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

Case No. LAO 0833762
Regular
Sep 07, 2007

IRMA MARTINEZ, IRMA A. NAVAREZ-MARTINEZ vs. CORONA CLIPPER, STATE COMPENSATION INSURANCE FUND, LIBERTY MUTUAL INSURANCE COMPANY, AMERICAN HOME ASSURANCE COMPANY

The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the case for further proceedings. This action defers the issue of injury to the psyche while affirming findings of industrial injury to the back, neck, shoulders, elbows, wrists, and fibromyalgia, based on a cumulative trauma period ending August 23, 1999. Fibromyalgia was properly considered as an issue, and substantial evidence supports the established cumulative trauma period and related injuries, despite the defendant's contentions.

FibromyalgiaCumulative traumaDate of injuryMandatory settlement conferenceIndustrial injuryAgreed medical examinationRheumatologistOccupational diseaseSubstantial evidenceStipulation
References
Case No. ADJ10268942, ADJ10268936, ADJ10268937, ADJ12179713
Regular
Aug 06, 2019

SANDRA VELASQUEZ vs. CITY OF HOPE NATIONAL MEDICAL , CENTER

The Workers' Compensation Appeals Board granted reconsideration to address applicant's claims of injury to her right knee and fibromyalgia. The Board found that the Agreed Medical Examiner's opinions on fibromyalgia were not substantial evidence as the physician deferred to a specialist, and further development of the record was needed for the right knee claim. The Board rescinded the original award and returned the matter to the judge for further proceedings on these deferred issues, affirming all other aspects of the original decision.

WCABAOE/COEPetition for ReconsiderationJoint Findings and AwardWCJAgreed Medical Examiner (AME)Substantial EvidenceFibromyalgiaRheumatologistRight Knee Arthroscopy
References
Case No. ADJ6408456
Regular
May 17, 2010

KENNETH M. HOOVER vs. CITY OF POMONA

The Appeals Board granted reconsideration of the WCJ's award of 100% permanent total disability. The Board found that the WCJ's decision was not supported by substantial evidence, primarily due to deficiencies in Dr. Grodan's medical reporting regarding the applicant's skin and cardiovascular conditions. The matter was returned to the trial level for further development of the record and a new decision. The Board confirmed the application of the 1997 Permanent Disability Rating Schedule and the admission of Dr. Shirman's report.

WORKERS' COMPENSATION APPEALS BOARDADJ6408456KENNETH M. HOOVERCITY OF POMONAreconsiderationFindings and Award and Orderworkers' compensation administrative law judgeWCJMay 172010
References
Case No. ADJ3770794 (MON 0325184)
Regular

KATHRYN MOSS vs. VIVENDI/UNIVERSAL (UNIVERSAL MUSIC GROUP), AMERICAN HOME ASSURANCE COMPANY, CHARTIS

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, rescinded the previous Findings and Award, and returned the case for a new decision. The WCAB found that the original decision by the Workers' Compensation Judge (WCJ) failed to adequately reference specific evidence and failed to provide a sufficient basis for its findings on permanent disability and apportionment. Additionally, the WCAB determined that the attorney's fee award lacked proper explanation and calculation. The matter is to be returned to the WCJ to issue a new decision that fully complies with legal requirements, particularly Labor Code section 5313.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationIndustrial InjuryPermanent DisabilityApportionmentFibromyalgiaIrritable Bowel Syndrome (IBS)Skin DisorderNeurodermatitis
References
Case No. ADJ3134277 (SAC 0237184)
Regular
Feb 11, 2010

KIMBERLY WATKINS vs. STATE OF CALIFORNIA, EMPLOYMENT DEVELOPMENT DEPARTMENT, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case involves an applicant seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision regarding her permanent disability rating. The applicant argues the assigned 39% permanent disability, resulting in a combined 95% disability with pre-existing conditions, is too low. She claims unrebutted medical and vocational expert evidence establishes total permanent disability (100%) due to her inability to compete in the labor market. The WCAB denied reconsideration, adopting the judge's report, but one commissioner dissented, arguing the evidence strongly supported a 100% disability finding.

Subsequent Injuries Benefits Trust FundCumulative traumaIndustrial injuryPermanent disability ratingVocational expertReconsiderationFindings and AwardAgreed medical evaluatorRheumatologistPsychiatrist
References
Case No. ADJ2640386
Regular
Nov 02, 2009

GRACIELA FUENTES vs. BCBG, CNA CASUALTY OF CALIFORNIA

The WCAB denied applicant's petition for reconsideration, upholding the WCJ's decision that applicant did not sustain an industrial injury in the form of fibromyalgia. The WCJ's decision was supported by substantial evidence.

Petition for ReconsiderationIndustrial InjuryUpper ExtremitiesNeckPsycheFibromyalgiaChronic Pain SyndromeAgreed Medical Evaluator (AME)RheumatologistOrthopedics
References
Case No. ADJ1383173, ADJ1689839
Regular
May 29, 2013

Gonzalo Rodriguez vs. Potential Industries, Chartis Costa Mesa, Applied Risk Omaha

The Workers' Compensation Appeals Board denied reconsideration of a finding that Gonzalo Rodriguez did not sustain industrial cumulative injuries. The applicant's testimony was deemed not credible due to inconsistencies and his admission of Alzheimer's disease. Furthermore, the medical report was found to lack substantial evidence, as it did not adequately address pre-existing conditions or definitively link the applicant's complaints to his employment. Finally, the Board found no basis to presume compensability due to late denials.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuryCumulative InjuryApplicant CredibilityMedical EvidenceAlzheimer's DiseasePrior Medical HistoryRheumatologistPresumption of Compensability
References
Case No. ADJ8866592
Regular
Jul 31, 2018

IRMA QUINTERO vs. EPISCOPAL SENIOR SERVICE CENTER dba SPRING LAKE VILLAGE

The Workers' Compensation Appeals Board granted reconsideration to address an error regarding temporary disability indemnity. The Board affirmed the finding of 41% permanent disability but deferred the issue of EDD lien recovery. Crucially, the Board found the rheumatologist's apportionment opinion substantial evidence, while the AME's apportionment opinion lacked sufficient reasoning. The case is returned to the WCJ for further proceedings on the EDD lien.

Workers' Compensation Appeals BoardIRMA QUINTEROEPISCOPAL SENIOR SERVICE CENTERATHENS ADMINISTRATORSFindings and AwardReconsiderationPermanent DisabilityApportionmentEDD LienComplex Regional Pain Syndrome
References
Case No. ADJ4552593 (MON 0258406) ADJ6674320
Regular
Jun 21, 2011

KIMBERLY DeNOVA-JOY vs. SANTA PAULA ELEMENTARY SCHOOL DISTRICT, CIGA On Behalf of FREMONT INSURANCE COMPANY In Liquidation, As Administered By CAMBRIDGE INTERGRATED SERVICES

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, remanding the case for further proceedings. The Board found the WCJ failed to fully address apportionment, a mandated issue. Specifically, the WCJ neglected to consider apportionment of orthopedic and psychiatric disability as determined by AMEs, beyond the rheumatologist's opinion on fibromyalgia. The Board also noted that existing medical reports may be stale, necessitating potential new evaluations.

Workers' Compensation Appeals BoardReconsiderationApportionmentPermanent DisabilityFibromyalgiaCumulative TraumaMedical EvidenceExpert Medical OpinionOrthopedicsPsychiatry
References
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