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

Case No. ADJ1290390 (SAC 0325027)
Regular
Feb 04, 2011

ELLEN LAMBERT vs. LOWES HOME IMPROVEMENT, KEMPER INSURANCE, SEDGWICK

In *Lambert v. Lowe's Home Improvement*, the Workers' Compensation Appeals Board granted reconsideration to defer the calculation of applicant's life pension and attorney's fees related to it pending the California Supreme Court's decision in *Duncan*. The Board affirmed the finding of 86% permanent disability with no apportionment, upholding the WCJ's reliance on the Agreed Medical Evaluator's opinion. However, the Board remanded the penalty calculation for further determination at the trial level due to unclear basis. The applicant's attorney's fee from the permanent disability award was affirmed at 15%.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityPenaltyAttorney FeeLife PensionAgreed Medical EvaluatorNew and Further Disability
References
2
Case No. ADJ10168011
Regular
Sep 25, 2017

BELINDA GO vs. SUTTER SOLANO MEDICAL CENTER

This case involved an applicant who self-procured cervical spine surgery after her employer denied authorization, which was upheld by an Independent Medical Review. Despite the denial, the Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The WCAB affirmed that injured workers are entitled to temporary and permanent disability for reasonable, self-procured medical treatment, even if initially unauthorized. The Board found the self-procured surgery was reasonable due to its positive outcome, and the Permanent Qualified Medical Evaluator's findings supported the disability award. The WCAB clarified that utilization review and independent medical review processes do not preclude temporary disability indemnity for self-procured treatment deemed reasonable.

Workers' Compensation Appeals BoardPetition for ReconsiderationUtilization Review (UR)Independent Medical Review (IMR)Self-Procured SurgeryTemporary Disability IndemnityPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Medical Treatment DisputesLabor Code Section 4600
References
14
Case No. ADJ2709955 (MON 0356320)
Regular
Jun 21, 2017

Mario Cocola vs. California Hospital Medical Center

The Workers' Compensation Appeals Board denied Mario Cocola's petition for reconsideration, upholding the finding that he sustained $69\%$ permanent disability from industrial injuries. Cocola argued the administrative judge erred by disregarding the Agreed Medical Examiner's opinion that he was totally disabled from the open labor market due to orthopedic injuries. The Board agreed with the judge's report that the physician's opinion lacked sufficient objective basis for the change in work restrictions. A dissenting opinion argued the medical and vocational evidence supported a $100\%$ permanent disability finding and requested clarification from the medical examiner.

Petition for ReconsiderationFindings of Fact and Awardpermanent disabilitycumulative traumalumbar spinecervical spinepsychecervicogenic headachesEmergency Unit CoordinatorAgreed Medical Examiner
References
1
Case No. MISSING
Regular Panel Decision

Matter of Wohlfeil v. Sharel Ventures, LLC

The claimant, injured in October 2007, was initially found by a Workers’ Compensation Law Judge and affirmed by the Workers’ Compensation Board to have a permanent partial disability and a 75% loss of wage-earning capacity. The claimant subsequently appealed this decision. Medical experts, including the claimant's treating physician, Clifford Ameduri, and an independent medical examiner, Guy Corkhill, consistently testified that the claimant was totally disabled and incapable of any gainful employment. Despite this overwhelming medical evidence, the Board concluded that the claimant could perform sedentary work. The appellate court reversed the Board's findings, determining that they were not supported by substantial evidence in the record. The court concluded that the evidence actually warranted a finding of a permanent total disability for the claimant.

Permanent Partial DisabilityLoss of Wage-Earning CapacitySpinal FusionSpinal Cord StimulatorMedical TestimonyIndependent Medical ExaminationSedentary WorkTotal DisabilitySubstantial EvidenceAppellate Review
References
3
Case No. MISSING
Regular Panel Decision

Claim of Soluri v. Superformula Products, Inc.

Claimant was injured in a work-related accident in 2001, establishing a claim for injury to their low back and left hip. Initially determined to have a total permanent disability, the workers' compensation carrier sought review. Due to conflicting medical opinions, the Workers’ Compensation Board referred the case to an impartial specialist, subsequently determining the claimant had a mild permanent partial disability. Claimant appealed, arguing the Board improperly relied on the impartial specialist's opinion for not adhering to medical guidelines. The court disagreed, affirming the Board's decision, stating that the Board is empowered to resolve conflicting medical opinions, and the impartial specialist's findings, consistent with other physicians, constituted substantial evidence.

