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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ7212946
Regular
Dec 13, 2012

JOSE QUINTERO vs. CORPORATE PERSONNEL NETWORK, NEW HAMPSHIRE INSURANCE CO., administered by CHARTIS

The Appeals Board granted reconsideration to address the admissibility of Dr. Konstat's psychiatric evaluation. The Board found Dr. Konstat's report inadmissible because it was a medical-legal evaluation obtained in violation of statutory procedures for represented employees, bypassing the requirement for an Agreed Medical Evaluator or Qualified Medical Evaluator. Consequently, the Board amended the prior award to exclude industrial injury to the psyche due to lack of substantial medical evidence. The applicant's award for orthopedic injuries and medical treatment was affirmed.

Workers' Compensation Appeals BoardJose QuinteroCorporate Personnel NetworkNew Hampshire Insurance Co.ChartisAmended Findings and Awardindustrial injuryleft shoulderneckback
References
Case No. ADJ3565194 (BAK 0139614)
Regular
Dec 04, 2015

TAMMY AGOSTA vs. VONS, A SAFEWAY COMPANY

The applicant sought reconsideration of a workers' compensation award of $61\%$ permanent disability for an industrial injury. She argued that the administrative law judge erred and that she should be found permanently totally disabled ($100\%$) based on vocational expert and medical evaluations. The Workers' Compensation Appeals Board denied her petition, adopting the WCJ's report. However, one commissioner dissented, arguing that the applicant's significant medical restrictions and vocational expert's opinion supported a finding of $100\%$ permanent disability.

AgostaVonsSafewayWorkers' Compensation Appeals BoardPetition for ReconsiderationFindings Orders and Awardadministrative law judgecumulative injuryright shoulderright upper extremity
References
Case No. ADJ6640151
Regular
May 12, 2011

CHERYL CIENFUEGOS vs. FOUNTAIN VALLEY SCHOOL DISTRICT, KEENAN & ASSOCIATES

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinding an order compelling the applicant to see a second Qualified Medical Evaluator (QME), Dr. Dao. The Board found that the applicant was not entitled to a second QME solely due to a delay in scheduling a supplemental examination with the first QME, Dr. Chiu. The Board reasoned that administrative rules regarding QME availability do not apply to supplemental evaluations. Consequently, the applicant must attend the rescheduled examination with Dr. Chiu.

Petition for RemovalQualified Medical EvaluatorPanel QMELabor Code sections 4060 and 4062.2Industrial injuryNeckShouldersUpper extremitiesPsycheAgreed Medical Evaluator
References
Case No. ADJ9845740
Regular
Dec 18, 2019

RICHARD OKUNIEWICZ vs. CHRISTOFFERSON TRANSPORTATION, QBE-PRAETORIAN INSURANCE COMPANY

This case concerns an employer's petition for removal challenging a judge's order denying a motion to compel an in-person vocational evaluation. The Appeals Board denied the petition, treating it as a reconsideration request because the underlying order resolved threshold issues. Although the decision was final regarding threshold matters, the Board reviewed the discovery dispute under the extraordinary removal standard. The majority found no significant prejudice or irreparable harm from denying the in-person evaluation, as a remote evaluation was deemed sufficient.

Petition for ReconsiderationPetition for RemovalFindings and OrderMedical-Legal EvaluationCompelSignificant PrejudiceIrreparable HarmThreshold IssueInterlocutory IssueVocational Evaluation
References
Case No. ADJ9011624
Regular
Dec 13, 2019

ELISHA HARDEN vs. COUNTY OF SACRAMENTO

This case concerns whether specific medical reports obtained for a disability retirement claim are admissible in a workers' compensation proceeding. The Appeals Board rescinded the prior ruling, holding these reports are relevant and may be provided to the orthopedic Agreed Medical Evaluator (AME) and psychiatric Qualified Medical Evaluator (QME). The Board found the reports relevant to the medical issues, even though they were not obtained through the standard workers' compensation medical-legal evaluation process. Consequently, the applicant's objection to providing these reports to the evaluators was overruled.

RemovalReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Medical-legal evaluatorsMedical recordsLabor CodeFindings and Orders (F&O)Disability retirementPermanent impairment
References
Case No. ADJ8363948
Regular
Oct 19, 2012

NICOLE NELSON vs. COUNTY OF SOLANO, INTERCARE HOLDINGS INSURANCE SERVICES

The defendant County of Solano sought removal to obtain a new panel of Qualified Medical Evaluators (QMEs) due to alleged ex parte communications between the applicant and the current QME. The Appeals Board denied this petition, finding that the communications were either insignificant and inconsequential or related to the QME examination itself. Specifically, emails concerning necessary forms and an insignificant mention of a claims adjuster's number did not violate the ex parte communication prohibition. Therefore, the WCJ's denial of the defendant's request for a new QME panel was upheld.

Petition for RemovalQualified Medical Evaluator (QME)ex parte communicationLabor Code section 4062.3termination of evaluationreplacement panelinsignificant communicationinconsequential communicationindustrial injurypsyche
References
Case No. ADJ72 02827
Regular
Apr 14, 2016

Luz Castro vs. Sharp Health Care, ACE American Insurance Company, ESIS, INC.

This case involves an applicant seeking workers' compensation benefits for industrial injuries to her neck, back, and psyche. The Appeals Board granted reconsideration because neither the applicant's nor the defendant's medical evidence sufficiently supported findings on psychological injury or permanent disability. Due to the unreliability of the orthopedic medical opinions and the psychologist's reliance on them, the Board deferred the issues of permanent disability and injury to the psyche. The matter is returned for further proceedings, including selecting a new orthopedic evaluator, before determining these deferred issues and attorney's fees.

Workers Compensation Appeals BoardPetition for ReconsiderationRemovalFindings and AwardVacating SubmissionNew and Further DisabilityIndustrial InjuryPermanent DisabilityPsycheApportionment
References
Case No. ADJ7662819
Regular
Apr 27, 2015

JEWELL McKEE vs. MARTEN'S TRANSPORT, LTD, ACE AMERICAN INSURANCE COMPANY

This case involves an applicant alleging industrial injuries to various body parts, including psyche, hearing, and gait disorder, following a fall. The defendant sought reconsideration of the original award, primarily challenging the findings of psyche injury and gait disorder, as well as the award of temporary disability and a permanent disability increase. The Appeals Board granted reconsideration, deferring the issues of gait disorder and all permanent disability findings due to insufficient medical evidence on gait causation and the improper piecemeal determination of permanent disability. The Board otherwise affirmed the findings of industrial injury to psyche, additional temporary disability, and ordered further medical evaluation by an AME or IME.

Workers' Compensation Appeals BoardMarten's TransportACE American InsuranceIndustrial InjuryPsyche InjuryGait DisorderPermanent DisabilityLabor Code Section 4658(d)(2)Temporary DisabilityAgreed Medical Evaluator (AME)
References
Case No. ADJ6736604
Regular
Sep 26, 2013

WHITNEY DITLEVSEN vs. GOLD COUNTRY TRUE VALUE, BERKSHIRE HATHAWAY

In this workers' compensation case, the applicant has been unable to secure a timely QME evaluation after four attempts due to scheduling issues with chosen physicians. The Appeals Board granted the applicant's petition for removal, overturning the WCJ's decision to issue another QME panel. The Board invoked its inherent powers to appoint a physician directly, deeming it necessary to expedite the resolution of permanent disability. A dissenting opinion argued this violated regulations and precedent by prioritizing expediency over established procedures.

Petition for RemovalQualified Medical EvaluatorPanel of QMEsAdministrative DirectorLabor Code Section 4062.2AD Rule 31.5(a)(2)Substantial EvidenceTimely EvaluationAgreed Medical EvaluatorWCJ
References
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