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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. ADJ10645876
Regular
Feb 07, 2023

GINA ROSALES vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board (WCAB) reconsidered a case where the applicant claimed work injuries to her psyche, head, back, and body systems. The WCAB rescinded the original decision, finding insufficient development of the medical record regarding the applicant's claims of GERD and hypertension. However, the WCAB upheld the finding that the applicant did not sustain psyche or orthopedic injuries arising out of and in the course of employment. The case is remanded for further proceedings to obtain a supplemental medical opinion on the body systems injuries and then for a new decision by the WCJ.

AOE/COEPro PerFindings and OrderOpinion on DecisionReconsiderationWCJHealth Services AssistantPsyche InjuryBody Systems InjuryGERD
References
Case No. ADJ823138 (OXN 0142604)
Regular
Oct 25, 2010

CHERYL PEET vs. COUNTY OF VENTURA, Permissibly SelfInsured, Administered By CORVEL CORPORATION

The Workers' Compensation Appeals Board is reconsidering a prior decision that found a deputy probation officer sustained industrial injuries resulting in 78% permanent disability. The defendant sought reconsideration, arguing the Qualified Medical Examiner's (QME) opinion, which formed the basis of the award, was ambiguous and unsubstantiated. The Board agrees that the QME's assessment of 60% whole person impairment is not adequately supported by the record, particularly in light of the applicant's own testimony regarding her daily activities. Therefore, the case is returned to the trial level for further evidence development and a new decision, with consideration for cost of living adjustments if a life pension is awarded.

Workers Compensation Appeals BoardCheryl PeetCounty of VenturaCORVEL CORPORATIONADJ823138OXN 0142604Opinion and Decision After Reconsiderationdeputy probation officerindustrial injuryright upper extremity
References
Case No. ADJ10666000
Regular
Jun 04, 2018

JUANA ALEMAN vs. CITISTAFF SOLUTIONS, OLD REPUBLIC INSURANCE, GALLAGHER BASSETT SERVICES, INC.

The applicant, Juana Aleman, seeks reconsideration of a decision that denied her workers' compensation claim for cumulative injury. The appeals board granted reconsideration because the panel Qualified Medical Examiner's (QME) report lacked substantial evidence. Specifically, the QME's description of the applicant's job duties was inconsistent with testimony from both the applicant and her supervisor. Consequently, the board rescinded the prior decision and returned the matter to the WCJ for further proceedings, recommending the parties provide an accurate job description to the QME.

Petition for ReconsiderationPanel Qualified Medical Examiner (QME)Substantial EvidenceJob Description InaccuracyCumulative InjuryWorkers' Compensation Appeals Board (WCAB)Medical OpinionLabor CodeRestored to CalendarFindings Order Opinion
References
Case No. ADJ9317724
Regular
Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal. The applicant sought to overturn a Minute Order compelling an orthopedic QME evaluation, arguing the existing orthopedic panel was improperly obtained and preferred a treating doctor. The Board adopted the WCJ's recommendation, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy not warranted here. The applicant's preference for a treating doctor did not override the WCJ's order for a QME evaluation requested to clarify a prior medical opinion regarding potential knee surgery.

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration
References
Case No. ADJ7785974
Regular
Mar 20, 2019

REFUGIO JOSE ALFARO (Deceased) vs. INTERSTATE HOME SERVICES, INSURANCE COMPANY OF THE WEST GROUP

This case involved a worker's compensation claim for death benefits after Refugio Alfaro died from a myocardial infarction. The defendant contested that the death was industrially caused, challenging the qualified medical examiner's (QME) opinion. The Appeals Board affirmed the finding of industrial causation, finding the QME's opinion substantial evidence supported by deposition testimony. However, the Board rescinded the award and returned the case for further proceedings to identify and determine eligibility of dependents, as the original applicant spouse was deceased.

AOE/COEmyocardial infarctiondeath benefitsQMEsubstantial evidencereconsiderationWCJindustrial causationdependencyaggravated condition
References
Case No. ADJ10007434
Regular
Sep 23, 2016

RUSSELL RASMUSSEN vs. CITY OF PETALUMA, REDWOOD EMPIRE MUNICIPAL INSURANCE FUND

This case concerns a firefighter's claim for a carotid pseudoaneurysm, which the original judge found work-related based on a QME's opinion. The employer sought reconsideration, arguing the QME's opinion lacked substantial evidence as it was speculative and not based on a history of trauma. The Board granted reconsideration, finding the QME's opinion impermissibly speculative. Ultimately, the Board amended the award to exclude the pseudoaneurysm as an industrial injury, reducing the permanent disability award.

Workers' Compensation Appeals BoardCity of PetalumaRussell RasmussenIndustrial cumulative traumaCardiac palpitationsCarotid pseudoaneurysmBattalion ChiefQualified Medical EvaluatorSubstantial medical evidencePetition for Reconsideration
References
Case No. ADJ189332 (SAC 0363079)
Regular
Jan 27, 2009

BONNIE SMITH vs. HUNTER DOUGLAS BYTHEWAYS, LIBERTY MUTUAL 29092 GLENDALE

The Appeals Board grants reconsideration, rescinds the WCJ's decision of November 6, 2008, and returns the matter for further proceedings and a new decision, due to errors in excluding evidence and procedural issues.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuryLow BackNeckRight Upper ExtremityQualified Medical EvaluatorQMEPanel QMEDefense QME
References
Case No. ADJ7857198
Regular
Jan 28, 2019

RANULFO CRUZ, (Deceased) vs. HALL MANAGEMENT CORPORATION, EVEREST NATIONAL INSURANCE, administered by AMERICAN CLAIMS MANAGEMENT, and COMPANION PROPERTY AND CASUALTY INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a decision awarding benefits to the estate of Ranulfo Cruz, a deceased farm laborer. The applicant's death was attributed to Coccidiomycosis (Valley Fever) and meningitis, contracted through exposure during his employment. The WCAB adopted the findings of the administrative law judge, who relied heavily on the medical opinion of Dr. Noriega, the panel QME. Dr. Noriega opined that the decedent's occupational duties, involving soil disruption in an endemic region, presented a statistically greater risk of exposure than non-work activities, establishing industrial causation.

Workers' Compensation Appeals BoardRanulfo CruzHall Management CorporationEverest National InsuranceCompanion Property and Casualty InsuranceADJ7857198Petition for ReconsiderationDeniedWCJ reportsubstantial evidence
References
Case No. ADJ1350207 (SRO 0141409) ADJ7636521
Regular
May 08, 2012

MICHELE WOODRUFF vs. G\u0026K MANAGEMENT, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding the prior order for a second QME panel in orthopedics. The Board found the administrative law judge prematurely ordered the panel before evidence was presented or the case was submitted for decision. The Board clarified that a judge can only order supplemental medical evaluations after trial if specific opinions are found deficient, not beforehand. The matter was returned to the trial level for further proceedings and eventual trial.

Petition for RemovalQualified Medical EvaluatorSecond QME PanelMcDuffie v. Los Angeles County Metropolitan Transit AuthoritySubstantial EvidenceMedical Record DevelopmentTrial Level ProceedingsOpinion and OrderCumulative Trauma ClaimMandatory Settlement Conference
References
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