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

Case No. SAL SJO 252436 (MF); SJO 246192
Regular
Jul 02, 2007

NIHAL HORDAGODA vs. State Compensation Insurance Fund

This case involves an employer's petition for reconsideration of an order authorizing medical treatment and admitting the Qualified Medical Examiner's (QME) reports. The employer argued the QME reports were inadmissible due to an alleged ex parte communication between the applicant and the QME, and that the awarded treatments were improper. The report recommends denying the petition, finding the communication was permissible under LC § 4062.3(h) and that the QME's opinions and awarded treatments for chronic pain were reasonable and not governed by ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4062.3Ophthalmological evaluationFunctional capacity evaluationUtilization ReviewACOEM GuidelinesChronic spinal conditionTreating physician
References
0
Case No. MISSING
Regular Panel Decision
Aug 18, 1995

Miller v. Chater

Plaintiff initiated this action to seek review of the Secretary of Health and Human Services' decision establishing June 1, 1992, as the onset date for Supplemental Security Income (SSI) benefits due to alleged disability from mental retardation. Magistrate Judge Carol E. Heckman issued a Report and Recommendation, advising denial of the Secretary's motion for judgment on the pleadings and remand for reconsideration. The Magistrate Judge found errors in the Administrative Law Judge's (ALJ) assessment of the plaintiff's functional limitations, particularly regarding social domain, and noted the ALJ's failure to consider the retroactivity inference from the Zebley class action stipulation. District Judge Arcara reviewed the Report and Recommendation, and with no objections filed, adopted its findings. Consequently, the defendant's motion for judgment on the pleadings was denied, and the case was remanded to the Secretary for further reconsideration, emphasizing a misapplication of post-Zebley requirements for adjudicating children’s SSI benefits claims.

Supplemental Security Income (SSI)Disability BenefitsMental RetardationChild Disability ClaimsAdministrative ReviewSocial Security ActAge-appropriate functioningMedical EvidenceFunctional LimitationsOnset Date
References
12
Case No. ADJ916227 (VNO 0474238)
Regular
Jun 11, 2009

JOANNA LEE FRADY vs. MAGIC FORD AUTO NATIONS, ZURICH, Adjusted By UNIVERSAL UNDERWRITERS GROUP

This case concerns an applicant's entitlement to further medical treatment for an admitted industrial injury to her back, neck, and right hand. The defendant sought reconsideration of a prior award finding the applicant entitled to treatment recommended by her treating physician, Dr. Caro, specifically a brain MRI, muscle and skin biopsies, and a neurological evaluation. The Appeals Board granted reconsideration, finding Dr. Caro's report conclusory and not substantial evidence, and instead amended the award to grant treatment as recommended by panel Qualified Medical Examiner Dr. Yousefi. Dr. Yousefi's reports, based on thorough examination and testing, concluded that invasive procedures like muscle and skin biopsies were not indicated and recommended an independent neurological evaluation for further clarification.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgeFuture Medical TreatmentIndustrial InjuryPermanent DisabilityTreating PhysicianQualified Medical ExaminerSubstantial Evidence
References
0
Case No. ADJ7564894
Regular
Jun 07, 2013

FLOR DE MARIA DE LEON vs. PORTO'S BAKERY, INC, TRAVELERS

Here's a summary for a lawyer: This case involves a lien claimant, First Choice Health UBC, whose lien was dismissed for failure to provide proof of timely payment of the lien activation fee at a lien conference. While the claimant's representative appeared for "FCH" and later submitted proof of payment for a different, similarly named entity (First Choice Medical Group), no proof was provided for First Choice Health UBC itself. The WCJ recommended denial of reconsideration, finding that the claimant failed to meet the requirements of Labor Code section 4903.06(a)(4) by not presenting evidence of activation fee payment for the correct entity at the conference, thus warranting dismissal with prejudice. The Appeals Board adopted the WCJ's report and denied the petition.

Lien ClaimantActivation FeePetition for ReconsiderationDismissal with PrejudiceContinuous TraumaServerBack InjuryKnee InjuryLower ExtremitiesNervous/Psyche
References
0
Case No. Dkt. No. 1
Regular Panel Decision
Mar 29, 2012

Hamilton v. Colvin

Plaintiff William Hamilton applied for Social Security disability benefits, which were denied by the Commissioner. Hamilton sought judicial review of this decision in federal court. Magistrate Judge Bianchini issued a Report and Recommendation, suggesting the court reverse the Commissioner's decision and remand the case for further proceedings due to errors in evaluating severe impairments, credibility, and the use of Medical-Vocational Guidelines. Senior District Judge Scullin accepted the Magistrate Judge's recommendations, granting Plaintiff's motion for judgment on the pleadings, denying the Defendant's, and reversing the Commissioner's denial of benefits. The case was remanded for reconsideration of Plaintiff's carpal tunnel syndrome, other alleged severe impairments, and the credibility determination.

