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

Case No. ADJ10715455
Regular
Mar 18, 2019

MICHAEL KAMM vs. COUNTY OF MONTEREY, P.S.I., administered by INTERCARE HOLDINGS INSURANCE SERVICES, INC.

In this case, the Appeals Board partially rescinded the WCJ's award for psychiatric injury due to inconsistencies in the medical opinion regarding predominant causation. While the Board affirmed the rejection of the good faith personnel action defense, it found Dr. Lopez's opinion lacked clarity on whether employment events were the predominant cause of the applicant's overall psychiatric disability. Therefore, the matter is returned to the WCJ for further development of the medical record to clarify predominant causation before a new decision can be issued.

Workers' Compensation Appeals BoardReconsiderationPsychiatric InjuryPredominant CausationLabor Code Section 3208.3(h)Good Faith Personnel Action DefensePanel Qualified Medical Evaluator (PQME)Dr. LopezAnxiety DisorderMajor Depression
References
3
Case No. ADJ10301846 ADJ8235335
Regular
Feb 07, 2019

Jack Kessler vs. E. \u0026 J. Gallo Winery

Defendant E. & J. Gallo Winery sought reconsideration of a Workers' Compensation Appeals Board decision that found applicant Jack Kessler sustained a compensable psychiatric injury. The Board denied reconsideration, affirming the administrative law judge's finding that industrial factors were the predominant cause of the applicant's psyche injury. The defendant argued the applicant failed to meet the "predominant cause" standard for psychiatric injuries and that combining two separate injuries was impermissible. The Board clarified that the issue of injury causation is distinct from the apportionment of permanent disability, and the applicant's medical evidence met the predominant cause standard.

Workers' Compensation Appeals BoardPetition for ReconsiderationNew and Further DisabilityPsyche InjuryPredominant CauseLabor Code section 3208.2Labor Code section 3208.3Cumulative TraumaSpecific InjuryApportionment
References
5
Case No. ADJ8645491
Regular
Apr 28, 2015

LEOPOLD VASQUEZ vs. G&K MANAGEMENT COMPANY, CHUBB INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings because the Agreed Medical Examiner's psychiatric opinion regarding the predominant cause of the applicant's injury was unclear, contradictory, and lacked substantial evidence. The AME confused causation of injury with apportionment of disability, and did not definitively state that industrial factors were the predominant cause of the psychiatric injury. The Board determined the medical record required further development to properly adjudicate the claim.

Workers' Compensation Appeals BoardIndustrial InjuryPsyche InjuryAgreed Medical ExaminerCausationApportionmentPersonnel Action DefenseLabor Code Section 3208.3Liberal ConstructionPreponderance of Evidence
References
13
Case No. ADJ9550103, ADJ9214819, ADJ9206482, ADJ9206483, ADJ9356685
Regular
Sep 04, 2014

NATHAN JACKSON vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied reconsideration of an applicant's psychiatric injury claim against the City of Los Angeles. The applicant failed to demonstrate by a preponderance of the evidence that actual employment events were the predominant cause of his psychiatric injury. Even if predominant cause were established, the Board found that lawful, nondiscriminatory, good faith personnel actions by the employer substantially contributed to the injury and barred compensation. The Board's decision was based on the reasoning in the arbitrator's report, which it adopted and incorporated.

Workers' Compensation Appeals BoardPetition for ReconsiderationPsychiatric InjuryPredominant CauseActual Events of EmploymentLabor Code Section 3208.3Affirmative DefenseLawful Nondiscriminatory Good Faith Personnel ActionSubstantial CauseTreating Physician Report
References
2
Case No. ADJ1936437 (RIV 0070095) ADJ211616 (RIV 0073390)
Regular
Jun 20, 2011

ROSE MARIE RODRIGUEZ vs. HI-DESERT MEMORIAL, ALPHA FUND

In this case, the Workers' Compensation Appeals Board (WCAB) denied reconsideration of a supplemental award. The WCAB affirmed the finding that lien claimants were entitled to reimbursement for psychiatric treatment provided to the applicant. This treatment was deemed a compensable consequence of the applicant's industrial left thumb injury, with medical experts opining the psychiatric condition was predominantly caused by the orthopedic disability. The WCAB found that the industrial physical injury was the predominant cause of the applicant's psychiatric condition, making the treatment necessary.

