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

Case No. ADJ8264840
Regular
May 30, 2018

GABRIELA ARROYO vs. STANFORD UNIVERSITY, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board granted applicant's Petition for Removal, rescinding the prior decision that denied a psychiatric Qualified Medical Evaluator (QME). The WCAB found that the administrative law judge improperly decided the issue of good cause to reopen, rather than the sole issue presented for trial: entitlement to a PQME in psychiatry. Granting removal was necessary due to potential prejudice and due process concerns. The Board substituted its own order, granting the applicant's request for a PQME in psychiatry.

PQMEPetition for RemovalWCABCompensable Consequence InjuryNew and Further InjuryDue ProcessGood Cause to ReopenStipulations with Request for AwardPermanent DisabilityFuture Medical Treatment
References
Case No. ADJ7873470, ADJ9373759
Regular
Oct 23, 2015

JUAN JOSE RAMIREZ vs. LYNAM INDUSTRIES INC., COMPWEST INSURANCE COMPANY

The Appeals Board granted the defendant's petition for removal, rescinding the WCJ's order to take the case off calendar for a QME evaluation in psychiatry. The Board found the WCJ erred by ordering further discovery after the close of discovery, as the defendant disputed the psychiatric injury and thus Labor Code section 4061(i) did not apply. The matter was ordered to be set for trial immediately on previously delineated issues.

Petition for RemovalLabor Code section 4061(i)Panel Qualified Medical EvaluatorPsychiatryPre-Trial Conference StatementDeclaration of Readiness to Proceedcumulative trauma injuryspecific injuryoff calendarsubstantial prejudice
References
Case No. ADJ6627019
Regular
May 06, 2013

SANDRA BERKENSTOCK vs. AGILENT TECHNOLOGIES

The defendant sought reconsideration of an order denying their request for a replacement Qualified Medical Evaluator (QME) panel in psychiatry/psychology. The applicant sustained industrial injuries including to her psyche. The administrative law judge denied the replacement panel because the QME's report was eventually received. However, the Workers' Compensation Appeals Board dismissed the defendant's petition. The Board ruled that the denial of a replacement QME panel is an interim, procedural order not subject to reconsideration under Labor Code section 5900(a).

WCABAgilent TechnologiesADJ6627019Petition for ReconsiderationQualified Medical EvaluatorQME panelpsychiatrypsychologyFlorence Thomas-RiddleLabor Code section 139.2(j)(1)(A)
References
Case No. ADJ11629744
Regular
Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

The applicant sought reconsideration after the WCJ denied injury claims to the brain, internal system, psyche, and sexual dysfunction, as well as the issuance of additional QME panels. The Appeals Board granted reconsideration, finding good cause existed for additional QME panels in internal medicine and psychiatry. The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred. The Board concluded that additional QME evaluations were necessary for a full adjudication of the claimed injuries outside of the admitted orthopedic injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche
References
Case No. ADJ7262375
Regular
Apr 20, 2012

JOSE R. GONZALEZ vs. GZ \& S, INC., ONE BEACON INSURANCE

This case involves a defendant's Petition for Removal of an administrative law judge's (WCJ) order to take a workers' compensation case off calendar. The WCJ granted the request because a QME panel in psychiatry was pending, which the applicant argued was necessary for discovery. The defendant contended the WCJ should have bifurcated and heard the issue of whether the injury arose out of and in the course of employment (AOE/COE). The Appeals Board dismissed the Petition for Removal primarily because it was unverified, a defect the defendant failed to cure after being notified. Even if considered on its merits, the Board would have denied the petition, agreeing with the WCJ that bifurcation was not warranted and no irreparable harm or prejudice to the defendant had been demonstrated.

