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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

Zenith Insurance Co. v. Ayala

Carmen Ayala sustained a lower back injury at work on January 28, 2006. Her initial diagnosis was later augmented to include lumbar radicular syndrome and L5-S1 spondylolisthesis (collectively, the "Lumbar Condition"). Zenith Insurance Company (Carrier) was notified of the injury on March 1, 2006, and despite having medical records of the Lumbar Condition by April 27, 2006, it did not dispute its compensability until July 28, 2006, 62 days after initial notice. A TWC hearing officer and appeals panel found that the Carrier waived its right to contest the compensability of the Lumbar Condition under Texas Labor Code Section 409.021 for failing to timely dispute it. The trial court granted summary judgment for Ayala, concluding the Carrier waived its right. The appellate court affirmed the trial court's judgment, rejecting the Carrier's argument that the Texas Administrative Code abrogates the waiver period for extent-of-injury disputes.

Workers' Compensation LawWaiver DoctrineCompensability DisputeLumbar SpondylolisthesisLumbar Radicular SyndromeTexas Labor CodeSummary Judgment AppealExtent of InjuryInsurance Carrier ObligationsTimely Dispute
References
7
Case No. ADJ10679103
Regular
Dec 14, 2017

LARRY SYKES vs. THE ANSCHUTZ CORPORATION, STARR INDEMNITY & LIABILITY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior finding of industrial injury to the applicant's lumbar spine. The Board found that the existing medical reporting from Dr. Hong, Dr. Jamasbi, and the PQME Dr. Schofferman did not constitute substantial evidence to support this lumbar spine injury finding. Therefore, the case is returned to the trial level to develop the record further on the lumbar spine injury issue.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryCervical SpineThoracic SpineLumbar SpineStagehandSecurity OfficerMedical Treatment RecordsSubstantial Evidence
References
0
Case No. ADJ10384099
Regular
Jan 29, 2018

RODOLFO RODRIGUEZ vs. ROBERT BOSCH AFTERMARKET DIVISION, ZURICH NORTH AMERICA

The Appeals Board granted reconsideration to amend the finding of fact, clarifying that the applicant sustained a compensable injury to his lumbar spine arising out of and occurring within the course of employment. While medical evidence supported the lumbar spine injury, the Board deferred the issue of lower extremities as an injured body part for further development. This decision affirmed the original finding regarding the lumbar spine, based on applicant's credible testimony and medical opinions from Drs. Hutchinson and Schaffzin.

AOE/COELumbar spineLower extremitiesPetition for ReconsiderationFinding of FactWCJMedical evidencePreexisting conditionAggravationLighting up
References
14
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
4
Case No. ADJ11027267
Regular
Feb 03, 2023

LUIS ROSALES vs. IRELAND TILE AND STONE INC., SEDGWICK 14779 SAN DIEGO

This case involves an injured tile setter, Luis Rosales, who claimed lumbar radiculopathy stemming from an admitted industrial lumbar contusion. The Workers' Compensation Appeals Board denied reconsideration of a prior order, upholding a finding of 0% permanent disability. This decision was based on the Qualified Medical Examiner's (QME) reports, which the Board found to be substantial evidence. The Board specifically rejected the applicant's argument that the QME's opinions were inconsistent, clarifying that the QME found the sacral cyst unrelated to the lumbar contusion, not that the symptoms were unrelated to the cyst.

Petition for ReconsiderationQualified Medical ExaminerPQMEDr. Sonusupplemental reportsubstantial evidencelumbar contusionsacral cystradiculopathypermanent disability
References
2
Case No. ADJ8413521
Regular
Apr 13, 2020

STEVEN KING vs. COUNTY OF SAN BERNARDINO

This Workers' Compensation Appeals Board case involves applicant Steven King's claims for injury arising out of and occurring in the course of employment, including bilateral shoulders, lumbar spine, cardiac system, hernia, skin disorder, hearing loss, and hypertension. The Board affirmed the finding of injury AOE/COE and the hypertension rating but remanded the case for further development of the record regarding the applicant's lumbar spine impairment. The administrative law judge's prior rejection of the Agreed Medical Examiner's (AME) supplemental opinion on lumbar spine disability was deemed an improper disregard of substantial medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings and Awardinjury arising out of and occurring in the course of employmentbilateral shoulderslumbar spinecardiac systemherniaskin disorderhearing loss
References
8
Case No. ADJ3649169
Regular
Feb 14, 2013

