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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ6591842
Regular
Jan 28, 2013

FRANCISCO LUJAN vs. MAXON INDUSTRIES, INC., CHARTIS COSTA MESA, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case involves a worker's compensation claim by Francisco Lujan against Maxon Industries, Inc. The defendant, Maxon Industries, filed a Petition for Reconsideration arguing that the Administrative Law Judge (ALJ) erred by relying on the medical opinions of Dr. Diane Weiss. The defendant contended Dr. Weiss's reports were not substantial evidence due to perceived discrepancies in symptom severity, lack of psychological testing, alleged ex parte communication, contradiction by another doctor, disregard of videotape evidence, and non-conformity with AMA Guides. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, adopting the ALJ's report which found Dr. Weiss's opinions credible and well-reasoned, supported by the applicant's testimony and corroborated by another medical expert on the critical issue of work capacity. The WCAB also upheld the ALJ's reliance on the vocational expert's report, finding it unrebutted, and found no error in the award of attorney's fees.

Petition for ReconsiderationAgreed Medical ExaminerElectric shockSub rosa videoGAF scorePsychological testingEx parte communicationAMA GuidesVocational expertUniform Reduction Method
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. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
Case No. ADJ13030119
Regular
Apr 28, 2023

MARIA YESENIA JARAMILLO JIMENEZ vs. EL POLLO LOCO, TECHNOLOGY INSURANCE administered by AMTRUST

Lien claimant Nogales Psychological Counseling appealed an administrative law judge's decision disallowing its lien for services. The Workers' Compensation Appeals Board granted reconsideration to further review the matter. Subsequently, the parties entered into a stipulation, agreeing to settle the lien claim for $6,500.00. The Board rescinded the original decision and approved the stipulation as the final resolution of the dispute.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings of Fact and OrderWCJDisallowed LienStipulationSettlementRescindedApproved
References
Case No. ADJ10551600
Regular
Mar 02, 2018

JOSE TORRES vs. COUNTY OF STANISLAUS, YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration because the primary treating physician's opinion, which formed the basis of the award, was not supported by substantial evidence. The physician's impairment ratings for the applicant's neck and back were based on outdated strength testing results from 1.5 years prior to his report and conflicted with more recent findings. The Board found the physician's examination inadequate, thus rescinding the award and remanding the case for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Award OpinionPermanent Disability RatingSubstantial EvidencePrimary Treating PhysicianQualified Medical EvaluatorJamar TestingOutdated Testing ResultsInadequate Examination
References
Case No. FRE 0191984
Regular
Aug 11, 2008

MARIA ROMERO vs. FOSTER POULTRY FARMS

This Workers' Compensation Appeals Board case involves a dispute over lien claimant Schroeder Chiropractic North's payment for services rendered to applicant Maria Romero. Both the defendant and the lien claimant petitioned for reconsideration of an amended findings and award. The Board granted reconsideration, amending the award to allow payment for chiropractic treatment from January 6, 2005, to October 18, 2006, while disallowing payment for specific services like manual muscle testing and radiography.

Workers' Compensation Appeals BoardReconsiderationLien ClaimantChiropractic TreatmentManual Muscle TestingRadiography TestsOrthoticsKnee BraceQualified Medical EvaluatorStipulations
References
Case No. ADJ10153886
Regular
Apr 23, 2018

MICHAEL BARROS vs. COUNTY OF RIVERSIDE SHERIFF'S DEPARTMENT

The applicant, a sheriff's investigator, injured his right knee while jogging off-duty. The employer, County of Riverside Sheriff's Department, denied the claim, asserting it was barred by Labor Code section 3600(a)(9) as an off-duty recreational activity. The Appeals Board rescinded the initial findings, ruling the injury was not compensable because the applicant failed to demonstrate his subjective belief that jogging was objectively reasonable or required by his employment. General employer preferences for physical fitness or its mention in performance evaluations, without specific directives or testing, are insufficient to overcome the statutory bar.

Labor Code section 3600(a)(9)AOE/COEoff-duty recreational activitysubjective beliefobjectively reasonableEzzy testvocational expectationphysical fitness requirementsperformance evaluationssubstantial nexus
References
Case No. ADJ9368263, ADJ9380293
Regular
Sep 15, 2015

JOSE MELCHOR vs. BRUTOCAO VINEYARDS, STAR INSURANCE COMPANY

This case involves a defendant's petition for removal regarding an order for a second Qualified Medical Examiner (QME) panel concerning the applicant's head injury. The Workers' Compensation Appeals Board (WCAB) granted removal to correct a clerical error in the original order. The WCAB affirmed the necessity of a second QME to further develop the medical record on the head injury claim, specifically in the specialty of Psychology-Clinical Neuro Psychology.

Petition for RemovalSecond QME PanelHead InjuryMedical Record DevelopmentWCJ Duty to Develop RecordPQME SpecialtyPSNPsychology-Clinical Neuro PsychologyMandatory Settlement ConferenceLack of Diligence
References
Case No. ADJ7197363
Regular
Feb 11, 2014

NARCISO NOVA vs. JC SALES, dba SHIMS BARGAIN, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a lien claimant, California Psychological Associates, seeking reconsideration for disallowed costs of psychological treatment for applicant Narciso Nova. The Workers' Compensation Appeals Board denied the petition, adopting the Administrative Law Judge's report. The judge found no evidence of an injury to the psyche or that the psychological treatment was medically necessary for the admitted cervical spine injury. Furthermore, the psychological reports were not incorporated into any primary treating physician reports, and treatment began nearly two years after the applicant reached maximum medical improvement.

WCABPetition for ReconsiderationPsychological treatmentMedical necessityPrimary treating physicianMaximum medical improvementLien claimantStipulations with Request for AwardPermanent disabilityReferral
References
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