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

Case No. ADJ10443669
Regular
Oct 04, 2017

Donna Carter vs. Rose International Group, OneBeacon Insurance Group

The Appeals Board affirmed the Workers' Compensation Judge's finding that Donna Carter sustained an industrial injury to her right knee and left wrist on May 18, 2016. Despite inconsistencies in the applicant's testimony regarding a slip and fall incident, her account was corroborated by a witness who found her on the floor. Medical records from the day of the incident also supported the applicant's claim, establishing a clear mechanism of injury. The Board found that the common sense nature of a slip and fall does not require expert medical opinion to establish industrial causation for the incident itself.

ADJ10443669Rose International GroupOneBeacon Insurance GroupDonna CarterWorkers' Compensation Appeals BoardOpinion and Decision After Reconsiderationslip and fallindustrial injuryright kneeleft wrist
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ8330411
Regular
Jul 07, 2017

LARRY SINGLETARY vs. PARAMOUNT PICTURES

The Workers' Compensation Appeals Board (WCAB) denied Paramount Pictures' petition for reconsideration, upholding the Administrative Law Judge's (ALJ) decision. Paramount argued the ALJ erred by applying a 50% WPI for the applicant's right lower extremity, instead of 30%, based on conflicting reports from an agreed medical examiner. The ALJ found the evidence insufficient to prove the applicant could walk more than a "block" without a walker, which was the key factor in the different WPI ratings. The WCAB gave great weight to the ALJ's credibility determinations and found no substantial evidence to overturn them.

Petition for ReconsiderationDeniedWCJCredibility determinationsGarza v. Workmen's Comp. Appeals Bd.Permanent disabilityWPIRight lower extremityOrthopedic AMESpecific date of 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. 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. ADJ7220018
Regular
Jul 23, 2012

LORENZO HERNANDEZ vs. TOYOTA OF GLENDALE, UNITED STATES FIRE INSURANCE CO.

The Appeals Board granted the defendant's petition for reconsideration of the initial award. The original award found the applicant sustained industrial injuries to his left knee, low back, wrists, and feet, and awarded temporary disability benefits. The Board rescinded the award and returned the matter to the trial level to clarify the correct insurance carrier and correct a finding regarding the applicant's right, not left, knee injury. Additionally, the defendant must provide further details on temporary disability payments and EDD lien credits.

Petition for ReconsiderationFindings Award and Orderindustrial injurymechanic technicianleft kneelow backright wristleft wristbilateral feetpsyche injury
References
Case No. ADJ7264915
Regular
Jul 15, 2013

ANA GONZALES vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

This case involves an applicant who sustained industrial psychiatric injury but whose orthopedic claims were denied due to insufficient medical evidence. The Appeals Board denied the applicant's petition for reconsideration, finding the applicant failed to present substantial medical evidence of industrial causation for her orthopedic complaints. A dissenting commissioner argued that the primary medical evaluator's report was deficient and lacked substantial evidence, warranting further development of the record on orthopedic injuries and other claims. The dissent emphasizes the Board's duty to ensure substantial justice, suggesting it should have ordered further investigation on the denied orthopedic issues.

WCABPetition for ReconsiderationFindings and Orderindustrial injurypsychelow backneckright shoulderright wristright elbow
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. ADJ3566472 (SFO 04633189)
Regular
Apr 05, 2010

MAURICE EDWARDS vs. CALIFORNIA PACIFIC MEDICAL CENTER

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued the judge erred by combining work restrictions for the left knee and subjective pain for the right knee. The Board found the rating justified, noting the Agreed Medical Examiner stated the applicant was more disabled due to right knee pain. The Board concluded the rater's testimony supported the combined rating without improper addition of disability percentages.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLeft KneeRight KneePsycheApportioned Permanent Partial DisabilityBilateral Knee DisabilityWork Restrictions
References
Case No. OXN 0129630, OXN 0129631
Regular
Jul 09, 2007

LUPE HERRERA vs. WAL-MART, AMERICAN HOME ASSURANCE

Lien claimants sought reconsideration of a Workers' Compensation Appeals Board award regarding industrial injuries to the applicant's right knee and wrist. They argued the administrative law judge improperly applied a 2004 fee schedule to services rendered prior to its effective date and misapplied burdens of proof. The Board denied reconsideration, finding the ALJ used the 2004 fee schedule as a reasonable guide, not as a strictly applicable regulation for pre-2004 services, and that their petition was timely.

Workers' Compensation Appeals BoardLien claimantsPetition for ReconsiderationJoint Findings and AwardIndustrial injuryRight kneeRight wristFee scheduleAmbulatory surgery centersBurden of proof
References
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