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

Case No. ADJ4225526 (GOL 0092072)
Regular
Apr 20, 2017

JESUS ARROYO vs. JOHN CRAVENS PLASTERING, STATE COMPENSATION INSURANCE FUND

This case involves Jesus Arroyo's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, adopting the reasoning of the workers' compensation administrative law judge. Medical evidence from Dr. Markovitz established that Arroyo suffered a total and permanent disability resulting from industrial injuries, including an aortic aneurysm repair and subsequent strokes. The Board found Dr. Markovitz's opinions constituted substantial medical evidence, despite conflicting defense opinions, and affirmed that all necessary medical care and permanent disability were industrially caused.

Workers' Compensation Appeals BoardJesus ArroyoJohn Cravens PlasteringState Compensation Insurance FundPetition for ReconsiderationAgreed Medical ExaminerGerald Markovitzechocardiogramaortic root dilationexpanding aortic aneurysm
References
Case No. ADJ252083 (NOR 0166266) ADJ3827633 (LAO 0784953) ADJ3395707 (LAO 0784956) ADJ629194 (LAO 0849490) ADJ2985386 (LAO 0784955) ADJ2625573 (LAO 0784951)
Regular
Apr 12, 2011

CLAUDIA DYER vs. BOEING/McDONNELL DOUGLAS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHARTIS INSURANCE

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the WCJ's findings of industrial injuries to the applicant's knees, neck, back, shoulders, hips, hands, and ankle across multiple dates. The Board found the WCJ's decision was supported by substantial evidence, specifically Dr. Nelson's well-reasoned medical opinions on causation and apportionment. CIGA's petition was also found deficient for failing to comply with procedural requirements for referencing the record. Finally, CIGA was estopped from asserting the statute of limitations defense due to the employer's knowledge of the injury and failure to provide notice of rights.

CIGAFremont InsuranceliquidationPetition for ReconsiderationJoint Findings and Awardindustrial injuryaircraft mechanickneesneckback
References
Case No. ADJ6845087
Regular
Feb 27, 2017

DENNIS DEMARCO vs. PACIFIC BELL TELEPHONE COMPANY, SEDGWICK CMS

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration in the case of Dennis Demarco. The defendant failed to meet its burden of proof for apportionment because the medical opinions presented were not sufficiently reasoned or based on reasonable medical probability. The Board adopted the WCJ's reasoning, which found the opinions of the agreed medical evaluators regarding industrial causation for sleep disorders to be persuasive.

ApportionmentMedical OpinionSubstantial EvidenceReasonable Medical ProbabilitySpeculativePertinent FactsAdequate ExaminationIndustrial CausationSleep DisordersAgreed Medical Evaluator (AME)
References
Case No. ADJ548925 (MON 0313676) ADJ2470845 (MON 0313677)
Regular
Jul 19, 2010

Barry Robey vs. HERTZ CORPORATION, NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, reversing a lower decision that awarded unapportioned permanent disability. The Board found that the Agreed Medical Examiner's (AME) apportionment of 50% of the applicant's left hip disability to a non-industrial arthritic condition was substantial medical evidence, despite the WCJ's finding that the AME's reasoning was "arbitrary." The Board emphasized that AME opinions on apportionment need only be based on reasonable medical probability, not certainty, and that the AME sufficiently explained his reasoning.

Workers Compensation Appeals BoardReconsiderationFindings and AwardCumulative TraumaIndustrial InjuryApportionmentAgreed Medical ExaminerPermanent DisabilityNon-industrial CausationLabor Code Section 4663
References
Case No. ADJ8168988
Regular
Oct 23, 2015

JOSE CEJA vs. YORBA LINDA CAR WASH, PENNSYLVANIA MANUFACTURERS INSURANCE GROUP

This case involves applicant Jose Ceja's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board denied reconsideration, upholding the finding that while Ceja sustained industrial injuries to his spine and knee, he failed to prove industrial causation for neurological, psychiatric, or sleep disorders. The medical evidence presented was deemed insufficient, lacking reasonable medical probability and proper reasoning for causation. Specifically, expert opinions were criticized for speculation, inadequate history, and reliance on applicant's subjective reporting without sufficient medical analysis.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrdersIndustrial InjuryCervical SpineLumbar SpineRight KneeNeurological SystemPsycheSleep Disorder
References
Case No. ADJ11406698
Regular
Feb 03, 2020

