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

Case No. ADJ7781989; ADJ8262771
Regular
Oct 03, 2013

MIRIAN GARCIA vs. COOPER COLD FOODS, INC., ILLINOIS MIDWEST INSURANCE AGENCY as administrator for STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) is granting reconsideration of its own prior decision and rescinding a July 23, 2013 decision that had overturned a prior finding of 2% permanent disability for applicant's right knee injury. The WCAB determined that its August 9, 2012 order granting reconsideration was improvidently granted because the applicant had already filed a successive and improper petition for reconsideration. Consequently, the prior order and the subsequent rescinded decision are vacated, and the applicant's petition for reconsideration is dismissed.

WCABReconsiderationPetition for ReconsiderationFindings and AwardAdministrative Law JudgePermanent DisabilityIndustrial InjurySuccessive PetitionImprovidently GrantedVacated
References
4
Case No. ADJ1142998 (RDG 0118288)
Regular
Aug 18, 2009

STEVE REYNOLDS vs. WYCKOFF LOGGING, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB had previously rescinded a finding that avascular necrosis was not a compensable consequence of the applicant's injury, finding the relied-upon medical opinion speculative. The defendant argues the WCJ correctly favored the opinion of Dr. Glancz over Dr. Barber. The WCAB denied reconsideration, reaffirming that Dr. Glancz's opinion was not substantial evidence due to repeated questioning of the injury mechanism, while Dr. Barber's opinion was persuasive and based on a complete history. Therefore, the WCAB maintained its prior decision that Dr. Barber's opinion constituted substantial evidence supporting the applicant's claim.

Avascular necrosiscompensable consequencesubstantial evidencemedical opinionworkers' compensation administrative law judgereconsiderationfindings and ordermedical treatmentindustrial basissubstantial evidence
References
1
Case No. ADJ3193987 (RIV 0037219)
Regular
Feb 26, 2009

DOUGLAS CRAWFORD vs. COUNTY OF SAN BERNARDINO FIRE DEPARTMENT, COUNTY OF SAN BERNARDINO

This case involves a lien claimant, Forensic Psychiatric Services, whose lien was initially slated for disallowance due to an unprepared representative at a conference. The lien claimant petitioned for the Workers' Compensation Administrative Law Judge's (WCJ) disqualification, alleging bias and an unwarranted opinion. The Appeals Board denied the disqualification petition, finding insufficient grounds. However, they granted the lien claimant's objection to the disallowance notice, rescinded it, and returned the matter to the trial level for further proceedings.

Workers' Compensation Appeals BoardForensic Psychiatric ServicesPetition for DisqualificationNotice of Intention to Disallow Lien ClaimWorkers' Compensation Administrative Law Judgeunprepared lien representativeunqualified opinionevinced enmityWCAB Rule 10452objection to NOI
References
0
Case No. ADJ7207861
Regular
May 06, 2011

STEVE TORDINI vs. JAMES DIEDRICH, PREFERRED EMPLOYERS INS. CO.

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contention that the WCJ erred in relying on the treating physician's opinion over the PQME's regarding permanent disability and apportionment. The Board found the treating physician's opinion unsubstantiated, as it included unqualified legal conclusions and improperly utilized AMA Guides criteria for apportionment. Consequently, the WCAB rescinded the prior award and returned the case for a new decision, directing the WCJ to base findings on the PQME's report. A dissenting opinion argued that both medical opinions were flawed and recommended further medical development.

PQMEWCJWPIapportionmentLabor Code sections 46634664Almaraz IIAMA GuidesDRE Lumbar Category IVdisc protrusion
References
4
Case No. ADJ635934
Regular
Sep 09, 2010

FRANCES LARUE vs. NORDMAN, CORMANY, HAIR & COMPTON, STATE COMPENSATION INSURANCE FUND

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's award finding permanent total disability and no apportionment for an applicant's back injury. The Board rescinded the award, finding the judge erred by relying on an orthopedist's opinion that failed to properly apportion disability to pre-existing scoliosis. The case is remanded for further proceedings to incorporate the apportionment opinion of the defendant's medical expert, who found 70% of the disability attributable to non-industrial scoliosis. A dissenting opinion argued that the defendant's medical expert's apportionment was also insufficient.

