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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ19527341
Regular
May 05, 2025

MARIA RAMIREZ vs. ROMAN CATHOLIC BISHOP OF MONTEREY, CALIFORNIA

Applicant Maria Ramirez sought reconsideration of a workers' compensation administrative law judge's order, which found no industrial injury. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the matter to the trial level for further proceedings. The Board determined that the WCJ's credibility finding, based on the delayed worsening of symptoms, required expert medical opinion to ascertain consistency with the claimed injury mechanism, thus necessitating further development of the medical and factual record.

ADJ19527341Petition for ReconsiderationFindings and OrderIndustrial InjuryRight Arm InjuryRight Wrist InjuryRight Hip InjuryRight Leg InjuryRight Foot InjuryWCJ Credibility Determination
References
Case No. ADJ8045546
Regular
Jul 29, 2013

THOMAS FORD III vs. WASTE MANAGEMENT, ACE AMERICAN INSURANCE CO.

This case involves a haul truck driver's claim for a low back and right hip injury against Waste Management. The defendant sought reconsideration, arguing the applicant's right hip condition was nonindustrial due to childhood surgeries and a prior car accident, citing a PQME's opinion. The Workers' Compensation Appeals Board granted reconsideration to correct clerical errors in the original award. They affirmed the finding of industrial injury to the right hip, finding the primary treating physician's opinion more persuasive than the PQME's, and amended the award to specify temporary disability indemnity and EDD lien reimbursement. Issues of future temporary disability, permanent disability, and apportionment remain deferred.

Industrial injuryLow back injuryRight hip injuryLeft hip injuryHaul truck driverCumulative traumaQualified medical evaluatorPrimary treating physicianSubstantial medical evidenceTemporary disability indemnity
References
Case No. SDO 0323941
Regular
Aug 20, 2007

CAPRICE SMITH vs. KINDERCARE LEARNING CENTER, SPECIALTY RISK SERVICES, AIG

This case concerns whether the old or new workers' compensation permanent disability rating schedule applies to an injury predating the 2005 schedule changes. The Board affirmed the WCJ's prior determination that the 1997 schedule applies due to a final, unchallenged finding on the matter. However, the Board granted reconsideration to amend the award, deferring the issue of permanent disability and attorney's fees for further proceedings at the trial level due to the WCJ's insufficient explanation of the disability rating and apportionment.

Workers' Compensation Appeals BoardKindercare Learning CenterSpecialty Risk ServicesAIGCaprice SmithSDO 0323941Petition for ReconsiderationAmended Findings and AwardPreschool TeacherIndustrial Injury
References
Case No. ADJ1950726 (MON 0361748), ADJ6963803, ADJ7198723
Regular
Mar 20, 2012

DANA BURREL vs. LONG BEACH UNIFIED SCHOOL DISTRICT, TRISTAR RISK MANAGEMENT

In three workers' compensation cases, the applicant sustained industrial injuries to her upper extremities on May 21, 2006, March 11, 2008, and July 28, 2008. The Appeals Board granted reconsideration to review the application of Labor Code section 4658(d)(2), which mandates a 15% increase in permanent disability payments when an employer fails to offer suitable work within 60 days of an injury becoming permanent and stationary. The employer stipulated to providing some medical treatment and returning the applicant to work, but failed to offer regular, modified, or alternative work for 12 months post-injury. The Board found the employer's contention of denial unsubstantiated by evidence and, following *Bontempo v. Workers' Comp. Appeals Bd.*, ruled that the 15% increase applies to all three cases.

Labor Code section 4658(d)(2)permanent disability increaseindustrial injuryright upper extremityright handright wristright shoulderright armleft wristleft hand
References
Case No. ADJ9423495
Regular
Feb 23, 2016

DEATRIZ DIAZ, BEATRIZ DIAZ vs. MISSION FOODS, TRAVELERS INSURANCE

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration, upholding the WCJ's findings. The Board also admonished applicant's legal representatives for submitting an unverified petition and referring to evidence not in the record. The WCJ found the applicant sustained industrial injury to her lumbar spine and right knee, but not her right hip. Crucially, based on the persuasive PQME reports, the WCJ determined the applicant sustained 0% permanent disability, finding applicant's treating physicians' reports lacked substantiality.

AOE/COEPetition for ReconsiderationWCJPQMETTDpermanent disabilitylumbar spineright kneeright hipsubstantial medical evidence
References
Case No. ADJ1498961
Regular
Sep 23, 2010

DALE ARNOLD vs. RALPH'S AKA KROGER

This case involves an applicant's claim for workers' compensation benefits for a right shoulder injury. While the initial award recognized industrial injury to the applicant's left shoulder, right elbow, and right forearm, the defendant sought reconsideration, arguing the right shoulder injury was not work-related. The Appeals Board granted reconsideration, finding the applicant failed to meet the burden of proof for the right shoulder injury. They disagreed with the primary treating physician's opinion and found the agreed medical evaluator's opinion more persuasive, ultimately reversing the finding for the right shoulder.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardCumulative TraumaIndustrial InjuryLeft ShoulderRight ElbowRight ForearmRight ShoulderPrimary Treating Physician
References
Case No. ADJ9210498
Regular
Apr 04, 2017

ELEANOR DEFRANCO vs. MONTEREY FISH COMPANY, ENSTAR (US) INC., dba ENSTAR ADMINISTRATORS FOR SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award that found industrial injury to applicant's right ankle, right shoulder, and back, but not her right knee. The WCAB rescinded the finding of industrial injury to the back, while otherwise affirming the prior decision. Specifically, the WCAB affirmed the finding that the applicant sustained industrial injury to her right ankle and right shoulder, and that medical treatment for her right knee is compensable to relieve the effects of the industrial injuries. The WCAB adopted the WCJ's reasoning for these decisions, including the application of the *Braewood* principle for treating the non-industrial knee condition.

Workers' Compensation Appeals BoardEleanor DefrancoMonterey Fish CompanyEnstarSeabright Insurance CompanyIndustrial InjuryRight AnkleRight ShoulderRight KneeBack Injury
References
Case No. ADJ2594700
Regular
Nov 16, 2009

LINDA SEGOVIA vs. CITY OF STOCKTON, Permissibly Self-Insured, Adjusted By YORK INSURANCE SERVICES GROUP

The Appeals Board granted reconsideration, rescinded the prior award finding that the applicant did not sustain an industrial injury to her right hip. The AME's opinion was given more weight than the treating physicians.

Compensable consequenceReconsiderationFindings & AwardIndustrial injuryRight hipLeft hipPolice officerPermanent total disabilityMedical treatmentMedically necessary
References
Case No. ADJ10667998
Regular
Mar 21, 2019

GRECIA ALFARO vs. APPLE, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves an applicant who sustained admitted injuries to her thoracic spine and left arm after a slip and fall at work. The applicant also claimed industrial injury to her psyche and right hip, which the employer contested. The Workers' Compensation Appeals Board (WCAB) denied reconsideration of the judge's finding that the applicant did not sustain an industrial injury to her right hip. The WCAB deferred to the judge's credibility determination, noting that the applicant's reporting of hip pain was inconsistent and poorly documented by treating physicians. The Board also cited that one physician's opinion can constitute substantial evidence, even if it conflicts with other medical opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJCredibility DeterminationSubstantial EvidencePhysician's OpinionAdmitted InjuryDenied InjuryRight HipPsyche
References
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