Workers' Compensation Appeals BoardRose Marie RodriguezHi-Desert MemorialAlpha Fundlicensed vocational nurseorthopedic injurypsyche injurycompensable consequenceLabor Code section 3208.3(b)(1)psychiatric treatment
References
6
Case No. ADJ2062277 (LAO0881144)
Regular
May 10, 2010

CARLOS BUENAVISTA vs. ALL AMERICAN WASH COMPANY, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the previous award. The Board found the WCJ erred in applying Labor Code section 3208.3 to psychiatric injury claims, as it requires demonstrating predominant cause from employment events for post-termination claims. Furthermore, the Board ruled that a medical report was not substantial evidence as it lacked sufficient reasoning. The case is remanded for further proceedings to develop the record on the issue of predominant cause and clarify injury dates.

WCABReconsiderationFindings and AwardIndustrial InjuryAOE/COELabor Code 3208.3Psychiatric InjuryPost-Termination ClaimSubstantial EvidenceDue Process
References
7
Case No. ADJ7847320
Regular
Nov 25, 2014

KAREN ROTAN vs. CITY OF LONG BEACH

This case concerns a psychiatric injury claim where the applicant argued that employment events were the predominant cause. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding that the Agreed Medical Evaluator's opinions supported the applicant's contention. The WCAB rescinded the original decision and substituted new findings. This establishes that the actual events of employment were the predominant cause of the applicant's psyche injury. The case is returned to the WCJ for further proceedings, specifically to determine if a good faith personnel action defense applies.

Workers' Compensation Appeals BoardPSYCHE INJURYARISING OUT OF AND OCCURRING IN THE COURSE OF EMPLOYMENT (AOE/COE)PREDOMINANT CAUSEAGGREED MEDICAL EVALUATOR (AME)GOOD FAITH PERSONNEL ACTIONLABOR CODE SECTION 3208.3RECONSIDERATIONFINDINGS OF FACT AND ORDERS (F&O)SUBSTANTIAL EVIDENCE
References
4
Case No. ADJ10393124
Regular
Oct 02, 2019

MINDY SPITZ vs. REALOGY HOLDINGS CORPORATION, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA

The applicant, Mindy Spitz, sought workers' compensation for a psychiatric injury, claiming it resulted from a violent act at work. However, the Workers' Compensation Appeals Board (WCAB) affirmed the prior decision that she did not prove her psychiatric condition was predominantly caused by employment events. The WCAB found that the incidents described by the applicant did not constitute a "violent act" as legally defined, thus requiring the predominant cause standard for compensation. Consequently, the WCAB concluded that the applicant's claim failed under the applicable legal standard and the evidence presented.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderAdministrative Law JudgeQualified Medical EvaluatorPredominant CauseSubstantial CauseViolent ActPsychiatric InjuryAOE/COE
References
10
Case No. ADJ8935673
Regular
Jun 08, 2015

ANGEL URRUTIA vs. CARDENAS MARKETS, INC.

The Workers' Compensation Appeals Board granted reconsideration of a decision denying applicant's claim for psychological injury. The Board found that while the applicant's alleged work events occurred, the medical evidence regarding predominant causation was unclear. Therefore, the matter was returned to the trial level for further development of the medical record, specifically requesting clarification from Dr. Surapaneni on whether actual employment events were the predominant cause of the applicant's injury. The Board emphasized the need for clear medical evidence establishing work-related causes as more than 50% of all causal factors.

Labor Code section 3208.3psychiatric injurypredominant causationindustrial cumulative traumagender transitionrestroom usediscriminationactual events of employmentsubstantial medical evidencefurther development of the record
References
6
Case No. ADJ3189130 (STK 0188538)
Regular
Dec 08, 2010

DAVID DYKES vs. E. & J. GALLO WINERY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision that found the applicant sustained a compensable industrial injury to his psyche. The Board found that the applicant failed to meet the burden of proof under Labor Code section 3208.3(b)(1) that actual employment events were the predominant cause of his psychiatric injury. Medical evidence submitted by the applicant's own psychologist was deemed insufficient due to lack of clear reasoning and an inability to establish predominant causation. Therefore, the Board amended the findings to reflect that no compensable industrial injury to the psyche was proven.

Workers' Compensation Appeals BoardE. & J. Gallo WineryDavid Dykesindustrial injurypsyche injurycompensable consequenceLabor Code section 3208.3(b)(1)predominant causesubstantial medical evidenceDr. Robert Schneider
References
4
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