Petition for RemovalWCJ ordermandatory settlement conferenceoff calendarQME panelpsychiatryAOE/COEstatute of limitationspost-termination filingbifurcation
References
Case No. ADJ7452091
Regular
Aug 14, 2013

JULIA PLEASANT vs. PACIFIC ALLIANCE MEDICAL CENTER, SAFETY NATIONAL CASUALTY CORPORATION

The Workers' Compensation Appeals Board denied Pacific Alliance Medical Center's petition for reconsideration. The Board adopted the findings of the Administrative Law Judge (WCJ), who found the applicant credible and her injuries supported by substantial medical evidence. The WCJ determined the applicant's psychiatric injury stemmed from cumulative trauma, not personnel actions. The defendants failed to present sufficient contrary evidence to overturn the original findings and award.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedWCJGarza v. Workmen's Comp. Appeals Bd.Agreed Medical ExaminerOrthopedicsPsychiatryApportionmentCumulative Trauma
References
Case No. ADJ2509613
Regular
Mar 21, 2011

DONALD RAY LEWIS vs. VIRATEC THIN FILMS, INC.

The Appeals Board granted reconsideration and amended the WCJ's decision to reclassify the applicant's occupational group from 360 to 480, reflecting his sandblasting duties more accurately. This change increased the applicant's permanent disability rating to 53% and the attorney's fee accordingly. However, the Board affirmed the WCJ's findings that the applicant did not sustain industrial injury to his psyche or GERD, and that his permanent and stationary date was correctly determined. The Board found substantial evidence supported the WCJ's reliance on the Agreed Medical Evaluators' opinions regarding the industrial injuries and apportionment.

Workers' Compensation Appeals BoardDonald Ray LewisViratec Thin FilmsInc.Insurance Company of the State of PennsylvaniaSedgwick Claims Management ServicesInc.ADJ2509613Petition for ReconsiderationSecond Amended Findings Award and Orders
References
Case No. ADJ8994015 ADJ8994016
Regular
Mar 29, 2018

JOHN BEVINGTON vs. COUNTY OF MARIPOSA, permissibly self-insured, administered by TRISTAR RISK MANAGEMENT

This case concerns a petition for reconsideration filed by the defendant, County of Mariposa, challenging a workers' compensation award. The Appeals Board granted the petition, affirming the original award but deferring issues of permanent disability, job displacement vouchers, and attorney's fees. This deferral is to allow for further medical evaluation regarding the apportionment of the applicant's psychological injury between two distinct orthopedic injuries. The matter is remanded to the trial level for these necessary further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings of FactAwardOrderOpinion on DecisionWorkers' Compensation Administrative Law JudgeApplicantDefendantCounty of Mariposa
References
Case No. ADJ11024218
Regular
Feb 07, 2020

CAMILLE CORTES vs. SAN BERNARDINO COUNTY OF PROBATION

The applicant, Camille Cortes, sought reconsideration of a Findings and Order that denied her claim for injury due to good faith personnel actions. The Appeals Board granted reconsideration, rescinded the original order, and found that the applicant sustained injury to her digestive and excretory systems. All other issues, including injury to her head and brain, were deferred. The Board found that the applicant did not claim a psychiatric injury, thus the good faith personnel action defense did not apply to her physical condition aggravation.

WCABPetition for ReconsiderationFindings and OrderWCJgood-faith personnel actiondue processQMEinternal medicinepsychiatrydigestive system
References
Case No. ADJ9328371
Regular
Oct 31, 2016

LEYLA FATHI vs. MISSION HOSPITAL REGIONAL MEDICAL CENTER, HARTFORD ACCIDENT & INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration because the WCJ's order for additional Qualified Medical Evaluator (QME) panels was an interlocutory procedural order, not a final determination of substantive rights or liabilities. The defendant's petition for removal was also denied, as they failed to demonstrate substantial prejudice or irreparable harm. While good cause for additional evaluations may have existed, the record was insufficient to make a definitive ruling on the merits of the removal. Therefore, the WCAB affirmed the WCJ's order for further medical development of the record.

Petition for ReconsiderationPetition for RemovalAdditional Panel QMEQualified Medical EvaluatorInternal MedicinePsychiatryNeurologyMedical Record DevelopmentFinal OrderInterlocutory Order
References
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