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

Case No. ADJ7962227
Regular
May 09, 2014

ANDREA REYNOSO vs. SANSUM CLINIC, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the initial finding that she did not sustain a cumulative injury during her employment. The applicant claimed new evidence, including EMG testing for wrist issues and diagnoses of pulmonary embolism and blood clots affecting her psyche, should have been considered. However, the Board found this evidence was not "newly discovered" and could have been discovered through due diligence prior to the settlement conference or trial. Even if admitted, the new evidence would not alter the conclusion that any industrial injury occurred in 1999, not during her employment with Sansum Clinic.

Workers' Compensation Appeals BoardCumulative InjuryAgreed Medical EvaluatorPetition for ReconsiderationFindings of Fact and OrderAOE/COECarpal Tunnel SyndromePulmonary EmbolismPsyche InjuryNew Evidence
References
Case No. ADJ6884625
Regular
Jun 19, 2012

JASON PETERSON, KIRSTIE MCCRAINE-PETERSON vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

This case concerns the death of Jason Peterson, a correctional officer, from a pulmonary embolism after injuring his calf in a kickboxing class. The applicant, his widow, claimed the injury and death were work-related, arguing the kickboxing class was a reasonable expectancy of employment due to a general fitness requirement and incentive program. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's decision, finding the claim barred by Labor Code Section 3600(a)(9) because the decedent's belief that kickboxing was required was not objectively reasonable, as mere general assertions of fitness expectations are insufficient. Commissioner Brass dissented, believing the decedent's participation was both subjectively and objectively reasonable given its likely benefit to his job performance as a correctional officer.

Labor Code Section 3600(a)(9)Pulmonary EmbolismCorrectional OfficerKickboxingOff-duty Recreational ActivityReasonable Expectancy of EmploymentSubjective BeliefObjective ReasonablenessEzzy testCity of Stockton v. Workers' Comp. Appeals Bd. (Jenneiahn)
References
Case No. FRE 0213272
Regular
Oct 02, 2007

ROGER MILLS vs. SUNRISE BUILDERS, VIRGINIA SURETY COMPANY, APPLIED RISK SERVICES

The Workers' Compensation Appeals Board affirmed the WCJ's decision, denying the applicant's contentions regarding a pulmonary injury. The Board found the applicant's permanent disability rating of 40% for an orthopedic injury was consistent with medical opinions and relevant case law, particularly regarding apportionment of pre-existing conditions. The decision disallowed claims for the pulmonary condition and associated medical treatment, upholding the original award.

Workers' Compensation Appeals BoardPulmonary/Respiratory InjuryOrthopedic InjuryPermanent and StationaryTemporary DisabilityPermanent Disability AwardApportionmentSB 899Agreed Medical EvaluatorBrodie v. Workers' Comp. Appeals Bd.
References
Case No. ADJ2562535 (BAK 0151733)
Regular
Jan 07, 2014

STEVE ADAMS vs. COUNTY OF KERN, Permissibly Self-Insured

The Workers' Compensation Appeals Board reversed a finding that the defendant did not unreasonably delay compensation payments. The applicant sustained an industrial injury to his pulmonary system, and medical evidence confirmed the injury was work-related. The Board found that despite the existence of an agreed medical examiner's report confirming the injury, the defendant's denial of liability persisted for an unreasonable period. Consequently, the defendant was found to have unreasonably delayed payments for temporary disability, permanent disability, and mileage reimbursement, with the penalty amount to be determined.

Industrial InjuryPulmonary SystemCode Compliance OfficerPermanent DisabilityReconsiderationLabor Code 5814Delay PenaltiesAgreed Medical ExaminerPulmonary DiseaseOccupational Asthma
References
Case No. ADJ4052884 (AHM 0136124) ADJ6520242
Regular
Feb 20, 2014

EMILIO EDDIE ROMERO (Deceased) SARA ROMERO (Widow) vs. CLOROX PRODUCTS MANUFACTURING

The Appeals Board granted the defendant's petition for removal, rescinding an order to replace a Qualified Medical Evaluator (QME). The WCJ had terminated the QME believing his partial review and stated refusal to review more records showed prejudgment on causation. However, the Appeals Board found it premature to disqualify the QME, noting his opinion of idiopathic pulmonary fibrosis as an unknown cause of disease could render additional MSDS irrelevant if correct. The Board ordered a deposition of the QME to explore his opinions and any alleged bias before deciding on a replacement, allowing further record development.

