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

Case No. ADJ2772961 (VNO 0505212)
Regular
May 20, 2011

Rodney Elkins vs. DE MOOR'S PAINTING, INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to clarify that the applicant's treating physician, not the Agreed Medical Evaluator, must direct and manage the decreasing narcotic treatment plan. The Board affirmed the award of a gym membership, exercise sessions, and sleep medication, finding these consistent with the AME's well-reasoned opinion and the treating physician's recommendations. The issue of radiofrequency nerve ablation was deferred as premature pending completion of the current treatment plan. Finally, the Board denied attorney fees under Labor Code section 5814.5, finding no unreasonable delay in compensation due to the defendant's reliance on the AME's medical opinion.

Workers' Compensation Appeals BoardAgreed Medical EvaluatorTreating PhysicianPetition for ReconsiderationFindings of Fact and AwardLabor Code Section 5814.5Medical TreatmentRadiofrequency Nerve AblationNarcotic AnalgesicsGym Membership
References
7
Case No. ADJ380850 (SAL 0117839)
Regular
Apr 26, 2011

Sandra Corona vs. LOS APTOS CHRISTIAN FELLOWSHIP CHILDCARE, CHURCH MUTUAL INSURANCE COMPANY

This case involves a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The original decision awarded the applicant further medical treatment, including a cervical radiofrequency ablation. The defendant argued that the applicant failed to follow the proper Labor Code Section 4062 process after their utilization review denied the treatment request. The majority of the WCAB denied reconsideration, holding that an applicant is not strictly required to use Section 4062 to dispute a utilization review denial and may proceed to an expedited hearing, especially when the employer failed to provide adequate information for the review. However, one commissioner dissented, arguing that Section 4062 mandates a dispute resolution process following utilization review.

Workers' Compensation Appeals BoardLabor Code Section 4610Labor Code Section 4062Utilization ReviewReconsiderationFindings and AwardPrimary Treating PhysicianExpedited HearingAgreed Medical ExaminerQualified Medical Examiner
References
2
Case No. ADJ3744023
Regular
May 15, 2009

JOSEPH CRABTREE vs. MITCHELL BERMAN CABINET MAKER, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of an award finding an industrial injury to the applicant's abdomen/groin (hernia) and a resulting peripheral nerve injury causing 24% permanent disability. The defendant argued the peripheral nerve injury was not supported and the disability rating was incorrect due to misapplication of the AMA Guides. The Board denied reconsideration, adopting the judge's report and finding that the medical evidence supported the peripheral nerve injury and the AMA Guides were correctly applied. The Board found the agreed medical evaluator's conclusions were well-reasoned and supported by the evidence.

Workers Compensation Appeals BoardIndustrial InjuryHerniaPeripheral Nerve InjuryPermanent DisabilityAgreed Medical Evaluator (AME)AMA GuidesPetition for ReconsiderationMedical EvidenceWCJ
References
4
Case No. ADJ900432 (SAC 0323091)
Regular
Dec 30, 2011

MARLENE COPUS vs. NORTH SACRAMENTO ELEMENTARY SCHOOL DISTRICT

This case involves a dispute over the necessity of spinal surgery for an applicant who sustained a cumulative trauma injury to her neck and back. While the applicant's treating physician recommended surgery, a second opinion physician disagreed, citing a lack of nerve root compression. The Appeals Board found that the medical evidence was insufficient to determine the necessity of surgery, particularly in light of ACOEM Practice Guidelines which generally recommend against surgery without nerve root compression. Therefore, the Board rescinded the prior award and remanded the case to appoint an independent physician to evaluate the applicant and determine the reasonableness and necessity of the proposed surgery.

Workers' Compensation Appeals BoardMarlene CopusNorth Sacramento Elementary School Districtcumulative traumaspinal surgerynerve root impingementcervical stenosisDr. OrisekDr. GregoriusACOEM Practice Guidelines
References
4
Case No. SAL 0103596
Regular
Jan 07, 2008

CHRISTIE GAYNES vs. GRANITE ROCK COMPANY, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration. The applicant sought to have a medical evaluation by an anesthesiologist or neurologist, arguing the chosen Agreed Medical Evaluator (AME), an orthopedist, lacked the necessary expertise for her specific nerve pain. The Board found the petition untimely and upheld the WCJ's recommendation for dismissal.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Compelling AttendanceMedical EvaluationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)WCJReport and RecommendationDismissed PetitionTimeliness
References
0
Case No. SAL 0048019
Regular
May 28, 2008

CONN TRENNER vs. MONTEREY PENINSULA AIRPORT DISTRICT, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, reversing the finding of unreasonable delay in authorizing the applicant's ablation procedure. However, the Board affirmed the finding of unreasonable delay in SCIF's payment of the applicant's co-payment for the procedure, upholding the associated penalty. The matter was returned to the trial level to determine the appropriate attorney's fee award under Labor Code section 5814.5.

Labor Code section 5814Labor Code section 4610Labor Code section 5814.5utilization reviewunreasonable delaypenaltyablation procedureco-paymentreimbursementattorney's fees
References
1
Case No. ADJ3361459
Regular
Oct 15, 2012

Christiane Flynn vs. YOLANDA'S OF VENTURA, AMERICAN HOME ASSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration and amended its prior decision regarding Christiane Flynn's injury. The applicant sustained injuries including right shoulder, brachial nerve, upper extremities, thoracic outlet syndrome, complex regional pain syndrome, psyche, and fibromyalgia. Her permanent disability was found to be 100% total, entitling her to weekly indemnity payments. A substantial attorney fee of $47,451.89 was deemed reasonable and ordered payable.

Christiane FlynnYolanda's of VenturaAmerican Home AssuranceAIG Claim ServicesADJ3361459VEN 0112129ReconsiderationAdministrative Law JudgeWaitressOccupational Group 322
References
0
Case No. ADJ8814296
Regular
Feb 16, 2017

JANET WILDER vs. CAPRI GLOBAL MANAGEMENT, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the Findings and Award (F&A) concerning applicant Janet Wilder's work-related injuries. The WCAB affirmed the F&A's findings regarding the nature of the injuries and psychiatric disability but found the medical evidence supporting the cranial/trigeminal nerve impairment was not substantial. Consequently, the WCAB deferred the issues of permanent disability and attorney's fees, remanding the case to the WCJ for further proceedings to develop the record on those specific issues.

Workers Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgePermanent DisabilityApportionmentQualified Medical EvaluatorCranial Nerve ImpairmentFacial DisorderPsychiatric Disability
References
3
Case No. ADJ8738819
Regular
Jun 10, 2015

Stephanie MOTEN vs. CITY OF LOS ANGELES

This case involves a dispute over Stephanie Moten's permanent disability rating following a work injury. Both the applicant and defendant sought reconsideration of an award of 19% permanent disability. The Appeals Board found the Agreed Medical Evaluator's (AME) permanent disability ratings were not substantial evidence due to improper application of the AMA Guides and failure to properly analyze nerve impairment. Consequently, the Board deferred the issues of permanent disability and attorney's fees, returning the case to the trial level for further proceedings.

Workers' Compensation Appeals BoardStephanie MotenCity of Los AngelesTristar Risk ManagementOpinion and Decision After ReconsiderationPermanent DisabilityAmerican Medical Association GuidesAMA GuidesAgreed Medical EvaluatorAME
References
5
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
4
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