JOSE MORENO vs. GREEN VALLEY LABOR INC., STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the WCJ's finding that the applicant sustained a back injury arising out of and occurring in the course of employment. The Board found that the Qualified Medical Examiner's (QME) reports provided substantial evidence for injury AOE/COE based on the "reasonable probability" standard. However, the Board found the QME's apportionment opinion lacked the necessary reasoning and detail to be considered substantial evidence. Therefore, the WCJ's findings regarding AOE/COE and the lack of substantial evidence for apportionment were upheld.

AOE/COEPetition for ReconsiderationQualified Medical ExaminerQMECumulative traumaPermanent disabilityApportionmentSubstantial evidenceWorkers' Compensation Appeals BoardWCJ
References
Case No. ADJ10335205
Regular
Feb 16, 2017

BARNARD VILLAR vs. STATE OF CALIFORNIA, CDCR, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board found the medical opinion of the panel Qualified Medical Examiner (PQME) to be substantial medical evidence, based on an adequate examination and supported by reasoning. This opinion was relied upon by the workers' compensation administrative law judge. Consequently, the applicant's petition was denied.

Petition for ReconsiderationDeniedWorkers' Compensation Appeals BoardWCJ ReportAdopted and IncorporatedSubstantial Medical EvidenceReasonable Medical ProbabilityPanel Qualified Medical ExaminerPQMEBarry Gwartz M.D.
References
Case No. ADJ10576692
Regular
Sep 25, 2017

DAVID GONZALEZ vs. SPORTS CAR ACCESSORIES, INC dba KAR TUNES, PROCENTURY INSURANCE COMPANY, administered by ILLINOIS MIDWEST INSURANCE AGENCY, LLC

The Workers' Compensation Appeals Board denied the petition for reconsideration in this case. The Board found the medical opinion of Panel Qualified Medical Examiner Dr. Pramila Gupta to be substantial evidence, based on an adequate examination and supported reasoning. The Board also deferred to the Workers' Compensation Judge's credibility determinations, which were based on observing witness demeanor. Therefore, the petition for reconsideration was denied.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationWCJOpinion and OrderSubstantial EvidenceReasonable Medical ProbabilityPanel Qualified Medical ExaminerPQMECredibility DeterminationsMedical Opinion
References
Case No. POM 291107
Regular
Oct 15, 2007

RAMON GALBADON vs. NEWPORT FARMS, INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded a $1,500 nominal permanent disability award, finding no substantial medical evidence that future disability was "reasonably probable" from the applicant's January 11, 2005 right inguinal hernia. The Board noted the applicant's physician stated he had no permanent disability and could return to work without restrictions. Instead, the Board reinstated a stipulated award for further medical treatment and benefits, consistent with the parties' agreement.

Nominal permanent disabilityLabor Code section 5802Industrial injuryRight inguinal herniaTruck driverReconsiderationStipulated awardFuture medical treatmentPhysician office visitsMedication refill
References
Case No. ADJ8586896
Regular
Dec 27, 2017

, Jose Benitez (Deceased), Zeferina Higuera Quezada vs. , AG Force, LLC, , Intercare Holding Insurance Services, , Gurmail Chehal and Samarjit Kaur, as Husband and Wife, Uninsured

This case concerns a deceased laborer, Jose Benitez, whose widow claimed his death from cellulitis resulted from an insect bite sustained while working for AG Force, LLC. Despite the lack of direct witnesses, the Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration. The WCAB found that the Administrative Law Judge's (ALJ) determination of industrial causation was supported by the credible testimony of the applicant's wife and medical reports. The Board emphasized the "reasonable probability" standard for industrial causation and gave deference to the ALJ's credibility findings.

Industrial causationreasonable probabilitycircumstantial evidencecredible testimonyWCJ credibility assessmentinsect bitecellulitisspider bitebrown recluse spiderattending physician
References
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