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

Case No. ADJ6630817
Regular
Dec 27, 2010

NADINE WHITEEAGLE vs. CENTRAL RECRIGERATOR SERVICES, GREAT WEST CASUALTY

This case concerns an applicant's shoulder injury resulting in 12% permanent disability. The defendant argued the Permanent Medical Evaluator (PQME) found 0% impairment and objected to the rater's consideration of surgery. However, the Appeals Board affirmed the WCJ's decision, finding the rating instruction was properly based on substantial medical evidence from the PQME's report, which included the applicant's shoulder surgery. The Board also noted the defendant's objection to the rating was untimely.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrderPermanent DisabilityPanel Qualified Medical Evaluator (PQME)Whole Person Impairment (WPI)AMA Guides to the Evaluation of Permanent ImpairmentDistal Clavicle ResectionRater InstructionsDEU Rater
References
Case No. ADJ4258585 (OXN 0130492) ADJ220258 (OXN 0130487)
Regular
Apr 17, 2018

ENRIQUE HERRERA vs. MAPLE LEAF FOODS, U.S. FIRE INSURANCE COMPANY, ALEA NORTH AMERICAN INSURANCE COMPANY

This notice informs parties that the Workers' Compensation Appeals Board (WCAB) intends to admit its rating instructions and a disability rater's recommended permanent disability rating into evidence. The WCAB previously granted reconsideration for further study. Parties have seven days to object to the rating instructions or the recommended rating, with specific procedures for addressing objections. If no timely objection is filed, the matters will be submitted for decision thirty days after service.

WORKERS' COMPENSATION APPEALS BOARDPermanent Disability RatingDisability Evaluation UnitRating InstructionsRecommended Permanent Disability RatingJoint RatingReconsiderationObjectionRater Cross-ExaminationRebuttal Evidence
References
Case No. ADJ887948 (SRO 0103492) ADJ4222536 (SRO 0103500) ADJ3891200 (SRO 0103496)
Regular
Oct 04, 2010

RICHARD CARROLL vs. CONSOLIDATED FREIGHTWAYS, INC., Permissibly Self-Insured, Reinsured By RELIANCE, In Liquidation, Adjusted By CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Workers' Compensation Appeals Board granted reconsideration and rescinded prior awards due to a due process violation. The applicant was denied the opportunity to cross-examine the Disability Evaluation Unit rater when the WCJ simultaneously issued decisions and the recommended rating. This prevented applicant's right to object or seek rebuttal evidence before submission for decision. The case is returned to the trial level for further proceedings, including potential rater cross-examination, and a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings Award and OrdersJoint Findings and AwardWCJDisability Evaluation UnitRating InstructionsDue ProcessCross-examinationRater
References
Case No. ADJ13757266, ADJ13757284
Regular
Jan 31, 2023

ARLEEN KETELES vs. COUNTY OF ALAMEDA, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding of 70% permanent disability for the applicant's cumulative trauma injury. The Board adopted the judge's reasoning that the defendant's arguments lacked merit. Specifically, the Board found Dr. Brose's medical opinions constituted substantial evidence and that the DEU rating was better reasoned than the defendant's rater's opinion. The defendant's contention that Dr. Brose's opinions were inconsistent with the AMA Guides was also rejected.

Workers' Compensation Appeals BoardCumulative InjuryPermanent DisabilityQualified Medical ExaminerAMA GuidesLabor Code Section 5313Findings and AwardPetition for ReconsiderationMedical OpinionImpairment Rating
References
Case No. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
Case No. ADJ696907 (VNO 0543817)
Regular
Jul 23, 2010

ROBERT PERCHLAK vs. WAL-MART, AVIZENT BENTONVILLE

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding Robert Perchlak's industrial injury claim against Wal-Mart. The applicant challenged the $44\%$ permanent disability rating, arguing the rating specialist improperly disregarded physician findings. The WCAB clarified that rating specialists are limited to rating based on WCJ instructions and cannot independently assess medical impairments or deviate from AMA Guides criteria. The WCAB amended the decision to defer permanent disability and attorney's fees, returning the case for further proceedings to clarify the physician's impairment findings and ensure proper rating procedures are followed.

Workers' Compensation Appeals BoardRobert PerchlakWal-MartAvizent BentonvilleOpinion and Decision After ReconsiderationPermanent DisabilityApportionmentDr. Arthur LipperAppeals Board Rule 10602Rater Authority
References
Case No. ADJ1735018
En Banc
Jun 03, 2010

CYNTHIA BLACKLEDGE vs. BANK OF AMERICA, ACE AMERICAN INSURANCE COMPANY

An en banc decision clarifying the respective roles of the evaluating physician, the workers’ compensation administrative law judge (WCJ), and the disability rater in determining whole person impairment (WPI). The Appeals Board amended the WCJ's decision and remanded the matter for further proceedings.

AMA GuidesWhole Person ImpairmentPhysician's RoleWCJ's RoleRater's RoleFormal Rating InstructionsSubstantial Medical EvidenceDisability Evaluation UnitNon-Formal RatingsEx Parte Communication
References
Case No. ADJ2419784 (LBO 0367096) ADJ2075423 (LBO 0367097) ADJ2337471 (LBO 0367098)
Regular
May 05, 2014

ANTHONY DE FAZIO vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration of a prior award concerning industrial injuries. The Board rescinded the previous award and returned the case to the trial level. This action was taken to allow the applicant's attorney to cross-examine the disability rater, a request that had been made previously. The matter will proceed with further proceedings and a new decision by the WCJ.

Petition for ReconsiderationJoint Findings and AwardPermanent DisabilityLabor Code section 3202Rating InstructionsCross-examine the raterRescindedRemandedWCJWorkers' Compensation Appeals Board
References
Case No. ADJ1058308 (VNO 0482296)
Regular
May 28, 2013

DONNA DeRUSSY vs. ANTELOPE VALLEY HEALTH CARE SYSTEM, TRAVELERS INSURANCE, SAFETY NATIONAL, FRONTIER INSURANCE

This case involves a workers' compensation appeal where the defendants seek reconsideration of a prior award. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The primary grounds for this decision were that the defendants were denied due process by not being given an opportunity to cross-examine the rating rater and that the award relied on outdated medical reports. The WCAB also suggested obtaining current medical evaluations due to the time elapsed since the original reports.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardAttorney FeesPermanent Disability RatingApportionmentIndustrial InjuryLumbar SpineTreating PhysiciansMedical Reports
References
Case No. ADJ1880658
Regular
Feb 09, 2011

CLAIRE COATS vs. STATE COMPENSATION INSURANCE FUND

The applicant sought reconsideration of a WCJ's decision that denied her motion to strike a permanent disability rating and denied her request for cross-examination of the rater. The Appeals Board granted reconsideration, finding that the applicant was improperly denied her due process right to cross-examine the rater. The Board rescinded the WCJ's decision and returned the case to the trial level for a new WCJ to conduct further proceedings and issue a new decision, allowing consideration of the applicant's other contentions. This procedural error regarding the cross-examination right necessitated the remand.

Workers' Compensation Appeals BoardClaire CoatsState Compensation Insurance FundFindings and Award and OrderSenior Claims AdjusterIndustrial InjuryPermanent DisabilityMotion to StrikeCross-examinationRater
References
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