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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. 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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
Case No. ADJ7937506, ADJ7937507, ADJ7937509
Regular
Oct 25, 2018

CHARLOTTE BEY HAWA vs. BURBANK UNIFIED SCHOOL DISTRICT

This case involves a dispute over the selection and validity of Qualified Medical Evaluators (QMEs) for an applicant's industrial injuries. The defendant sought removal after the Workers' Compensation Judge (WCJ) struck the reports of Dr. Martinson, a replacement QME. The Appeals Board granted removal, rescinded the order striking Dr. Martinson's reports, and ordered the parties to select an Agreed Medical Examiner or have the WCJ appoint a physician, as both prior QMEs were unavailable. The Board found the applicant's two-year delay in objecting to Dr. Martinson precluded her objection.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationQualified Medical Evaluator (QME)Replacement QME panelStipulated Medical EvaluatorAgreed Medical ExaminerLabor Code Section 5710DWC Rules 31.5DWC Rules 35.5
References
Case No. ADJ11066144
Regular
Feb 12, 2018

ELVIA ANGUIANO DE RANGEL vs. RUIZ FOOD, SAFETY NATIONAL INSURANCE COMPANY

This case concerns a workers' compensation claim for injuries sustained by Elvia Anguiano de Rangel while employed by Ruiz Food. The initial findings by the WCJ awarded injury to the right shoulder, neck, and low back, but the defendant sought reconsideration, arguing that prior medical reports should have res judicata effect and that current medical evidence is insufficient. The Appeals Board granted reconsideration, rescinded the initial findings, and returned the case to the trial level. This decision stems from the Board's determination that neither the applicant's treating physician's report nor the defendant's relied-upon QME report constituted substantial medical evidence, necessitating further development of the record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactQualified Medical EvaluatorPanel Qualified Medical EvaluatorRes JudicataCollateral EstoppelSubstantial Medical EvidenceCumulative TraumaAgreed Medical Examiner
References
Case No. ADJ10758803
Regular
Feb 07, 2018

JOSEPH ROBINSON vs. CITY OF RIVERSIDE

The Appeals Board granted reconsideration, rescinding the prior Findings and Award because the Qualified Medical Examiner's (QME) report lacked substantial evidence. The QME's opinion on cumulative trauma injury appeared based on an incorrect legal understanding, failing to acknowledge the cumulative effect of repetitive job demands over time. Consequently, the matter is returned to the WCJ for further proceedings, potentially including a new medical evaluation, to address the applicant's claimed cumulative trauma injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardQualified Medical ExaminerCumulative TraumaSubstantial Medical EvidenceLabor CodeAggravationAOE/COEPolice Officer
References
Case No. ADJ1434238 (SFO 0461609)
Regular
Jul 18, 2012

DANIEL PRATHER vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board granted reconsideration to review the administrative law judge's (WCJ) findings on permanent disability and apportionment. The Board rescinded the original award, finding that neither the applicant's treating physician nor the defense qualified medical examiner provided substantial medical evidence on apportionment. Due to complex medical issues and inadequate development of the record, the case is returned to the trial level for further proceedings, including the potential selection of an Agreed Medical Examiner or a physician appointed by the Board.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentQualified Medical Examiner (QME)Substantial Medical EvidenceLabor Code §4663Cumulative TraumaSpine Injury
References
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
Case No. ADJ6803561
Regular
Dec 07, 2012

PATRICIA FRANCO vs. RUIZ FOODS, AMERICAN ZURICH INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a previous award due to insufficient medical evidence supporting the applicant's cumulative trauma claim. The board found that the medical opinions from the treating physician and the qualified medical evaluator were speculative and lacked necessary reasoning regarding causation and apportionment to pre-existing conditions like rheumatoid arthritis. Consequently, the case is returned to the trial level for further development of the medical record, potentially including an Agreed Medical Examiner. This ensures due process by requiring a decision based on substantial evidence.

Cumulative TraumaQualified Medical Evaluator (QME)ApportionmentSubstantial EvidenceMedical OpinionReasonable Medical ProbabilityIncomplete Medical RecordsPre-existing ConditionRheumatoid ArthritisPrimary Treating Physician
References
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