Disability benefitsSocial Security ActJudicial reviewAdministrative Law JudgeReport and RecommendationCarpal Tunnel SyndromeResidual Functional CapacityCredibility determinationVocational expertRemand
References
41
Case No. ADJ4001687
Regular
Oct 21, 2010

CHRISTINA MENDEZ SORIA vs. JANITORIAL MANAGEMENT SERVICES, THE ZENITH INSURANCE COMPANY

In this workers' compensation case, lien claimants sought reconsideration of a prior award denying their claims due to insufficient evidence of industrial injury. The lien claimants argued the Administrative Law Judge erred and that their due process rights were violated by the defendant's failure to serve subpoenaed medical reports. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter to the trial level for further proceedings and a new decision. This action was based on the Judge's Report and Recommendation, which the Board adopted.

Lien claimantsReconsiderationFindings and AwardIndustrial injuryUpper backLeft shoulderDue processSubpoenaMedical reportsWCJ
References
1
Case No. ADJ5096605
Regular
May 28, 2013

JACK ODAY vs. WICKES LUMBER CORP., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that deemed a defense medical report admissible but insufficient to justify denial of treatment and ordered treatment consistent with the applicant's treating physician. The WCAB found both Dr. Lipton's report inadmissible as substantial evidence due to its age and lack of examination, and Dr. Dayton's treatment recommendations deficient for not specifying industrial injury causation. Consequently, the WCAB rescinded the previous order, returning the case for further development of the record to determine necessary industrial injury treatment and to allow for a proper medical-legal evaluation. The Board denied removal but granted reconsideration to correct the procedural and substantive issues regarding medical evidence and treatment authorization.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderAdministrative Law JudgeMedical TreatmentStipulated AwardPrimary Treating PhysicianQualified Medical EvaluatorMedical-Legal Evaluation
References
10
Case No. MISSING
Regular Panel Decision
Feb 29, 2012

House v. Commissioner of Social Security

Plaintiff Sheryl L. House sought judicial review of the Commissioner of Social Security's denial of her disability insurance benefits application. A Magistrate Judge issued a Report and Recommendation, concluding that the Administrative Law Judge's decision finding Plaintiff not disabled was supported by substantial evidence. The Magistrate Judge recommended granting the Commissioner's motion for judgment on the pleadings and denying Plaintiff's similar motion. The District Judge adopted this Report and Recommendation in its entirety, thus upholding the denial of disability benefits.

Disability BenefitsSocial Security ActAdministrative Law JudgeResidual Functional CapacityTreating Physician's RuleMedical-Vocational GuidelinesCredibility AssessmentPhysical ImpairmentsJudicial ReviewMotion for Judgment on Pleadings
References
54
Case No. ADJ 4252592 (VNO 0411668)ADJ 3234790 (VNO 0443319) (MF)
Regular
May 04, 2012

HARRY WINSTON vs. CITY OF LOS ANGELES

This case concerns a petition for reconsideration by the City of Los Angeles challenging the Administrative Law Judge's (ALJ) finding of a single cumulative trauma injury. The applicant stipulated to two separate cumulative trauma periods for various injuries, but subsequent medical opinions from treating physicians concluded there was one continuous cumulative trauma injury spanning the applicant's entire employment. The ALJ amended the stipulations to align with this medical evidence and dismissed one of the applicant's cases as duplicative. Therefore, the ALJ recommends denying the employer's petition for reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationCumulative Trauma InjuryAmended FindingsOpinion on DecisionStipulationsMedical EvaluationQualified Medical EvaluationAgreed Medical EvaluationDate of Injury
References
10
Case No. ADJ7534979
Regular
Apr 17, 2012

MARK WINKLER vs. SONNEN MOTORCARS

In this workers' compensation case, the defendant sought reconsideration of an administrative law judge's (WCJ) award regarding industrial injury dates, EDD reimbursement, and permanent disability increases. The defendant identified inconsistencies between the WCJ's findings and award. The WCJ recommended granting reconsideration to address these errors. Due to acknowledged errors in both the original decision and the WCJ's report, the Appeals Board granted reconsideration, rescinded the original award, and returned the matter to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardSonnen Motorcarsservice advisorindustrial injurylow backtemporary disabilitypermanent disabilityEDD reimbursementLabor Code section 4658(d)petition for reconsideration
References
0
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