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

Case No. MISSING
Regular Panel Decision

Matter of Levitsky v. Garden Time, Inc.

Claimant sustained a work-related right shoulder injury in 2009. The Workers’ Compensation Board (WCB) awarded schedule loss of use (SLU) but apportioned the award, attributing most of the disability to preexisting degenerative arthritis and a 1981 injury, and only 10% to the 2009 injury. The appellate court reversed this decision, ruling that apportionment was improper. The court reasoned that a preexisting condition, even if symptomatic, does not warrant apportionment unless it was disabling in a compensation sense before the current injury. Since the claimant remained fully employed and capable of performing duties despite prior shoulder issues, the prior conditions were not considered disabling. Therefore, the claimant is entitled to the full 60% SLU award for the 2009 injury.

Workers' CompensationSchedule Loss of UseApportionmentPreexisting ConditionDegenerative ArthritisShoulder InjuryDisabilitySymptomaticAppellate ReviewReversed
References
7
Case No. GRO 0029816, GRO 0029817
Significant

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision to apportion 50% of the applicant's permanent disability to a preexisting degenerative arthritis, holding that Labor Code section 4663, as amended by SB 899, permits apportionment based on causation from non-industrial factors supported by substantial medical evidence.

SB 899apportionmentcausationpermanent disabilitypreexisting arthritismedical evidencesubstantial evidenceLabor Code section 4663compensable consequenceQME
References
58
Case No. MISSING
Regular Panel Decision
Feb 27, 2013

Claim of Crane v. Dalrymple Gravel & Contracting Holding

The claimant successfully applied for workers' compensation benefits after sustaining a left shoulder injury in 2004, resulting in a permanent partial disability. The employer and its workers’ compensation carrier sought reimbursement from the Special Disability Fund, citing the claimant's preexisting conditions of hypertension and degenerative disc disease. However, the Workers’ Compensation Board denied this application, concluding that the carrier failed to demonstrate that these preexisting conditions hindered the claimant's job potential. Upon appeal, the decision of the Board was affirmed, as substantial evidence, including the claimant’s testimony and medical reports, supported the finding that her preexisting conditions did not affect her ability to work.

Workers' CompensationPermanent Partial DisabilitySpecial Disability FundReimbursementPreexisting ConditionsHypertensionDegenerative Disc DiseaseEmployabilitySubstantial EvidenceAppellate Review
References
3
Case No. MISSING
Regular Panel Decision
Apr 05, 2012

Claim of Hartman v. Top's Market, Inc.

The carrier appealed a Workers' Compensation Board decision denying reimbursement from the Special Disability Fund, despite the claimant's preexisting hypertension and degenerative knee disease. The Workers' Compensation Law Judge initially granted reimbursement, but the Board reversed, finding the carrier failed to prove the preexisting condition hindered the claimant's job potential. The court affirmed the Board's decision, noting the claimant's knee pain was intermittent, managed by medication, and did not cause work restrictions or lost time, thus not qualifying for reimbursement.

Workers' CompensationSpecial Disability FundReimbursementPreexisting ConditionPermanent ImpairmentHindrance to EmployabilityMaterially and Substantially Greater DisabilityAppellate DivisionMedical EvidenceClaimant Testimony
References
10
Case No. MISSING
Regular Panel Decision
Nov 30, 2015

Claim of Gramza v. Buffalo Board of Education

Claimant, a teacher, sustained a work-related injury to his left shoulder and neck in 2005 and was subsequently classified with a permanent partial disability. The employer sought reimbursement from the Special Disability Fund, citing the claimant's preexisting medical conditions, including rheumatoid arthritis and hypertension. The Workers' Compensation Board granted this application, prompting an appeal from the Fund. The court affirmed the Board's decision, finding substantial evidence that the claimant's rheumatoid arthritis was a permanent condition restricting hand use and hindering general employability. An independent medical reviewer's opinion further supported that the claimant's overall disability was significantly greater due to the combined effect of both conditions.

