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Case No. ADJ1862557 (SAL 0085137)

Regular

Sep 02, 2016

JULIAN GONZALEZ vs. S. MARTINELLI & COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation, TRISTAR RISK MANAGEMENT

This case involves Julian Gonzalez's claim for permanent total disability due to a 1999 back injury. The defendant, CIGA, sought reconsideration of the award, challenging the administrative law judge's reliance on vocational expert and medical reports. CIGA argued these reports did not constitute substantial evidence and that psychological overlay evidence was unaddressed. The Workers' Compensation Appeals Board denied CIGA's petition, affirming the original award of permanent total disability and adopting the judge's reasoning.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAliquidationTristar Risk Managementpermanently totally disabledvocational expertsubstantial evidenceQualified Medical EvaluatorDr. Clayman

References

Case No. MISSING

Regular Panel Decision

Claim of Reitzen v. Brooklyn Carpet Exchange

The case involves an appeal from decisions of the Workers’ Compensation Board concerning a claimant who sustained a permanent partial disability from a back injury. Despite unanimous medical recommendation for a myelogram and potential surgery, the claimant refused treatment. The Board found his refusal reasonable due to 'subjective fear with a severe psychiatric overlay.' The employer and its insurance carrier appealed, arguing the refusal was unreasonable. The appellate court affirmed the Board's decision, citing substantial evidence that the claimant's rejection of treatment was based on more than groundless fear.

Permanent Partial DisabilityBack InjuryMedical Treatment RefusalMyelogramSurgeryPsychiatric OverlayReasonable RefusalAppellate ReviewEmployer LiabilityInsurance Carrier Liability

References

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JULIAN GONZALEZ vs. S. MARTINELLI & COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION INSURANCE COMPANY, in liquidation, TRISTAR RISK MANAGEMENT

Claim of Reitzen v. Brooklyn Carpet Exchange

Permanent Partial DisabilityBack InjuryMedical Treatment RefusalMyelogramSurgeryPsychiatric OverlayReasonable RefusalAppellate ReviewEmployer LiabilityInsurance Carrier Liability