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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. ADJ2628303
Regular
Apr 01, 2014

GLORIA CAIRES vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE

The Appeals Board rescinded the original award and returned the case for further proceedings due to insufficient medical evidence on apportionment. Specifically, the Board found that the opinions of the orthopedic and psychiatric medical evaluators regarding the apportionment of permanent disability lacked substantial medical evidence. The orthopedic evaluator's apportionment methodology, referencing an AMA Guides example, was deemed improper under current Labor Code sections 4663 and 4664. The psychiatric evaluator's apportionment was also found insufficient as it did not adequately explain how psychiatric permanent disability should be apportioned separately from injury causation.

Workers' Compensation Appeals BoardPermanent Disability ApportionmentQualified Medical Evaluator (PQME)Agreed Medical Evaluator (AME)American Medical Association Guides to the Evaluation of Permanent ImpairmentRange of Motion MethodDiagnosis-Related Estimate (DRE) MethodCompensable ConsequenceCausation of Permanent DisabilitySubstantial Medical Evidence
References
Case No. VNO 0380163
Regular
Dec 14, 2007

LAWRENCE REICHELT vs. CITY OF LOS ANGELES (LAPD), Permissibly Self-Insured

The City of Los Angeles sought removal to obtain a psychiatric QME evaluation for an applicant who claimed psychiatric injury related to a past industrial injury. The Board granted removal, holding that Labor Code section 4062.1 applies prospectively to all injuries, regardless of date. The Court amended the previous order to allow the defendant to request a panel of three psychiatric QMEs under section 4062.1(b).

RemovalPetition for RemovalQualified Medical EvaluatorPsychiatric EvaluationLabor Code Section 4062.1SB 899Date of InjuryProspective ApplicationSection 4067.5Competing Statutory Provisions
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. 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. 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. ADJ8908443
Regular
Aug 04, 2017

Abdias Gonzalez vs. Areg Khachikian, Guard Insurance Company

This case concerns the applicant's petition for removal to obtain necessary psychiatric and neurological QME evaluations. The applicant argues that proceeding to trial without this medical evidence would cause irreparable harm due to a severe depressive condition. While the WCJ initially denied reopening discovery, they acknowledged compelling reasons for further medical reporting. The Appeals Board granted the petition for removal, converting the trial date to a status conference to allow the WCJ to facilitate a schedule for obtaining the required medical discovery and ensure substantial justice.

Petition for RemovalMandatory Settlement ConferenceQualified Medical Evaluatorpsychiatric evaluationneurological evaluationtreating physiciansevere depressive conditiondiscovery closurePetition to Reopen Discoverysubstantial prejudice
References
Case No. ADJ7452452
Regular
Oct 22, 2018

EMMA GUTIERREZ vs. AO/THE UNIVERSITY CORP. /CAL STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and rescinded the lower findings. The Board found the WCJ erred by acting as a medical expert rather than requesting further development of the record regarding the applicant's psychiatric injury claim. The case is remanded for further proceedings to properly develop the medical evidence concerning the psychiatric claims, potentially through additional expert reports or evaluations.

WCABAOE/COEPetition for ReconsiderationFindings Award Ordercompensable consequence psychiatric injuryAgreed Medical Evaluator (AME)Substantial EvidenceMedical OpinionLabor Code Section 3208.3Predominant Cause
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
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