Workers' CompensationSpecial Disability FundReimbursementPreexisting ImpairmentRheumatoid ArthritisPermanent Partial DisabilityMaterially and Substantially Greater DisabilityGeneral EmployabilityIndependent Medical ReviewerAppellate Division
References
6
Case No. GRO 0029816, GRO 0029817
En Banc

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision, holding that under Labor Code section 4663 as amended by SB 899, apportionment of permanent disability is based on causation and may include pre-existing, non-industrial conditions like degenerative arthritis, provided there is substantial medical evidence to support the percentage of non-industrial causation.

SB 899ApportionmentCausationPermanent DisabilityPreexisting ConditionDegenerative ArthritisSubstantial Medical EvidenceMedical ProbabilityLabor Code Section 4663Compensable Consequence
References
56
Case No. ADJ3625445 (AHM 0123968)
Regular
Mar 01, 2010

DAVID ROMAN vs. REGENTS, UNIVERSITY OF CALIFORNIA, Permissibly Self-Insured, Adjusted By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn a finding of 5% permanent disability after apportionment for a neck injury, arguing the medical examiner's opinion was not substantial evidence and that treatment couldn't be apportioned. The Board found the administrative law judge's reliance on the medical examiner's opinion, which attributed the worsening condition to pre-existing degenerative arthritis, was supported by substantial evidence. The Board also clarified that further medical treatment was awarded, but surgery specifically would be considered non-industrial due to the apportionment finding.

Workers Compensation Appeals BoardPermanent DisabilityApportionmentQualified Medical ExaminerSubstantial EvidenceIndustrial InjuryNeck InjuryReconsiderationWCJMMI
References
9
Case No. ADJ2543168
Regular
May 17, 2010

CHARLES POPPER vs. WESTSIDE EXPRESS, INC, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found that the Agreed Medical Examiner's (AME) opinion on apportionment was substantial evidence, despite the original judge's finding of 100% permanent disability. The AME concluded that 25% of the applicant's permanent disability was attributable to pre-existing degenerative arthritis, consistent with recent legislative changes requiring apportionment based on causation. The Board determined that the AME's report met the criteria for substantial evidence, necessitating a re-evaluation of the disability rating.

Workers' Compensation Appeals BoardReconsiderationApportionmentLabor Code Section 4663Senate Bill 899Agreed Medical Examiner (AME)Jamie Contreras M.D.Permanent DisabilityCausationPreexisting Degenerative Arthritis
References
6
Case No. MISSING
Regular Panel Decision

Sattanino v. Sanitary District Number 6

In 2003, the claimant, a sanitation worker, sustained bilateral knee injuries from a slip and fall during work. The self-insured employer's third-party administrator acknowledged the claim but contested the schedule loss of use and apportionment. A Workers' Compensation Law Judge initially apportioned a significant part of the claimant's knee impairment to preexisting arthritis. However, the Workers’ Compensation Board reversed this, ruling that apportionment was inapplicable since the prior condition was not a compensable injury and the claimant had been fully employed despite it. The Board established the schedule loss of use at 50% for the right leg and 32.5% for the left leg. The employer's subsequent appeal was unsuccessful, and the Board's decision was affirmed.

Workers' CompensationApportionmentSchedule Loss of UsePreexisting ConditionArthritisKnee InjurySanitation WorkerEmployer AppealWorkers' Compensation BoardMedical Report
References
4
Case No. MISSING
Regular Panel Decision
Apr 20, 2009

Claim of Kot v. Beth Ameth Home Attendant Service

The claimant, a home care attendant, applied for workers' compensation benefits after sustaining injuries, including a left hip injury, while attempting to lift a patient in April 2004. Initially, the claim was established for other injuries, but a Workers’ Compensation Law Judge later found the hip injury causally related. However, the Workers’ Compensation Board reversed this decision, relying partly on an impartial specialist's opinion that the hip injury stemmed from a preexisting inflammatory arthritis rather than the work incident. The Appellate Division affirmed the Board's decision, concluding that the specialist's and an independent medical examiner's opinions constituted substantial evidence to support the finding that the hip injury was not causally related to the employment.

Workers' CompensationHip InjuryCausationPreexisting ConditionMedical OpinionImpartial SpecialistAppellate ReviewSubstantial EvidenceInflammatory ArthritisAvascular Necrosis
References
5
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