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

Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
Case No. SAL 0103596
Regular
Jan 07, 2008

CHRISTIE GAYNES vs. GRANITE ROCK COMPANY, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration. The applicant sought to have a medical evaluation by an anesthesiologist or neurologist, arguing the chosen Agreed Medical Evaluator (AME), an orthopedist, lacked the necessary expertise for her specific nerve pain. The Board found the petition untimely and upheld the WCJ's recommendation for dismissal.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Compelling AttendanceMedical EvaluationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)WCJReport and RecommendationDismissed PetitionTimeliness
References
Case No. ADJ6913767
Regular
Jul 05, 2012

YOLANDA BARCENAS vs. IN HOME SUPPORT SERVICES (IHSS), STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, finding that the applicant's psychiatric reports were inadmissible. The primary treating physician, an orthopedist, did not review or incorporate the reports from the applicant's treating psychiatrist, nor did he designate the psychiatrist to provide opinions. Consequently, the Board struck the finding of injury to the psyche and amended the permanent disability award to 28%, solely based on orthopedic findings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityPrimary Treating PhysicianOrthopedistPsychiatristAdmissibility of ReportsLabor Code Section 4061.5Injury to Psyche
References
Case No. ADJ635934
Regular
Sep 09, 2010

FRANCES LARUE vs. NORDMAN, CORMANY, HAIR & COMPTON, STATE COMPENSATION INSURANCE FUND

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's award finding permanent total disability and no apportionment for an applicant's back injury. The Board rescinded the award, finding the judge erred by relying on an orthopedist's opinion that failed to properly apportion disability to pre-existing scoliosis. The case is remanded for further proceedings to incorporate the apportionment opinion of the defendant's medical expert, who found 70% of the disability attributable to non-industrial scoliosis. A dissenting opinion argued that the defendant's medical expert's apportionment was also insufficient.

ApportionmentPermanent Total DisabilityQualified Medical EvaluatorOrthopedistDegenerative ScoliosisCausationLabor Code Section 4663Senate Bill 899Substantial EvidenceFindings and Award
References
Case No. ADJ7735457, ADJ6720971, ADJ7722714, ADJ7336302, ADJ6841161
Regular
Jan 25, 2013

JOHN HARRIS vs. CALIFORNIA DEPARTMENT OF JUSTICE, STATE COMPENSATION INSURANCE FUND, COUNTY OF SACRAMENTO, TRISTAR INSURANCE

The Workers' Compensation Appeals Board dismissed John Harris's Petition for Reconsideration because it was not taken from a final order, as the prior decision did not determine substantive benefit entitlement. Furthermore, the petition was deemed successive, as it sought to re-litigate an issue previously denied under a different procedural designation. The Board had previously denied applicant's request for removal regarding an orthopedist evaluation of his right knee, finding no significant prejudice. Therefore, the Petition for Reconsideration was dismissed.

Petition for ReconsiderationPetition for RemovalNon-final orderSuccessive petitionSubstantive issueEntitlement to benefitsOrthopedist evaluationSignificant prejudiceIrreparable harmWCJ denial
References
Case No. ADJ6938516 (LBO)
Regular
Jul 16, 2010

Robert Enciso vs. SANTA CLARITA CONCRETE, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to correct the date of injury in Robert Enciso's case from February 1, 2009, to January 16, 2009. While Enciso claimed injury to other body parts and sought further benefits, the Board affirmed the original findings that the injury was solely to his left index finger and resulted in no permanent disability or need for further medical treatment. This decision was based on stipulations made by Enciso's former attorney and supported by the medical opinion of Dr. Hakimian. The Board also found that the employer provided proper notice regarding the Medical Provider Network.

Petition for ReconsiderationFindings and OrderDate of InjuryPermanent DisabilityTemporary DisabilityMedical TreatmentStipulationsAverage Weekly EarningsMedical TreatmentMPN
References
Case No. ADJ3770794 (MON 0325184)
Regular

KATHRYN MOSS vs. VIVENDI/UNIVERSAL (UNIVERSAL MUSIC GROUP), AMERICAN HOME ASSURANCE COMPANY, CHARTIS

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, rescinded the previous Findings and Award, and returned the case for a new decision. The WCAB found that the original decision by the Workers' Compensation Judge (WCJ) failed to adequately reference specific evidence and failed to provide a sufficient basis for its findings on permanent disability and apportionment. Additionally, the WCAB determined that the attorney's fee award lacked proper explanation and calculation. The matter is to be returned to the WCJ to issue a new decision that fully complies with legal requirements, particularly Labor Code section 5313.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationIndustrial InjuryPermanent DisabilityApportionmentFibromyalgiaIrritable Bowel Syndrome (IBS)Skin DisorderNeurodermatitis
References
Case No. AD10769216
Regular
Dec 13, 2019

Richard Hovannisian vs. UCLA, Permissibly Self-Insured, Administered By SEDGWICK CMS

The WCAB granted reconsideration and deferred issues of lumbar spine injury and permanent disability from a prior award. The WCJ's decision relied on a QME report that failed to establish industrial causation for the lumbar spine injury and lacked sufficient explanation for departing from AMA Guides methodology for permanent disability ratings. The Board found these deficiencies meant the decision was not based on substantial medical evidence. Further proceedings are required for the QME to adequately address causation, rating methodology, and lumbar spine classification.

WCABPetition for ReconsiderationFindings of Fact & Awardindustrial injurylumbar spinepermanent disabilitysubstantial medical evidencedue processDisability Evaluation Unitpanel qualified medical evaluator
References
Case No. VNO 438338
Regular
Aug 17, 2007

CINDY HEWITT vs. RALPHS GROCERY STORE

The Appeals Board granted reconsideration, admitting Dr. Gumbs' reports into evidence, overturning the prior ruling that excluded them. They found that applicant sustained a cumulative industrial injury to her feet ending September 24, 2001, despite a potential earlier injury in 1991. All other issues remain deferred for further proceedings.

WCABRalphs Grocery Storecumulative injuryorthopedistpodiatristplantar fasciitisindustrial causationmedical-legal reportLabor Code § 5412reconsideration
References
Case No. ADJ2610305 (WCK 63412) ADJ3981181 (WCK 63413) ADJ1135990 (OAK 339001)
Regular
Mar 24, 2009

CATHY D. KRAUS vs. VETERINARY SURGICAL ASSOCIATES, FIREMAN'S FUND

This case involves a dispute over the correct temporary disability indemnity rate for an applicant injured in 2001. The applicant's original agreed rate was $420 per week based on $630 average weekly earnings, but a subsequent injury in 2006 led to payments at $480 per week. The WCJ awarded an indemnity rate of "at least $480 per week" for the 2001 injury, citing post-injury earnings as evidence of earning capacity. The Appeals Board granted reconsideration, rescinded the award, and remanded for further proceedings. The Board emphasized that post-injury earnings should only be considered if scheduled or reasonably anticipated at the time of the 2001 injury, per *Kyllonen*, and noted insufficient analysis in the WCJ's decision.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary Disability IndemnityAverage Weekly EarningsIndustrial InjuryShouldersLabor Code § 4656(c)StipulationsAgreed Medical Evaluator
References
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