ApportionmentPermanent Total DisabilityQualified Medical EvaluatorOrthopedistDegenerative ScoliosisCausationLabor Code Section 4663Senate Bill 899Substantial EvidenceFindings and Award
References
2
Case No. VNO 483286
Regular
Jul 16, 2007

ROBERT WALKER vs. MARSHALLS, CNA CLAIM PLUS, INC.

The Appeals Board granted reconsideration and rescinded the prior award, finding that the medical evidence regarding causation and apportionment was critically flawed. Neither the applicant's treating physician nor the defendant's QME adequately addressed these issues with sufficient reasoning and complete medical histories. The case is returned to the trial level for further development of the medical record, including obtaining supplemental opinions from physicians, before a new decision is made.

Workers' Compensation Appeals BoardRobert WalkerMarshall'sCNA Claim PlusInc.Findings and AwardIndustrial InjuryBack InjuryFoot InjuryPermanent Disability
References
17
Case No. SJO 238655 SJO 238656 SJO 238657
Regular
Apr 02, 2008

JAMES BEENE vs. ANDERSON CHEVROLET/AUTONATION, INC., ACE-USA, UNIVERSAL UNDERWRITERS GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award because the Agreed Medical Examiner's opinion was based on an incorrect legal theory regarding industrial causation. The Board found that the AME's opinion that the applicant's vascular condition was not industrially caused or aggravated was not substantial evidence, requiring further development of the record. Therefore, the case was returned to the trial level for the AME to provide a supplemental opinion on whether the vascular condition was industrially caused or a consequence of the admitted injury.

workers compensationindustrial injuryvascular systemagreed medical evaluatorAMEreconsiderationtemporary disability indemnityTDIlien claimsubrogation
References
15
Case No. ADJ11320525
Regular
Jul 01, 2019

LOURDES OCAMPO vs. SWEETWATER UNION HIGH SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration of the initial decision, finding the orthopedic QME's opinions did not constitute substantial evidence. Applicant contended the QME's opinions were inconsistent with medical literature regarding the acceleration of pre-existing conditions. The Board agreed that the QME seemed to conflate causing arthritis with aggravating a pre-existing condition. Therefore, the Board rescinded the original findings and returned the case for further development of the record, specifically regarding the extent of applicant's walking and a clearer medical opinion on causation.

AOE/COEQualified Medical Examiner (QME)Petition for ReconsiderationFindings and Order (F&O)substantial evidenceorthopedichip arthritisdegenerative joint diseaseindustrial causationacceleration of condition
References
9
Case No. ADJ10523108
Regular
Aug 29, 2017

MIGUEL ZAVALA vs. REPUBLIC SERVICES, INC., ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award, finding the Agreed Medical Examiner's (AME) opinion regarding permanent disability lacked substantial evidence. The AME stated a strict application of the AMA Guides would not reflect applicant's impairment but failed to adequately explain this deviation or the reasoning behind using grip strength as a measure. The WCAB remanded the case to the WCJ for further proceedings, specifically requesting development of the record with a further opinion from the AME. This action aligns with precedent requiring medical opinions to provide sufficient reasoning beyond mere conclusions.

Workers' Compensation Appeals BoardRepublic ServicesInc.ACE American Insurance CompanyCannon Cochran Management ServicesMiguel ZavalaFindings and AwardPermanent DisabilityAgreed Medical ExaminerAMA Guides
References
7
Case No. ADJ7744441
Regular
Jan 03, 2020

PAULIN SANDOVAL vs. RANSOME COMPANY, TRAVELERS CASUALTY & SURETY COMPANY

The Appeals Board granted reconsideration due to an incomplete record preventing a meaningful review of the applicant's contentions regarding apportionment and permanent disability. The WCJ's decision is rescinded and the case is returned to the trial level for further proceedings to create a proper record. Issues surrounding medical opinions on employability and apportionment need to be revisited by the WCJ. The Board expressed no final opinion on the merits of the applicant's petition.

Workers' Compensation Appeals BoardPaulin SandovalRansome CompanyTravelers Casualty & Surety CompanyReconsiderationFindings and AwardIndustrial InjuryLow BackPsycheApportionment
References
2
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