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

Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ7084863, ADJ7380456
Regular
Aug 05, 2011

JAMES LAMB vs. THE KENAN ADVANTAGE GROUP, AMERICAN ZURICH INSURANCE CO.

This case involves a truck driver, James Lamb, who sustained a lumbar spine injury with radicular pain during his employment. The defendant sought reconsideration of the prior award finding injury only to his lumbar spine. Subsequently, the applicant and defendant reached a settlement via a Compromise and Release agreement. The Appeals Board granted reconsideration, rescinded the prior award, and returned the matter to the trial level for review of the settlement.

Workers' Compensation Appeals BoardKenan Advantage GroupAmerican Zurich Insurance Co.Gallagher BassettJoint Findings Award and Ordertruck drivercumulative periodlumbar spineradicular painlower extremities
References
Case No. MON 349751
Regular
May 09, 2008

Frances Brown vs. COCA COLA, Permissibly Self-Insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration, amending the original decision to clarify that applicant sustained industrial injury to her back with radicular pain in her hips, legs, ankles, and feet. The Board affirmed the WCJ's finding that the claim was not barred by the statute of limitations, crediting the applicant's testimony that she first knew her condition was work-related in April 2007. Reconsideration was granted based on the defendant's arguments, but the amended decision largely affirmed the original award.

Workers' Compensation Appeals BoardCumulative traumaStatute of limitationsDate of injuryEmployment Development DepartmentReconsiderationFindings and AwardRadicular painLumbar spineOrthopedic body parts
References
Case No. ADJ9 989540
Regular
Apr 13, 2016

FELIX GARCIA vs. EUREST FINE DINING, NATIONAL UNION FIRE INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the applicant's petition for removal, upholding the administrative law judge's decision to allow a Qualified Medical Evaluator (QME) panel in neurology. The applicant argued this was prejudicial as his primary treating physician was a chiropractor, but the Board found he failed to demonstrate irreparable harm. The WCJ's report, which the Board adopted, noted that a neurologist was best qualified to evaluate potential radicular pain and nerve conduction studies. Therefore, removal was deemed an extraordinary remedy not warranted in this case.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorPrimary Treating PhysicianSpecialtyChiropracticNeurologyIndustrial InjuryRadicular PainEMG/NCS
References
Case No. ADJ9010662
Regular
Dec 04, 2017

ELSA UMANZOR vs. TWO CHEFS ON A INSPE, INSURANCE, administered by SEDG, CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board adopted the WCJ's report, correcting a typo to clarify that Dr. Shlens found no work-related injury. The Board gave significant weight to the WCJ's credibility determinations and found no substantial evidence to reject them. Therefore, the applicant's petition for reconsideration was denied.

WCABPetition for ReconsiderationDeniedWCJDr. ShlensApplicant's complaintsnot attributedrepetitive workobjective evidencecumulative trauma
References
Case No. ADJ869605
Regular
Nov 19, 2012

MILES GRAY vs. AT&T, permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant who sustained a severe right lower extremity injury, leading to multiple surgeries, significant leg length discrepancy, and fused ankle/foot, requiring constant mobility aids. The Agreed Medical Evaluator (AME) provided opinions on impairment, and vocational experts testified regarding the applicant's ability to return to work. The Workers' Compensation Appeals Board denied reconsideration of the prior award, finding substantial evidence supporting the applicant's unsuitability for rehabilitation. Defendant's supplemental reply did not alter this decision.

Agreed Medical EvaluatorVocational ExpertPetition for ReconsiderationDeniedRight Lower Extremity InjuryMultiple FracturesLeg Length DiscrepancyShoe LiftAnkle FusionGait Derangement
References
Case No. ADJ237483
Regular
Nov 13, 2012

RAYEK J. FAHOUM vs. KAISER FOUNDATION HOSPITAL

The Workers' Compensation Appeals Board denied Rayek J. Fahoum's petition for reconsideration, upholding the findings of the Workers' Compensation Judge. The Judge's report found Fahoum sustained industrial injury to his neck and low back with secondary chronic pain syndrome, awarding 41% permanent disability. This decision relied on the opinions of the Agreed Medical Examiner and Dr. Renee Rinaldi, who concluded Fahoum experienced symptom magnification and that his condition was chronic pain syndrome, not fibromyalgia as claimed by Dr. Allen Salick. The Board extended great weight to the Judge's credibility findings regarding the medical opinions.

Workers' Compensation Appeals BoardReconsideration DeniedAgreed Medical ExaminerSubstantial Medical EvidenceFibromyalgiaChronic Pain SyndromeSymptom MagnificationOrthopedic InjuryLumbosacral StrainCervical Strain
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. ADJ8731635
Regular
Apr 02, 2019

Daissy Contreras vs. CRESTWOOD BEHAVIORAL HEALTH, UNION FIRE INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior award, finding the medical record inadequate to determine applicant's claim of Complex Regional Pain Syndrome (CRPS). While some physicians noted symptoms consistent with CRPS, the Agreed Medical Examiner (AME) found no objective evidence. The Board ordered the matter returned to the trial level for further development of the medical record by appointing a pain management specialist. This new evaluation will aim to diagnose the applicant's right upper extremity condition and determine its industrial causation.

Complex Regional Pain SyndromeCRPSskin injuryrashcumulative traumaAgreed Medical ExaminerAMEskin conditionright upper extremitypain management specialist
References
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