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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. ADJ7927652
Regular
Oct 25, 2016

Bozenna Kasperowicz vs. Metropolitan State Hospital, State Compensation Insurance Fund

This case involves an industrial injury to the applicant, a psychiatric technician, sustained on June 14, 2011, from a patient strike to the head. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over psychiatric impairment and a sleep disorder rating. The WCAB affirmed the original award but reduced the permanent disability rating from 76% to 70% by excluding the sleep dysfunction impairment. The WCAB found Dr. O'Brien's opinion on psychiatric impairment more persuasive than conflicting medical evaluations and determined Dr. Matos's opinion on sleep impairment lacked substantial medical evidence due to staleness.

WCABReconsiderationPsychiatric ImpairmentWhole Person ImpairmentGAF ScoreSleep DisorderSubstantial Medical EvidencePermanent DisabilityQualified Medical EvaluatorInsomnia
References
Case No. ADJ7044663 ADJ7044664 ADJ11257861
Regular
Feb 26, 2020

DAVID PURCELL vs. ALLIED AVIATION HOLDINGS CORPORATION, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, AMERICAN INTERNATIONAL GROUP, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address the applicant's claim that his psychiatric and physical disabilities should be added, not combined, leading to a potential $100 \%$ permanent disability award. The WCJ had previously found $82 \%$ permanent disability based on a combination of injuries. The WCAB rescinded the original decision, finding the record lacked substantial evidence on whether the psychiatric disability's "synergistic effect" on physical impairments warranted addition. The case is returned to the WCJ for further proceedings to clarify this issue and develop the record for a new decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrdersPermanent DisabilityPsychiatric DisabilityPhysical DisabilityAgreed Medical ExaminerSynergistic EffectCombination of ImpairmentsAddition of Impairments
References
Case No. ADJ7449576
Regular
May 11, 2016

MANNY WINNINGHAM vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS

This case concerns an applicant seeking total permanent disability benefits based on a brain injury. The applicant argued for conclusive total disability under Labor Code section 4662(a)(4) due to permanent mental incapacity. The Board affirmed the WCJ's finding that while the applicant suffered serious psychiatric impairments leading to overall total disability, the specific cognitive impairments did not meet the threshold for the *conclusive* presumption of total disability under section 4662(a)(4). Therefore, apportionment was still applicable, and the previous award of $84\%$ permanent disability was upheld.

Permanent total disabilityLabor Code section 4662(a)(4)Conclusive presumptionApportionmentBrain injuryPermanent mental incapacityGlobal Assessment of Functioning ScaleCognitive impairmentPsychiatric impairmentCorrectional officer
References
Case No. ADJ9162432
Regular
Oct 23, 2017

TEODORO LARIOS vs. EASTBAY EQUITIES, INC. dba WENDY'S OLD FASHIONED HAMBURGERS, AMTRUST NORTH AMERICA

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded lien claims for psychiatric treatment. The defendant argues that Labor Code section 3208.3(d) bars these claims due to insufficient employment duration and that the prior WCAB opinion is res judicata. The WCAB granted reconsideration, rescinded the WCJ's decision, and remanded the case for further proceedings. The WCAB clarified that while psychiatric conditions may be claimed as compensable consequence injuries post-January 1, 2013, they do not increase permanent impairment ratings, and the six-month employment requirement under section 3208.3(d) still applies unless the treatment was essential for a physical injury.

Workers' Compensation Appeals BoardLabor Code Section 3208.3(d)Res JudicataMedical Treatment Utilization Schedule (MTUS)Official Medical Fee Schedule (OMFS)Independent Bill ReviewCompensable Consequence InjuryPsychiatric InjuryPermanent ImpairmentLength of Employment
References
Case No. ADJ7181658
Regular
May 13, 2014

Sheriee Borela vs. State of California, Department of Motor Vehicles, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration and rescinded a previous award. The employer challenged the administrative law judge's (ALJ) method of combining orthopedic and psychiatric permanent disability ratings, arguing it should have used the Combined Values Chart (CVC) instead of simple addition. The Board found the ALJ abused her discretion by not applying the CVC without sufficient medical evidence to justify an alternative method. The case was returned for a new permanent disability rating utilizing the CVC.

Workers' Compensation Appeals BoardPermanent Disability RatingCombined Values ChartOrthopedic ImpairmentsPsychiatric ImpairmentsAdditive FashionSchedule for Rating Permanent DisabilitiesAgreed Medical ExaminersWhole Person ImpairmentApportionment
References
Case No. ADJ7514251
Regular
Aug 31, 2017

MARIA GALVAN vs. PACIFIC BUILDING CARE, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted reconsideration to address applicant's claims regarding permanent disability and psychiatric impairment. The Board found that the Agreed Medical Examiner's (AME) reports lacked substantial evidence for permanent disability ratings due to insufficient reasoning. Consequently, the Board deferred the issue of lumbar spine permanent disability and ordered further proceedings to develop the medical record. The original Findings, Award and Orders were otherwise affirmed.

Agreed Medical ExaminerSubstantial EvidencePermanent Partial DisabilityLumbar Spine InjuryOrthopedicPsychiatric ImpairmentTemporary Disability RateMedical Record DevelopmentPetition for ReconsiderationFindings Award Orders
References
Case No. ADJ8814296
Regular
Feb 16, 2017

JANET WILDER vs. CAPRI GLOBAL MANAGEMENT, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the Findings and Award (F&A) concerning applicant Janet Wilder's work-related injuries. The WCAB affirmed the F&A's findings regarding the nature of the injuries and psychiatric disability but found the medical evidence supporting the cranial/trigeminal nerve impairment was not substantial. Consequently, the WCAB deferred the issues of permanent disability and attorney's fees, remanding the case to the WCJ for further proceedings to develop the record on those specific issues.

Workers Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgePermanent DisabilityApportionmentQualified Medical EvaluatorCranial Nerve ImpairmentFacial DisorderPsychiatric Disability
References
Case No. ADJ6662275
Regular
Jun 13, 2011

DARRIN BEAN vs. CITY OF CHULA VISTA

This case involves an applicant seeking workers' compensation for a skin cancer injury. The applicant contests the testimony of an independent medical expert, Dr. Brigham, who offered an opinion on his impairment rating that differed from the agreed medical evaluator's (AME). The Appeals Board granted the applicant's Petition for Removal, ruling that Dr. Brigham's testimony was inadmissible as he was neither an AME nor a treating physician and his testimony was not in rebuttal to formal rating instructions. Consequently, Dr. Brigham's testimony was stricken, the prior order was rescinded, and the case was returned to the trial level for further proceedings based solely on admissible medical evidence.

Petition for RemovalAgreed Medical EvaluatorAMA GuidesWhole Person ImpairmentPermanent Disability RatingClass 1 ImpairmentClass 2 ImpairmentClass 3 ImpairmentMedical Evidence AdmissibilityRebuttal Testimony
References
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