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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. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ2931695 (VNO 0522520) ADJ1823406 (VNO 0546227)
Regular
Jul 16, 2012

SANDY CASTLE vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal because it was untimely and unverified, violating WCAB Rules 10843(a) and 10844. The petition sought to rescind an order that took the case off calendar without ruling on the applicant's issues regarding an agreed medical evaluator's payment and a benefit printout. The Board adopted the judge's report and recommendation, finding the petition procedurally deficient. One commissioner dissented, arguing the judge should have ordered the benefit printout and payment of the AME's bill.

Petition for RemovalWorkers' Compensation Appeals BoardWCJDeclaration of Readiness to ProceedAgreed Medical EvaluatorAMEBenefit PrintoutWCAB Rule 10843(a)WCAB Rule 10844Untimely Petition
References
Case No. ADJ1315350 (VNO 0557111)
Regular
Apr 20, 2012

LINDA KAMBOW vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, VALLEY STATE PRISON FOR WOMEN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by an inmate laborer for orthopedic and psychiatric injuries. The Workers' Compensation Appeals Board denied reimbursement to Hepps Pharmacy for medications, as no prescription was provided. The Board also reversed an award to Southern California Mental Health Associates for psychiatric treatment, ruling that inmate psychiatric injuries are not compensable under Labor Code section 3208.3(j). The Board found that the psychiatric injury was a consequence of the industrial orthopedic injury, and thus not a compensable independent non-industrial condition requiring treatment to relieve orthopedic effects.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code 3208.3(j)Inmate laborerIndustrial orthopedic injuryNon-industrial psychiatric treatmentPrimary treating physicianSubstantial medical evidenceCompromise and Release AgreementLien trial
References
Case No. ADJ3817836 (SJO 0250881)
Regular
May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability
References
Case No. ADJ8203843
Regular
Aug 15, 2016

GARY KUBECK vs. CALETTI JUNGSTEN CONSTRUCTION, AMERICAN ZURICH INSURANCE COMPANY

In this workers' compensation case, the defendant sought reconsideration of the original finding that the applicant sustained $71\%$ permanent disability, arguing the judge improperly rejected the Agreed Medical Evaluator's (AME) apportionment opinion on psychiatric injury. The Board granted reconsideration, amending the award to include $35\%$ non-industrial apportionment to the applicant's psychiatric disability. This resulted in a revised permanent disability award of $68\%$. The Board found the AME's opinion on apportionment constituted substantial medical evidence and was not unpersuasive.

ApportionmentAgreed Medical Evaluator (AME)Psychiatric InjuryPermanent DisabilityFindings and AwardPetition for ReconsiderationIndustrial InjuryNon-industrial ApportionmentCausationSubstantial Medical Evidence
References
Case No. ADJ3615708 (BAK 0147668) ADJ2881957 (BAK 0147353) ADJ1664277 (BAK 0147354)
Regular
Oct 27, 2015

FRANCISCO JAVIER CASILLAS vs. SAN JOAQUIN VALLEY TRANSPORTATION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision, arguing that a key psychiatric AME report was unreliable and that the WCJ failed to address this in the opinion. The WCAB denied the reconsideration, finding that the WCJ properly relied on the reports of a different psychiatric AME, thus rendering the applicant's argument regarding the disputed report irrelevant. However, the WCAB granted reconsideration on its own motion to correct clerical errors in the original decision identified by the parties. The matter was then remanded to the WCJ to reissue a corrected decision.

California Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Awards and OrdersAgreed Medical Evaluator (AME)Dr. John StalbergDr. Carl Marusaksubstantial medical evidencepsychiatric claimspermanent disabilitylabor code section 132a
References
Case No. ADJ2162178 (FRE 0200410) ADJ972133 (FRE 0197989)
Regular
Apr 04, 2011

SANDRA LAPLANTE vs. WALMART ASSOCIATES, INC., AMERICAN HOME ASSURANCE

This case involves a dispute over the apportionment of psychiatric disability following industrial injuries. The applicant, Sandra Laplante, sustained multiple injuries in two separate incidents while employed by Walmart. The primary issue on reconsideration is whether the Agreed Medical Examiner's (AME) testimony supports apportionment of her psychiatric disability to non-industrial causes. The Appeals Board granted reconsideration, rescinded the prior decision, and returned the case for further proceedings, finding the AME's updated opinion on apportionment to be well-reasoned and based on substantial evidence.

Workers' Compensation Appeals BoardReconsiderationApportionmentPsychiatric disabilityAgreed Medical Examiner (AME)Labor Code section 4663Senate Bill 899CausationPermanent disabilityIndustrial injury
References
Case No. ADJ1023653 (MON 0331335)
Regular
Feb 05, 2009

BARBARA ARANA vs. THE HOME DEPOT, SEDGWICK CMS

The Workers' Compensation Appeals Board affirmed a prior decision regarding applicant Barbara Arana's industrial injury at The Home Depot, which caused back and psyche injuries. The Board found that the Agreed Medical Evaluator's (AME) report provided substantial evidence for apportioning 33 1/3% of the applicant's lumbar disability to pre-existing conditions. While one commissioner dissented, arguing the AME's apportionment report lacked clarity on the causal link between prior conditions and current disability, the majority adopted the WCJ's findings. This decision upholds the original award of 39% permanent disability after apportionment.

Agreed Medical Evaluator (AME)ApportionmentIndustrial InjuryLumbar DisabilityPsychiatric DisabilityPermanent DisabilityReconsiderationFindings and AwardSubstantial EvidencePre-existing Conditions
References
Case No. ADJ2012304 (STK 0213737)
Regular
May 27, 2014

HILARIO GONZALES vs. DIRK LIMAS CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involved an applicant seeking reconsideration of a Workers' Compensation Judge's decision that denied his psychiatric injury claim due to insufficient employment duration and labeled his accident as not "sudden and extraordinary." The Appeals Board granted reconsideration, finding the psychiatric injury claim compensable because the applicant's testimony, uncontradicted by the defense, established the accident as a sudden and extraordinary employment condition. The Board also ruled the psychiatric expert's reports admissible and remanded the case for further proceedings on permanent disability and future medical care, particularly concerning cognitive and psychiatric conditions. The issue of apportionment of permanent disability was deferred pending further development of the record.

Labor Code section 3208.3(d)sudden and extraordinary employment conditionpsychiatric injurypermanent disabilityfuture medical carereconsiderationvocational expertApportionmentPQMEAME
References
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