's skin and cardiovascular conditions. The matter was returned to the trial level for further development of the record and a new decision. The Board confirmed the application of the 1997 Permanent Disability Rating Schedule and the admission of Dr. Shirman's report.

WORKERS' COMPENSATION APPEALS BOARDADJ6408456KENNETH M. HOOVERCITY OF POMONAreconsiderationFindings and Award and Orderworkers' compensation administrative law judgeWCJMay 172010
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. ADJ6481250 ADJ7453468
Regular
Jun 06, 2011

PUI HOY vs. HYATT REGENCY SAN FRANCISCO, LIBERTY MUTUAL 29073 GLENDALE

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, rescinded the prior decision, and returned the case for further medical record development. The WCAB found that the Administrative Law Judge's award of temporary disability benefits was not supported by substantial medical evidence due to ambiguities in the Agreed Medical Examiner's reports. Specifically, the reports lacked clear reasoning on causation, permanent and stationary dates, and the impact of the applicant's back and knee conditions on her ability to work. The matter is remanded for the WCJ to obtain a supplemental report from the examiner to clarify these critical issues.

Pui HoyHyatt Regency San FranciscoLiberty MutualPetition for ReconsiderationFindings of Fact and Awardtotally temporarily disabledtemporary disability indemnity benefitssubstantial medical evidenceAgreed Medical Examiner (AME)Peter Mandell
References
Case No. ADJ11066144
Regular
Feb 12, 2018

ELVIA ANGUIANO DE RANGEL vs. RUIZ FOOD, SAFETY NATIONAL INSURANCE COMPANY

This case concerns a workers' compensation claim for injuries sustained by Elvia Anguiano de Rangel while employed by Ruiz Food. The initial findings by the WCJ awarded injury to the right shoulder, neck, and low back, but the defendant sought reconsideration, arguing that prior medical reports should have res judicata effect and that current medical evidence is insufficient. The Appeals Board granted reconsideration, rescinded the initial findings, and returned the case to the trial level. This decision stems from the Board's determination that neither the applicant's treating physician's report nor the defendant's relied-upon QME report constituted substantial medical evidence, necessitating further development of the record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactQualified Medical EvaluatorPanel Qualified Medical EvaluatorRes JudicataCollateral EstoppelSubstantial Medical EvidenceCumulative TraumaAgreed Medical Examiner
References
Case No. MON 254928
En Banc
Feb 25, 2002

James Mc Duffie vs. Los Angeles County Metropolitan Transit Authority, Constitution State Service Company

The Board held that when a medical record requires further development after a case has been submitted, the preferred procedure is to first seek supplemental opinions from the physicians who have already reported in the case, rather than immediately appointing a new medical evaluator.

En Banc DecisionMedical Record DevelopmentSupplemental Medical OpinionsAgreed Medical EvaluatorQualified Medical EvaluatorCourt Appointed Medical ExaminerApportionmentStatute of LimitationsIndustrial InjuryBus Operator
References
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