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Case Law Database

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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ803377 (RIV 0075685) ADJ6675892
Regular
Oct 05, 2017

SANDRA ARMENTA vs. SAN BERNARDINO SHERIFF'S DEPARTMENT

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address a plainly erroneous finding of fact in an Independent Medical Review (IMR) determination. The IMR incorrectly stated there was no documentation of constipation, despite medical reports confirming this issue, which was a basis for denying Amitiza. The WCAB also noted a case numbering error in the original findings of fact. Consequently, the WCAB rescinded the findings and returned the matter to the trial level for correction and further proceedings regarding the IMR determination's validity.

WCABReconsiderationIndependent Medical Review Determination (IMR)Findings of Fact (FOF)San Bernardino Sheriff's DepartmentApplicantPlainly Erroneous FactDocumentationPain ReliefFunctional Benefit
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ1566624 (MON 0329177) ADJ4125360 (MON 0329180)
Regular
Jul 19, 2011

LAURA LINDQUIST vs. SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE; CORVEL CORPORATION

This case concerns the correct permanent disability rating schedule to apply for an injury occurring before January 1, 2005. The Board affirmed the WCJ's decision to use the 1997 PDRS, finding an exception applied due to prior medical reporting indicating permanent disability. However, the Board amended the permanent disability indemnity award and attorney's fee amount based on the WCJ's correction of a mathematical error. The case is returned to the trial level for further proceedings reflecting this corrected award.

WORKERS' COMPENSATION APPEALS BOARDFindings and AwardPetition for ReconsiderationFindings of Factpermanent disabilitypermanent disability indemnity2005 Permanent Disability Rating Schedule1997 Permanent Disability Rating ScheduleLabor Code section 4660(d)treating physician
References
Case No. ADJ4151507 (SFO 0487197)
Regular
Feb 02, 2020

Tracy Sullivan vs. Café Amsterdam, State Compensation Insurance Fund

The Appeals Board granted reconsideration and amended the previous award, finding the applicant's burn injury did not qualify for the "severe burns" exception to the temporary disability indemnity limit under Labor Code section 4656(c)(3)(D). Consequently, temporary disability indemnity is limited to 104 weeks from the commencement of payments on August 10, 2004. The Board affirmed the WCJ's finding that the applicant's psychiatric injury was compensable, meeting the "sudden and extraordinary" employment condition exception. Clerical errors in the original findings were also corrected.

ADJ4151507SFO 0487197Tracy SullivanCafé AmsterdamState Compensation Insurance FundPetition for ReconsiderationFindings Award and OrderWCJindustrial injurycervical spine
References
Case No. ADJ6526021
Regular
Sep 07, 2016

BENJAMIN ZAMUDIO vs. MATOS DAIRY, INC., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, reversing a prior administrative law judge decision that denied an applicant's appeal of an Independent Medical Review (IMR). The Board found the IMR determination was based on a plainly erroneous factual finding regarding the necessity of the applicant's prescribed medication, Vimovo, which violated Labor Code section 4610.6(h)(5). Because the IMR acted in excess of its powers due to this error, the case is remanded for a new IMR review by a different reviewer.

Independent Medical ReviewLabor Code section 4610.6Petition for ReconsiderationFindings Of FactAdministrative DirectorPlainly Erroneous Finding of FactUtilization ReviewIndustrial InjuryLow Back InjuryPermanent Disability
References
Case No. ADJ8115084
Regular
Jun 02, 2014

MARY HAYWORTH vs. KCI HOLDINGS USA, INC., FIDELITY AND GUARANTY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior finding that the applicant failed to establish a plainly erroneous fact in an Independent Medical Review (IMR) determination. The Board found the IMR decision was based on a plainly erroneous mistake of fact because it evaluated a request for dorsal medial branch block injections as though it were a request for facet injections, which are different procedures. Consequently, the medical treatment dispute is remanded to the Administrative Director for review by a different independent review organization or reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewLabor Code Section 4610.5Plainly Erroneous Finding of FactMedical Treatment DisputeUtilization ReviewAdministrative DirectorDorsal Medial Branch BlockFacet InjectionsMTUS Guidelines
References
Case No. ADJ2068970 (STK 0167616)
Regular
Jul 21, 2016

Norman McAtee vs. Briggs & Pearson Construction, State Compensation Insurance Fund

The applicant seeks reconsideration of a WCJ's decision that dismissed his appeal of an Independent Medical Review (IMR) determination regarding pain medication. The IMR found the medication medically unnecessary, but the applicant argues this was based on a plainly erroneous finding of fact regarding the applicable treatment guidelines. The Appeals Board granted reconsideration, finding the IMR determination was indeed based on a plainly erroneous interpretation of the medical treatment guidelines. Consequently, the Board rescinded the WCJ's decision and remanded the case for a new IMR by a different reviewer.

Workers' Compensation Appeals BoardIndependent Medical ReviewPlainly Erroneous Finding of FactLabor Code Section 4610.6Medical Treatment GuidelineOpioid TherapyPermanent DisabilityVocational RehabilitationAdministrative Law JudgeReconsideration
References
Case No. ADJ1313860
Regular
Mar 07, 2017

Kevin Voelker vs. D. Frey Plastering Co., State Compensation Insurance Fund

This case involves a workers' compensation applicant challenging an Independent Medical Review (IMR) determination that denied authorization for shoulder surgery. The applicant argued the IMR incorrectly applied guidelines for acromioplasty/impingement syndrome instead of guidelines for a rotator cuff tear, which was the actual condition for which surgery was requested. The Appeals Board granted reconsideration, finding the IMR's determination was based on a plainly erroneous mistake of fact readily apparent from the submitted records, not requiring expert opinion. Consequently, the Board rescinded the IMR determination and remanded the matter for a new IMR process.

Workers' Compensation Appeals BoardIndependent Medical ReviewPetition for ReconsiderationFindings and OrderPlainly Erroneous Finding of FactMedical Treatment Utilization ScheduleRequest for AuthorizationRotator Cuff TearAcromioplastyImpingement Syndrome
References
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