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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. ADJ3778927 (SFO 0460851) ADJ334222 (OAK 0285716) ADJ2101319 (SFO 0437718) ADJ4065670 (OAK 0285715)
Regular
Jan 23, 2012

KIMBERLY ROBERTS vs. CITY AND COUNTY OF SAN FRANCISCO, INTERCARE INSURANCE SERVICES

The defendant sought reconsideration or removal of a WCJ's order directing a new psychiatric QME panel due to a perceived conflict of interest with Dr. Hank Sigal, who was associated with the defendant's prior QME. The Appeals Board dismissed the Petition for Reconsideration, finding the WCJ's order was not a final appealable decision. The Board denied the Petition for Removal, concluding the defendant failed to demonstrate the order would result in significant prejudice or irreparable harm. Consequently, the original order requiring a new QME panel stands.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWCJ Orderconflict of interestQME panelpsychiatric QMEreplacement QMEstipulationsinterim order
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. ADJ10800397
Regular
May 20, 2019

MARILYN RAMIREZ GALVEZ vs. NIAGARA BOTTLING LLC, SAFETY NATIONAL INSURANCE CO.

The applicant sought a QME panel in psychology for a claimed psychiatric injury after orthopedic and internal medicine evaluations. The WCJ denied the request, finding no substantial medical evidence for a psychological QME. The Appeals Board granted removal, rescinded the WCJ's order, and found good cause for a psychological QME panel. This decision allows the applicant to pursue necessary medical-legal discovery regarding her disputed psychological injury claim.

Petition for RemovalFindings and OrderQualified Medical EvaluatorQME panelpsychologypsychiatric injurydiscoveryinternal medicineorthopedic QMEhypertension
References
Case No. OAK 0343580
Regular
Jul 21, 2008

KENRICK BELGRAVE vs. DAVITA, INC., BROADSPIRE

The Workers' Compensation Appeals Board denied DaVita, Inc.'s petition for removal, upholding the WCJ's order for a second QME panel. The original QME report was found deficient for failing to conduct a multilevel analysis required for psychiatric injuries and for improperly rating disability under an outdated schedule. Although the applicant's letter to the QME was inappropriate, it was not deemed prejudicial enough to prevent a supplemental report if the initial report had met statutory standards.

Removal PetitionQualified Medical EvaluatorPanel QMEPsychiatric InjuryGood Faith Personnel ActionMultilevel AnalysisPredominant CausePermanent Disability Rating Schedule2005 PDRS1997 PDRS
References
Case No. ADJ8668832
Regular

BACILIO ANGEL SALAZAR vs. SAN DIEGO PERSONNEL AND EMPLOYMENT AGENCY, INC., AMTRUST NORTH AMERICA for CASTLEPOINT NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding a prior order that deemed a QME report timely. The Board found Dr. Tahami's psychiatric evaluation report was untimely served on the defendant. As the defendant objected prior to receiving the report, they are entitled to a replacement QME panel in psychiatry.

Petition for RemovalQualified Medical EvaluatorQME paneluntimely reportreplacement QMEAdministrative Director RuleLabor Codepsychiatric injurymedical-legal evaluationsubstantial prejudice
References
Case No. ADJ94 70576
Regular
Jun 26, 2017

CARLOS CAMARGO vs. COX PETROLEUM TRANSPORT, EM OIL TRANSPORT, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the applicant's Petition for Reconsideration, rescinded the original Finding and Order, and returned the case for further proceedings. The WCAB found that the primary medical evaluator's (QME) reports were not substantial evidence because they were based on incomplete and inaccurate history, and failed to consider the impact of industrial stress on the applicant's internal medicine conditions. Additionally, the WCAB determined that a separate evaluation by a psychology or psychiatry QME was warranted to address the applicant's psychiatric injury claim, as the internal medicine QME deferred to mental health specialists. Therefore, the record requires further development regarding both the physical and psychiatric aspects of the applicant's claimed industrial injuries.

AOE/COEQMEhypertrophic obstructive cardiomyopathyindustrial stresspsychiatric injuryDSM-IVLabor Code section 3208.3preponderance of the evidenceaggravated conditionsupplementation of the record
References
Case No. GOL 92085, GOL 92086
Regular
Mar 01, 2009

AMADO ORTIZ vs. SANTA BARBARA MISSION ROOFING, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to amend the original award, reducing the permanent total disability indemnity rate from $490 to $430.08 per week as stipulated by the parties. The Board affirmed the finding of 100% permanent disability and the inclusion of psychiatric injury, upholding the exclusion of the defendant's dual-QME reports due to procedural violations. Applicant's psychiatric report was deemed substantial evidence despite defendant's claims of staleness.

Workers' Compensation Appeals BoardJoint Findings and AwardReconsiderationQualified Medical Evaluator (QME)Psychological QMEPsychiatric injuryPermanent total disabilityTemporary disability rateIndustrial injuriesRoofer
References
Case No. ADJ10237267
Regular
Jan 31, 2018

KENNETH ANGEL vs. ABLE ENGINEERING, ZURICH NORTH AMERICA

This Workers' Compensation Appeals Board case concerns applicant Kenneth Angel's request for a replacement Qualified Medical Evaluator (QME) in dentistry. Angel argued that the assigned QME, Dr. David Polushkin, was not licensed to practice at the West Covina location where the evaluation occurred. The Board denied reconsideration, finding insufficient evidence that Dr. Polushkin was ineligible to practice at that location, as "address of record" does not necessarily preclude other authorized practice sites. Furthermore, the Board noted that issues of QME eligibility are within the purview of the Administrative Director, not the Appeals Board.

QME panelreplacement QMEdental QMEWCJPetition for ReconsiderationAmended Findings of FactverificationwaivereligibilityAdministrative Director
References
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