BRUCE LIBERTY vs. LOS ANGELES UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured

This case concerns an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) order denying his claim for lumbar spine injury. The applicant alleged a lumbar injury from a physical therapy incident following a compensable cervical and shoulder injury. The WCAB denied reconsideration, adopting the WCJ's report which relied on the Agreed Medical Examiner's (AME) opinion. The AME found no industrial injury to the lumbar spine, citing a lack of contemporaneous evidence and a history of degenerative disc disease. The WCAB determined the applicant's presented "new" evidence was either previously reviewed or unpersuasive, upholding the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedBruce LibertyLos Angeles Unified School DistrictPermissibly Self-InsuredCase Number ADJ3649169Workers' Compensation Administrative Law JudgeAgreed Medical ExaminerLumbar Spine Injury
References
0
Case No. 2016-02-0282
Regular Panel Decision
Dec 15, 2017

Moffitt, David v. Allied Metals Company

David Moffitt, a welder, filed a workers' compensation claim for lumbar and cervical injuries sustained on March 26, 2015. While the parties stipulated a compensable lumbar injury, the central dispute revolved around the causation of the cervical injury. The Court, presided over by Judge Brian K. Addington, ultimately ruled that Mr. Moffitt failed to prove the work-related causation of his cervical injury, citing a lack of early complaints and the more persuasive opinions of Drs. Duncan and Brasfield over Dr. Lorio. Consequently, Moffitt was awarded permanent partial disability and temporary total disability benefits solely for his lumbar injury, with attorney fees and costs also assessed, while benefits for the cervical injury were denied. The Court also made alternative findings for appellate review regarding the cervical injury.

Workers' CompensationLumbar InjuryCervical InjuryCausation DisputePermanent Partial DisabilityTemporary Total DisabilityMedical Opinion ConflictAuthorized Treating PhysicianSpinal StenosisDisc Herniation
References
3
Case No. 2019-03-0262
Regular Panel Decision
Mar 11, 2021

Mays, April v. Fast Pace Medical Clinic, PLLC

April Mays, an employee, fell at work and initially received treatment for her neck and cervical spine. She sought additional treatment for her lumbar and thoracic spine, which Fast Pace Medical Clinic, PLLC, denied. The Court reviewed conflicting medical opinions from Dr. Paul Johnson, the panel-selected physician, and Dr. C.M. Salekin, an independent medical examiner. Dr. Salekin diagnosed lumbosacral radiculopathy and probable rod displacement related to the fall, recommending further evaluation. The Court found Ms. Mays presented sufficient proof to rebut Dr. Johnson's causation opinion, which stated the lumbar and thoracic pain was unrelated to the work injury without detailed explanation. Therefore, the Court granted Ms. Mays's claim for the requested lumbar and thoracic MRIs and an orthopedic evaluation.

Workers' CompensationExpedited HearingMedical Treatment DenialCausation DisputeIndependent Medical Examination (IME)Pre-existing Condition AggravationLumbar Spine InjuryThoracic Spine InjuryCervical RadiculopathyOrthopedic Evaluation
References
1
Case No. 04-09-00401-CV
Regular Panel Decision
Jul 21, 2010

Texas Mutual Insurance Company v. Sarah Ochoa

Sarah Ochoa sustained a lumbar sprain injury at work and filed a workers' compensation claim. Texas Mutual Insurance Company, the carrier, initially accepted the lumbar sprain but disputed later claims of extensive lumbar disc pathology as an ordinary disease of life. The hearing officer found a sprain/strain injury superimposed on pre-existing degenerative conditions but also ruled that Texas Mutual waived its right to contest the extent of injury by not timely disputing it within 60 days, making the degenerative conditions compensable. Texas Mutual appealed to the state district court, which granted Ochoa's no-evidence motion for summary judgment. This appellate court reverses and remands the trial court's judgment, holding that the 60-day waiver rule in the Texas Labor Code does not apply to extent-of-injury disputes, citing Texas Supreme Court precedent.

Workers' CompensationSummary JudgmentWaiver RuleExtent of Injury DisputeLumbar SprainDegenerative Disc DiseasePre-existing ConditionAppellate ReviewTexas Labor CodeJudicial Precedent
References
7
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