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

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
Case No. GRO 0031810
En Banc
Dec 07, 2006

JOEY M. COSTA vs. HARDY DIAGNOSTIC, STATE COMPENSATION INSURANCE FUND

The Appeals Board, in an en banc decision, holds that the applicant has not met the burden of proving the new Permanent Disability Rating Schedule (PDRS) invalid and affirms that rebuttal evidence to a rating is permissible under the new schedule.

PDRSSB 899Labor Code section 4660en bancrebuttal evidencecosts of rebuttal evidenceRAND Reportfuture earnings capacityempirical dataAMA Guides
References
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
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
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
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
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
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
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
Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
En Banc
Apr 06, 2009

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

The Appeals Board granted reconsideration in two consolidated cases to address the rebuttal of the AMA Guides in the 2005 Schedule for Rating Permanent Disabilities and permitted the filing of amicus briefs to aid in its deliberations.

Amicus briefsReconsiderationEn banc decisionThreshold issueAMA GuidesPermanent disabilityRebuttalFinal orderInterlocutory orderLegislative history
References
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