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

Case No. ADJ9683216
Regular
Sep 30, 2016

DUNIA DE LA CRUZ vs. SOOD ENTERPRISES, INC. dba JACK IN THE BOX, SECURITY NATIONAL INSURANCE COMPANY ADMINISTERED BY AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) denied defendant's petition for reconsideration and dismissed its petition for removal. The WCAB found that an additional Qualified Medical Examiner (QME) panel in rheumatology was appropriate to further develop the medical record on causation, as recommended by the initial orthopedic QME. Defendant argued the WCJ erred by ordering this without first determining applicant's credibility and AOE/COE, but the Board deemed the need for a rheumatological evaluation a critical issue justifying reconsideration. Therefore, the WCAB upheld the WCJ's order for an additional QME panel.

QME panelrheumatologyAOE/COEcredibilitymedical causationdepositionsupplemental evaluationgood causethreshold issuesreconsideration
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ8491619 ADJ9586677
Regular
May 17, 2019

Edward GAA vs. Intercare Holdings Insurance, The Hartford

The Workers' Compensation Appeals Board granted applicant's petition for removal, overturning a prior order that denied a rheumatological evaluation. While dismissing the petition for reconsideration, the Board found good cause for an additional QME panel in rheumatology, acknowledging the orthopedic QME's limited expertise in this specialty. The applicant must still attend a re-evaluation with the orthopedic QME, who must review a job analysis.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Rheumatological evaluationOrthopedic QMECumulative traumaIndustrial injuryMedical-legal issuesBias
References
Case No. ADJ1 0127152
Regular
Jun 26, 2017

ROBERT CARLOS vs. GENESIS LOGISTICS INC., NEW HAMPSHIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied applicant Robert Carlos's Petition for Removal. Carlos sought to rescind an order that took his case off calendar pending a supplemental report from an orthopedic QME and requested a rheumatology QME panel or a hearing. The WCAB adopted the Workers' Compensation Judge's report, finding that Carlos failed to demonstrate substantial prejudice or irreparable harm required for removal. Consequently, the WCAB affirmed the order and denied the petition.

WORKERS' COMPENSATION APPEALS BOARDPetition for RemovalWCJQualified Medical EvaluatorQME panelorthopedicrheumatologytaken off calendarsupplemental reportdiscretionary power
References
Case No. ADJ2580958 (MON 0351589)
Regular
Feb 16, 2016

ESTRELLA LOPEZ vs. OUTRIGGER LOGGING SERVICES, dba THE CRACIELA BURBANK, WAUSAU INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of an award of 100% permanent total disability. The Board found that the medical opinions supporting the award were not substantial evidence because they failed to consider the latest orthopedic report which identified some complaints as non-industrial. Furthermore, the vocational expert's report was deficient as it relied on inadmissible rheumatology reports and did not account for the orthopedic findings. Consequently, the award was rescinded, and the case was returned to the trial level for further proceedings to develop the record.

Workers Compensation Appeals BoardPetition for ReconsiderationDecision After ReconsiderationFindings and AwardPetition to ReopenNew and Further DisabilityPermanent Total DisabilityIndustrial InjuryPsycheBack
References
Case No. ADJ10633327
Regular
Jul 31, 2019

JUANITA PONCE DE LEON vs. SOUTHERN CALIFORNIA EDISON

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior Findings and Orders. The Board found that the applicant's physician's report was improperly excluded as evidence, as it did not rebut a prior QME's opinion but addressed a separate, unaddressed medical condition. Consequently, the Board overruled the objection to this report and the primary treating physician's subsequent report adopting its findings. The Board also found good cause for an additional Qualified Medical Evaluator panel in rheumatology to address the applicant's disputed fibromyalgia claim.

AOE/COEfibromyalgiaQME panelrheumatologyDr. SalickDr. AunadmissibilityLabor Codemedical evaluationreconsideration
References
Case No. ADJ1058308 (VNO 0482296)
Regular
May 28, 2013

DONNA DeRUSSY vs. ANTELOPE VALLEY HEALTH CARE SYSTEM, TRAVELERS INSURANCE, SAFETY NATIONAL, FRONTIER INSURANCE

This case involves a workers' compensation appeal where the defendants seek reconsideration of a prior award. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The primary grounds for this decision were that the defendants were denied due process by not being given an opportunity to cross-examine the rating rater and that the award relied on outdated medical reports. The WCAB also suggested obtaining current medical evaluations due to the time elapsed since the original reports.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardAttorney FeesPermanent Disability RatingApportionmentIndustrial InjuryLumbar SpineTreating PhysiciansMedical Reports
References
Case No. ADJ3316075 (VNO 0426272), ADJ3521326 (VNO 0294306)
Regular
Jun 28, 2012

CHRISTINE COLFER AUCHTERLONIE vs. RALPHS GROCERY COMPANY

The Workers' Compensation Appeals Board granted Ralphs Grocery Company's petition for reconsideration to address the apportionment of applicant Christine Colfer Auchterlonie's permanent disability. The Board found the prior determination of 100% permanent disability, without apportionment for fibromyalgia, lacked sufficient medical evidence under Labor Code sections 4663 and 4664. Consequently, the case was returned to the trial level for the appointment of a regular physician to evaluate apportionment, particularly concerning the overlap between the applicant's prior industrial injuries and her current fibromyalgia condition. A new decision will be issued after this further evaluation.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityApportionmentLabor Code section 4664Labor Code section 4663Cumulative Trauma InjuryFibromyalgiaPhysician Evaluation
References
Case No. ADJ2073428 (VNO 0465400) ADJ1610465 (VNO 0540972) ADJ3247765 (VNO 00384869)
Regular
Apr 04, 2011

JAY ZAVERI vs. STATE COMPENSATION INSURANCE FUND; Legally Uninsured

The applicant sought reconsideration of a workers' compensation award, arguing for a 100% permanent disability rating and challenging the permanent disability start date used for attorney fee commutation. The Appeals Board denied the petition, finding insufficient evidence to establish total permanent disability, as the applicant was currently employed and medical opinions did not definitively support such a rating. The Board also ruled that the applicant waived arguments regarding the rating of specific injuries by failing to properly object, and that even if considered, separate ratings for back, knee, and plantar fasciitis conditions would not result in a higher award due to fibromyalgia being the primary cause and rating higher. Finally, the Board clarified that the July 2, 2000 date was only relevant to the attorney fee commutation calculation and not to the determination of permanent disability indemnity payments.

WCABPetition for ReconsiderationJoint Findings and AwardWorkers' Compensation Judge (WCJ)Industrial InjuryBack InjuryHip InjuryBilateral Knee InjuryBilateral Foot InjuryBilateral Plantar Fasciitis
References
Case No. ADJ6859121
Regular
Mar 24, 2016

ALVARO GIRON vs. ARI THANE FOAM PRODUCTS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) denied the applicant's Petition for Removal. Removal is an extraordinary remedy granted only upon a showing of substantial prejudice or irreparable harm. The WCAB found that the applicant failed to demonstrate such prejudice, particularly concerning a dispute over Dr. Laqui's deposition fees. The WCAB adopted the WCJ's report, which concluded that reconsideration would be an adequate remedy if necessary. Therefore, the petition for removal was denied.

Petition for RemovalWorkers' Compensation Appeals BoardQualified Medical EvaluatorQME panelinternal medicinerheumatologydepositionrecord reviewfee schedulesubstantial prejudice
References
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