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Case Law Database

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

Case No. ADJ3615708 (BAK 0147668) ADJ2881957 (BAK 0147353) ADJ1664277 (BAK 0147354)
Regular
Oct 27, 2015

FRANCISCO JAVIER CASILLAS vs. SAN JOAQUIN VALLEY TRANSPORTATION, STATE COMPENSATION INSURANCE FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision, arguing that a key psychiatric AME report was unreliable and that the WCJ failed to address this in the opinion. The WCAB denied the reconsideration, finding that the WCJ properly relied on the reports of a different psychiatric AME, thus rendering the applicant's argument regarding the disputed report irrelevant. However, the WCAB granted reconsideration on its own motion to correct clerical errors in the original decision identified by the parties. The matter was then remanded to the WCJ to reissue a corrected decision.

California Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Awards and OrdersAgreed Medical Evaluator (AME)Dr. John StalbergDr. Carl Marusaksubstantial medical evidencepsychiatric claimspermanent disabilitylabor code section 132a
References
4
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 The original decisions are rescinded, and the matters are returned for further proceedings, allowing both parties time to obtain rebuttal and response reports from their respective DFEC experts.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. ADJ7284005 ADJ7912473
Regular
Mar 04, 2020

RONALD PHILPOT vs. PERFORMANCE DAIRY SERVICES, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ULLICO CASUALTY COMPANY, IMPERIUM INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, rescinding the prior findings and ordering that reports from Drs. Miner and Van de Bittner be admitted into the record and provided to the IME. The Board found it was error to strike these reports, as admissibility and substantiality are distinct issues, and the IME should review all relevant evidence for a complete evaluation. Consequently, the record will be further developed, and the defendant CIGA's petition for reconsideration was dismissed.

Workers' Compensation Appeals BoardCIGAULLICOIMPERIUM INSURANCE COMPANYTRISTAR RISK MANAGEMENTJoint Findings of FactAward and OpinionAOE/COEIndependent Medical EvaluatorAgreed Medical Evaluator
References
0
Case No. ADJ446518 (MON 0327707)
Regular
Jul 22, 2009

LINO LEMUS vs. CALIFORNIA SKATE FACTORY, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of an award granting the applicant 64% permanent disability for a right hand and psyche injury. The original judge relied on the Agreed Medical Examiner's (AME) report for the disability rating, but later conceded in his reconsideration report that the AME's opinion was unreliable. The Appeals Board granted reconsideration, rescinded the award, and returned the case to the trial level. This action was taken because the Appeals Board could not affirm the award based on the judge's conflicting statements about which medical evidence he actually relied upon.

Workers' Compensation Appeals BoardLino LemusCalifornia Skate FactoryState Compensation Insurance FundADJ446518ReconsiderationFindings and AwardPermanent DisabilityIndustrial InjuryAgreed Medical Examiner
References
0
Case No. LAO 0841263, LAO 0840495
Regular
Feb 01, 2008

LORENZA FERNANDEZ vs. MOTEL 6, USF\& G

This case involves a worker's compensation applicant seeking reconsideration of a prior award that denied her claim for psychiatric injury. The applicant argues the judge improperly relied on a medical report obtained in violation of agreed-upon procedures and excluded a crucial rebuttal report. The Appeals Board granted reconsideration, agreeing that the defendant's medical report should have been excluded, and returned the matter for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryPsyche InjuryAgreed Medical Evaluator (AME)Labor Code sections 4061 and 4062Substantial EvidenceDue ProcessDiscovery
References
1
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. ADJ2337190 (LAO 0829672) ADJ3193895 (LAO 0829673) ADJ187762 (LAO 0829674)
Regular
Apr 21, 2009

OLIVIA HUERTA vs. GMP LABORATORIES, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, Dr. Elena Konstat, seeking reconsideration of a Workers' Compensation Appeals Board decision that limited reimbursement for her medical-legal reports. The Board found that the original decision erred in disallowing two of Dr. Konstat's three medical-legal reports. The Board clarified that the Official Medical Fee Schedule for treatment rates does not apply to medical-legal expenses, and the testimony of the defendant's lien negotiator was not substantial evidence. Consequently, the Board granted reconsideration, rescinded the original finding, and substituted a new finding allowing reimbursement for all three of Dr. Konstat's medical-legal reports, with the exact amounts, penalties, and interest to be determined.

Medical-legal lienReconsiderationFindings and AwardIndustrial injuryNervous system injuryPsycheLicensed clinical psychologistMedical-legal expensesOfficial Medical Fee Schedule (OMFS)Compromise and Release (C&R)
References
1
Case No. ADJ11699310
Regular
Dec 18, 2020

JACQUELYN OTT vs. COUNTY OF VENTURA - HEALTH CARE AGENCY

Both applicant and defendant sought reconsideration of a prior award. The Appeals Board granted reconsideration, rescinded the award, and returned the case to the WCJ for further proceedings. The Board found that the Qualified Medical Examiner's (QME) reports regarding permanent disability were not substantial evidence because they did not adequately explain the reasoning for using grip strength as the primary impairment factor, especially given the applicant's reported pain. The Board also noted that the QME reports did not sufficiently summarize the reviewed medical records.

Workers' Compensation Appeals BoardPermanent Disability RatingQualified Medical ExaminerAMA GuidesWrist InjuryGrip StrengthImpairment RatingReconsiderationFindings of Fact and AwardSubstantial Evidence
References
14
Case No. ADJ9544109
Regular
Feb 26, 2018

PAULA McKENNEY vs. INLAND VALLEY MEDICAL CENTER, ACE AMERICAN INSURANCE COMPANY

This case concerns a workers' compensation claim for an applicant who sustained injuries to her neck, spine, elbow, hip, and psyche. The defendant sought reconsideration of an award that included 68% permanent disability and the exclusion of a QME report. The Appeals Board granted reconsideration to amend the award, clarifying that the August 15, 2017 report from Dr. Clark is excluded from evidence. The Board affirmed the original award, finding the defendant failed to prove prior permanent disability apportionment and that the exclusion of Dr. Clark's report was proper.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardQualified Medical ExaminerLabor Code section 4664apportionmentsubstantial evidencetreating physiciancertified nurse's assistantmandatory settlement conference
References
2
Case No. ADJ10087976 ADJ10087977
Regular
Jan 17, 2019

ANNA MEDRANO vs. KAISER PERMANENTE

This case involves a registered nurse seeking reconsideration of a workers' compensation award. The applicant argued the WCJ erred by not striking a psychiatric PQME's report and by not finding separate permanent disability for sleep impairment. The Board granted reconsideration solely to amend the attorneys' fees awarded against temporary disability benefits, affirming the original findings regarding injury, disability periods, and permanent disability rating. The WCJ's report on reconsideration was largely adopted, with adjustments specifically for the calculation of attorney's fees on temporary disability.

Workers' Compensation Appeals BoardKaiser PermanenteSedgwick Claims Management ServicesJoint Findings and AwardPetition for ReconsiderationTemporary Total DisabilityTemporary Partial DisabilityPermanent DisabilityLabor Code section 4661.5Labor Code section 4654
References
0
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