Petition for RemovalPQMEPanel Qualified Medical EvaluatorCausationIdiopathic Pulmonary FibrosisMaterial Safety Data SheetsMSDSSubstantial Medical EvidenceDepositionMcDuffie v. Los Angeles County Metropolitan Transit District
References
Case No. ADJ7658097
Regular
Aug 14, 2017

John Cummins vs. VIP Limousines \& Coaches, Inc., Commerce and Industrial Insurance Company, Barrett Business Services, Inc.

This case involves an applicant who claimed injury to multiple body parts, including upper extremities, back, neck, abdomen (hernia), and lower extremities. The Workers' Compensation Appeals Board (WCAB) affirmed the original findings, except they specifically ruled against injury to the applicant's upper extremities based on the Agreed Medical Examiner's opinion. The WCAB also clarified that temporary disability benefits should commence from September 14, 2010, the date of hernia repair surgery, and deferred the determination of the exact date of injury for the cumulative trauma. The court also upheld the applicant's average weekly earnings determination, finding the applicant's testimony and records credible and unrebutted.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAgreed Medical Examiner (AME)Qualified Medical Evaluator (QME)temporary disability indemnitydate of injurycumulative traumahernia repairpulmonary embolism
References
Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ7383066
Regular
Apr 18, 2012

FRANK LOCKETT, Deceased SARAH LOCKETT, Widow vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied reconsideration of the decision barring the widow's death benefits claim. The Board adopted the Administrative Law Judge's report, which found the claim untimely under Labor Code Section 5406. This was because the deceased employee had previously stipulated to an injury date, and his death occurred more than 240 weeks after that date. The applicant's petition for reconsideration failed to provide specific record references as required by WCAB Rule 10842(b).

Labor Code Section 5406Death ClaimStatute of LimitationsIntervivos Determination240-Week RuleCumulative TraumaCardiovascular InjuryPulmonary EmbolismDependent's RightsLatent Disease
References
Case No. ADJ3925550 (FRE 0184373) ADJ4624174 (FRE 0184374) ADJ4237232 (FRE 0189809) ADJ2179378 (SDO 0355087) ADJ1685377 (SDO 0355094)
Regular
Mar 17, 2009

, Robert Sedam (decedent), Kelley Sedam (widow), dependent children vs. OMNI FLIGHT HELICOPTERS and INSURANCE COMPANY OF PENNSYLVANIA, Adjusted By AIG CLAIM SERVICES, INC.

The WCJ found that the claim for death benefits concerning the June 12, 2006 death of decedent was barred by Labor Code section 5406. The Appeals Board affirmed the WCJ's decision.

compensable consequence injuryLabor Code section 5406death benefits240-week limitationdeep vein thrombosisdate of injurypermanent disabilitycardiac arrestpulmonary embolismindustrial causation
References
Case No. ADJ3971871 (GRO 0033312)
Regular
Feb 26, 2009

HENRY P. WEIGEL JR. vs. COUNTY OF SANTA BARBARA, COUNTY OF SANTA BARBARA RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior findings, and remanded the case. The Board found that the judge erred in denying apportionment of the applicant's back disability, as Dr. Miller's opinion constituted substantial evidence of causation apportionment. The matter is returned to the trial level for a new decision, including apportionment of the applicant's back disability. The Board will address other issues raised by the defendant upon remand.

Workers Compensation Appeals BoardDeputy SheriffIndustrial InjuryLow BackPsychePulmonary EmbolismGastrointestinal SystemCompensable ConsequencePermanent DisabilityApportionment
References
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