Workers' Compensation BenefitsPermanent Partial DisabilityImpartial Medical ExaminationMedical OpinionsSubstantial EvidenceBoard's AuthorityAppellate DivisionDisability RatingWork-Related InjuryMedical Guidelines
References
4
Case No. MISSING
Regular Panel Decision

Claim of VanDermark v. Frontier Insurance

In this workers' compensation appeal, the employer and its carrier challenged two decisions by the Workers’ Compensation Board concerning a claimant's permanent total disability. The claimant sustained a back injury in 1998 and was initially found to have a permanent partial disability. However, the Board later modified the award, concluding the claimant had a permanent total disability after August 2004, a finding supported by the testimony of her treating orthopedic surgeon despite conflicting medical evidence. The employer also contested the denial of their applications for reconsideration and/or full Board review, arguing insufficient evidence and an abuse of discretion. The appellate court affirmed the Board's decisions, deferring to its resolution of conflicting medical evidence and finding no arbitrary or capricious action in denying reconsideration, as no new evidence was presented.

Workers' Compensation LawPermanent Total DisabilityPermanent Partial DisabilityMedical EvidenceConflicting Medical OpinionsBoard's DiscretionReconsideration ApplicationFull Board ReviewAppellate ReviewSufficiency of Evidence
References
6
Case No. SJO 0258870
Regular
Jul 29, 2008

WARREN BROWER vs. DAVID JONES CONSTRUCTION, INC., STATE COMPENSATION INSURANCE FUND

The applicant sought reconsideration of a decision that found it premature to determine permanent disability due to not reaching maximum medical improvement, despite temporary disability payments ending at the statutory 104-week cap. The Appeals Board denied reconsideration, agreeing that the applicant remains temporarily totally disabled and has not reached a permanent and stationary status, as per the agreed medical evaluator. Therefore, the applicant is not yet entitled to permanent total disability benefits.

Warren BrowerDavid Jones ConstructionState Compensation Insurance FundSJO 0258870Petition for ReconsiderationFindings and Ordertemporary disabilitypermanent disabilitymaximum medical improvementaggregate disability payments
References
9
Case No. MISSING
Regular Panel Decision

Claim of Martone v. Niagara Frontier Transportation Authority-Metro

In 2005 and 2007, a bus driver (claimant) suffered work-related neck and back injuries. Initially, a Workers’ Compensation Law Judge found him permanently totally disabled. However, the Workers’ Compensation Board modified this, determining he had a permanent partial disability with a 75% loss of wage-earning capacity based on medical evidence and other factors. The claimant appealed this decision, arguing a lack of substantial evidence for the partial disability finding. The Appellate Division affirmed the Board's decision, noting medical reports indicating submaximal efforts, high medication dosages, symptom magnification, and the ability to ambulate, which supported the finding of partial disability. The court also upheld the 75% loss of wage-earning capacity, finding it supported by substantial evidence after considering the claimant's impairment, work restrictions, age, education, and work experience.

Permanent Partial DisabilityWage-Earning CapacityChronic Pain SyndromeLumbar Spine SurgeryMedical EvidenceSubmaximal EffortsSymptom MagnificationAppellate ReviewBoard DecisionMedical Treatment Guidelines
References
2
Case No. MISSING
Regular Panel Decision

Matter of Williams v. Preferred Meal Systems

Claimant, a driver, suffered injuries to his right knee and back in 2009 while making a delivery, leading to an established workers' compensation claim. The claim was later amended to include consequential adjustment disorder, and the Workers' Compensation Board ultimately found that claimant had sustained a permanent total disability from May 2012 onward. The employer, workers’ compensation carrier, and policy administrator appealed this decision, arguing that further proof was needed regarding claimant's vocational and functional capacity. The court affirmed the Board's decision, holding that extensive evidence of vocational and functional capacity is not required when medical proof demonstrates a permanent total disability and inability to engage in any gainful employment, as benefits continue for life in such cases. The court found substantial evidence in the opinions of treating and independent medical examination orthopedists to support the finding of permanent total disability.

Workers' CompensationPermanent Total DisabilityWage-Earning CapacityMedical ProofVocational CapacityFunctional CapacityAppellate ReviewNew York LawDisability BenefitsClaimant Rights
References
4
Case No. ADJ6671476
Regular
Nov 15, 2016

DEBORAH PAINE vs. CITY OF SEBASTOPOL, Permissibly Self-Insured

This case involves a dispute over a 15% reduction in permanent disability indemnity under Labor Code section 4658(d)(3)(a). The defendant, City of Sebastopol, argued the applicant's prior treating physician's reports did not definitively establish maximum medical improvement, thus negating their obligation to make an estimate of permanent disability before offering modified work. The Appeals Board granted reconsideration, finding the defendant was indeed entitled to the reduction, as the medical reports lacked a specific WPI rating and relied on physician judgment. Consequently, the permanent disability award was reduced by 15%.

Labor Code section 4658(d)(3)(a)permanent disability indemnityreconsiderationFindings and Awardstipulated injuryprimary treating physicianqualified medical examinationpermanent and stationary statusoffer of regular workmedical reports
References
2
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