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

Case No. ADJ1078163, ADJ3341185
Significant
Sep 03, 2009

Applicant vs. Workers' Compensation Appeals Board

The court holds that a permanent disability rating under the 2005 Schedule is rebuttable, but any rebuttal evidence concerning Whole Person Impairment (WPI) must be founded within the four corners of the AMA Guides.

AMA GuidesPermanent Disability RatingRebuttablePrima Facie EvidenceWhole Person ImpairmentScheduleLabor Code Section 4660SB 899En Banc DecisionWorkers' Compensation Appeals Board
References
73
Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
En Banc
Feb 03, 2009

MARIO ALMARAZ, JOYCE GUZMAN vs. ENVIRONMENTAL RECOVERY SERVICES, STATE COMPENSATION INSURANCE FUND, MILPITAS UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

In a consolidated en banc decision, the Appeals Board holds that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable and remands two separate cases to their respective WCJs to determine if the standards for rebuttal have been met.

AMA Guides2005 Schedulerebuttablepermanent disabilityinequitable awarddisproportionate awardfair and accurate measuremedical opinionsadministrative law judgeWCJ
References
61
Case No. ADJ1177048
Significant
Sep 03, 2009

Wanda Ogilvie, Applicant vs. City and County of San Francisco, Permissibly Self-Insured

This en banc decision clarifies that a permanent disability rating established by the 2005 Schedule is rebuttable, the burden of rebuttal rests with the party disputing the rating, and a rating may be rebutted by challenging one of its components, such as the Diminished Future Earning Capacity (DFEC) adjustment factor.

Permanent DisabilityDiminished Future Earning CapacityDFECSchedulePrima Facie EvidenceRebuttableBurden of ProofRAND DataAMA GuidesOccupational Group
References
54
Case No. ADJ1177048
En Banc
Sep 03, 2009

WANDA OGILVIE vs. CITY AND COUNTY OF SAN FRANCISCO

This en banc decision clarifies that a permanent disability rating established by the Schedule is rebuttable, the burden of which rests with the disputing party. It affirms that a primary method of rebuttal is to challenge a component element, such as the Diminished Future Earning Capacity (DFEC) adjustment factor, by providing an individualized factor consistent with statutory requirements.

Diminished Future Earning CapacityDFEC2005 ScheduleRebuttablePrima Facie EvidencePermanent Disability RatingLabor Code section 4660RAND dataIndividualized Adjustment FactorWhole Person Impairment
References
51
Case No. ADJ 4564224
En Banc
Sep 17, 2008

Maria Tapia vs. Skill Master Staffing, Liberty Mutual Insurance Company

This case establishes that a medical lien claimant bears the burden of proving its charges are reasonable, and the billing alone does not suffice as proof. A lien may be deemed unreasonable on its face, even without rebuttal evidence. The Appeals Board affirmed the WCJ's decision to reduce the lien based on various forms of rebuttal evidence showing the billed amount was excessive.

Workers' Compensation Appeals BoardSB Surgery CenterLiberty Mutual Insurance CompanyKunz v. Patterson Floor Coveringsreasonable value of servicesoutpatient surgery center lienburden of proofrebuttal evidencegeographic areaDiagnosis Related Groups
References
11
Case No. MISSING
Regular Panel Decision

Claim of Bordenet v. Maines Paper & Food Service

Claimant was injured slipping on ice in a work parking lot while retrieving a paycheck. His workers' compensation claim, initially denied by a Workers’ Compensation Law Judge, was later reversed by the Workers’ Compensation Board. The employer and its workers’ compensation carrier appealed, arguing that the Board failed to consider their untimely filed rebuttal. The appellate court reversed the Board’s decision and remitted the matter to the Board to exercise its discretion regarding the acceptance of the carrier’s rebuttal.

Workers' CompensationWorkplace InjurySlip and FallParking Lot IncidentPaycheck RetrievalUntimely FilingRebuttal SubmissionBoard ReviewAppellate ReviewRemittal
References
1
Case No. ADJ3103905
Regular
Oct 28, 2011

JOSE PENALOZA VALDEZ vs. MANUEL AVILA, TRANSGUARD INSURANCE, Administered By FRYE CLAIMS CONSULTATION

This case concerns an applicant awarded 68% permanent disability, including a significant portion for psyche injury, based on a psychologist's report. The defendant appeals, arguing the psychologist's report was improperly admitted and they were denied the opportunity for rebuttal. The Appeals Board rescinded the award, finding that while the report was admissible, the defendant should have been allowed to obtain a rebuttal report, especially since the psychologist was not the primary treating physician. The case is returned for further proceedings to develop the record regarding the psyche injury and disability claims.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryPsyche InjuryPermanent DisabilityMedical Report AdmissibilityQualified Medical EvaluatorAgreed Medical EvaluatorDeclaration of Readiness to ProceedMandatory Settlement Conference
References
0
Case No. ADJ7859239, ADJ7859246
Regular
Mar 10, 2014

BELINDA BURTON vs. SAN LUIS OBISPO CHILD DEVELOPMENT CENTER, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The applicant seeks reconsideration of two decisions regarding permanent disability ratings, arguing she was denied the opportunity to rebut the defense's Diminished Future Earning Capacity (DFEC) expert report. The Board granted reconsideration, finding the applicant was deprived of due process by not being afforded adequate time to obtain a rebuttal report to the defense's late-disclosed DFEC expert report. The original decisions are rescinded, and the matters are returned for further proceedings, allowing both parties time to obtain rebuttal and response reports from their respective DFEC experts. Discovery will then be closed, and the parties can request trial.

Diminished Future Earning CapacityDFEC expert reportRebuttal reportDue processWCAB Rule 10507Mandatory Settlement ConferenceVocational expert evidencePermanent disability ratingReconsiderationFindings and Award
References
6
Case No. ADJ1205641
Regular
Mar 26, 2012

TERESA EDGE vs. RALPH'S GROCERY STORE

This case involves a deli manager injured in 2004, claiming 82% permanent disability and rebuttal of the Diminished Future Earning Capacity (DFEC) factor based on previous Appeals Board rulings. The defendant argued against the rebuttal and challenged the applicant's average weekly earnings calculation. The Appeals Board rescinded the original award and remanded the case for further proceedings. This is due to subsequent Supreme Court and Court of Appeal decisions, specifically *Baker* and *Ogilvie III*, which impact the proper application of permanent disability ratings and earnings calculations. The judge must now reconsider these issues in light of the new legal precedents.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardDeli ManagerIndustrial InjuryNeckShouldersHandsWristsPermanent Disability
References
5
Case No. ADJ10002681
Regular
Sep 07, 2018

ALLISON WIGGINS vs. KERN VALLEY STATE PRISON, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address the applicant's claim of industrial heart injury, which was initially denied by the administrative law judge despite a finding of industrial hypertension. The Board found that the applicant, a correctional officer, is entitled to a rebuttable presumption of industrial causation for heart trouble under Labor Code § 3212.2. Crucially, the Court determined that the record needs further development to clarify industrial contribution to the applicant's valvular insufficiency, considering the absence of an anti-attribution clause in § 3212.2 which differs from other related statutes. Therefore, the case is returned to the trial level for further development of evidence and a decision on rebuttal of the presumption.

Labor Code section 3212.2heart trouble presumptioncorrectional officerbicuspid aortic valvevalvular diseaseindustrial injurypermanent disabilitycumulative periodrebuttal of presumptionagreed medical evaluator
References
7
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