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

Case No. VNO 348369 VNO 348370 VNO 348371 VNO 348372
Regular
Feb 13, 2008

RUBEN C. GONZALEZ vs. L.A.C.M.T.A.

The Workers' Compensation Appeals Board (WCAB) denied LACMTA's Petition for Removal, adopting the Workers' Compensation Administrative Law Judge's (WCJ) report. The WCJ recommended denial because LACMTA failed to demonstrate significant prejudice or irreparable harm, and the medical record needed further development regarding the applicant's new diabetes diagnosis and its potential industrial relation. Therefore, the petition was formally denied by the WCAB.

WORKERS' COMPENSATION APPEALS BOARDLACMTAMedical Record DevelopmentDiabetes DiagnosisIndustrially Related ConditionReasonable Medical ProbabilityPetition for RemovalWCAB Rule 10843Significant PrejudiceIrreparable HarmWorkers' Compensation Administrative Law Judge
References
Case No. ADJ7091661
Regular
Apr 02, 2014

JOSE CONTRERAS vs. SPECIALTY MEATS, INC., TRAVELERS CASUALTY & SURETY COMPANY, COMPWEST INSURANCE COMPANY

This case involved Jose Contreras alleging a continuous trauma injury to multiple body parts while employed as a butcher. The Workers' Compensation Appeals Board denied his Petition for Reconsideration, adopting the findings of the administrative law judge (WCJ). The WCJ found no industrial injury, relying on Qualified Medical Evaluator (QME) reports that attributed the conditions to pre-existing or degenerative issues. The WCJ also found Contreras to be not credible due to inconsistencies and similarity to prior claims, and denied his attempt to elect against a specific defendant on the trial date.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJIndustrial injuryFinal orderRemovalSpecialty MeatsInc.Travelers Casualty & Surety CompanyCompWest Insurance Company
References
Case No. ADJ11320525
Regular
Jul 01, 2019

LOURDES OCAMPO vs. SWEETWATER UNION HIGH SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration of the initial decision, finding the orthopedic QME's opinions did not constitute substantial evidence. Applicant contended the QME's opinions were inconsistent with medical literature regarding the acceleration of pre-existing conditions. The Board agreed that the QME seemed to conflate causing arthritis with aggravating a pre-existing condition. Therefore, the Board rescinded the original findings and returned the case for further development of the record, specifically regarding the extent of applicant's walking and a clearer medical opinion on causation.

AOE/COEQualified Medical Examiner (QME)Petition for ReconsiderationFindings and Order (F&O)substantial evidenceorthopedichip arthritisdegenerative joint diseaseindustrial causationacceleration of condition
References
Case No. ADJ2804761 (LAO0886335)
Regular
Jun 13, 2014

RUBEN PEREZ ARAUJO vs. CENTIMARK CORPORATION, ARCH INSURANCE COMPANY, BROADSPIRE

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contentions regarding the applicant's Petition to Reopen. The Board found no good cause to reopen the claim for new and further disability related to the applicant's left upper extremity, left lower extremity, insomnia, urological, or internal conditions. This decision was based on the applicant's failure to present substantial evidence of new and further disability beyond what was previously adjudicated or known at the time of the initial award. However, the Board noted that the employer's liability for medical treatment for these conditions may still exist, irrespective of disability findings.

Workers' Compensation Appeals BoardPetition to ReopenNew and Further DisabilityGood CauseLabor Code Section 5410Agreed Medical ExaminerFindings and AwardInsomniaUrological IssuesInternal Systems
References
Case No. ADJ7329378;ADJ7329380
Regular
May 09, 2013

JOANNA LOPEZ vs. WILLIAM S. HART UNIFIED SCHOOL DISTRICT, YORK INSURANCE COMPANY

This case involves applicant Joanna Lopez's claim for workers' compensation benefits against William S. Hart Unified School District and York Insurance Company. Lopez alleged her psyche, sleep disorder, gastrointestinal system, and headaches stemmed from industrial stress. The Workers' Compensation Appeals Board denied her Petition for Reconsideration, upholding the WCJ's findings. The WCJ found Lopez's testimony lacked credibility and that her condition was not predominantly caused by industrial factors, with a significant portion attributed to pre-existing conditions and the employer's good faith personnel actions. The Board deferred to the WCJ's credibility determination and adopted the reasoning in the WCJ's report.

Predominant causeIndustrial exposureStressQME reportSubstantial evidenceCredibility findingPetition for ReconsiderationWCJ reportPreexisting conditionGood faith personnel action
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ401125 (LAO 0843257)
Regular
Dec 24, 2010

ORETHA BOYD vs. SERVICE CRAFT LOGISTICS, COLONIAL RISK

The Workers' Compensation Appeals Board granted reconsideration to reverse the finding of temporary total disability and the need for future medical treatment for the applicant's heart condition and hypertension. The Board found insufficient substantial medical evidence to support that these pre-existing conditions, aggravated by work stressors, caused the claimed period of disability. Applicant's prior carpal tunnel injury and its ongoing treatment were identified as the primary cause of her absence from work. The award was modified to remove temporary disability and future medical treatment for the heart/hypertension, and attorney fees were adjusted accordingly.

Workers' Compensation Appeals BoardOretha BoydService Craft LogisticsColonial RiskAmended Findings and Awardindustrial injuryheart conditionhypertensiondiabetestemporary total disability
References
Case No. ADJ324819 (SAL 0120615) ADJ3483975 (SAL 0119560)
Regular
Jul 20, 2010

KATHERINE GONZALES vs. COUNTY OF MONTEREY, LIBERTY MUTUAL

This case concerns an injured worker's attempt to continue treatment with her physician, Dr. Klassen, after he left the defendant's Medical Provider Network (MPN). The defendant argued that the worker's condition did not meet the criteria for continued treatment with a non-MPN physician under Labor Code section 4616.2. The Workers' Compensation Appeals Board (WCAB) granted reconsideration because there was insufficient medical evidence to determine if the worker's condition qualified. The WCAB rescinded the prior decision and returned the case for further proceedings, ordering the trial judge to obtain a report from Dr. Klassen regarding the necessity of continued treatment.

Workers' Compensation Appeals BoardMPNMedical Provider NetworkLabor Code section 4616.2continuity of treatmentprimary treating physicianacute conditionserious chronic conditionterminal illnessauthorization
References
Case No. ADJ8501790
Regular
Jul 29, 2015

Kelly Chase vs. St. Louis Blues Hockey Club, Federal Insurance Company

The Workers' Compensation Appeals Board (WCAB) reversed a prior finding of industrial injury for a professional hockey player against the St. Louis Blues. The WCAB found insufficient connection to California for jurisdiction, citing the player's limited games in the state compared to his overall career. This decision followed the precedent set in *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*, which requires a legitimate and substantial connection to the state for jurisdiction. The WCAB concluded that 21 games out of 485 did not meet this standard for a cumulative injury claim.

WCABSt. Louis Blues Hockey ClubFederal Insurance CompanyADJ8501790Opinion and Decision After Reconsiderationcumulative industrial injuryprofessional hockey playersubject matter jurisdictionstatute of limitationssubstantial medical evidence
References
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
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