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

Case No. ADJ2005173 (AHM 0132388)
Regular
Jan 25, 2010

RUFUS TANKSLEY vs. CITY OF SANTA ANA

The Workers' Compensation Appeals Board granted reconsideration to both applicant and defendant. The Board rescinded the prior decision, finding that the medical reports of Drs. Jay and Stewart were admissible under pre-SB 899 procedures applicable to the claimed date of injury. The case was returned to the trial level for admission of these reports, further medical development if necessary, and a new decision addressing all issues, including the statute of limitations defense.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersPanel Qualified Medical ExaminersQMEMedical Report AdmissibilityLabor Code §4060(d)Statute of LimitationsLabor Code §5405Cumulative Period
References
Case No. LAO 0795696
Regular
Jul 09, 2007

DULCE MONTES vs. NATIONWIDE PAGING, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The applicant sought reconsideration of a decision mandating transfer into the defendant's Medical Provider Network (MPN) for treatment. The Workers' Compensation Appeals Board denied reconsideration, affirming that MPNs, as established by SB 899, allow for transfer of care regardless of prior treatment relationships or awards. The Board found no evidence applicant met exceptions to MPN transfer rules and rejected arguments based on pre-SB 899 law or MPN rule unconstitutionality.

MPNMedical Provider NetworkPrimary Treating PhysicianReconsiderationFindings of FactLabor Code Section 4616Appeals Board Rule 9767.9Transfer of CareSB 899Babbitt v. Ow Jing
References
Case No. MON 0261251 MON 0315082
Regular
Mar 17, 2008

RICHARD HICKS vs. BRAND & HILL PRODUCTIONS, LEGION INSURANCE, CALIFORNIA INSURANCE GURANTEE ASSOCIATION

The Workers' Compensation Appeals Board granted reconsideration and rescinded the previous award because the Administrative Law Judge's decision on permanent disability was based on a medical report predating SB 899, which failed to address apportionment as required by current law. The court found inconsistencies in the apportionment of disability, particularly regarding pre-existing conditions and subsequent cumulative trauma. The case was returned to the trial level for further development of the record on apportionment to comply with post-SB 899 legal standards.

CIGALegion InsuranceSB 899apportionmentDr. Charles SadlerDr. Thomas SheryLabor Code section 4663cumulative traumapermanent disabilitymedical treatment
References
Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)
Regular
Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns applicant Dennis Timmons' petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Appeals Board reversed a prior award, finding applicant failed to prove a pre-existing permanent partial disability from a 1991 cervical fusion surgery prior to his 2000 industrial injury. Applicant argued the fusion itself constituted a previous impairment and that SB 899's apportionment changes should apply, but the Board affirmed its decision. The Board reiterated that contemporaneous medical evidence is required for SIBTF eligibility, and that SB 899 did not alter SIBTF's established requirements.

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751
References
Case No. SRO 0132302 SRO 0137260 SRO 0137261
Regular
Apr 25, 2008

ROMAN BELTRAN vs. PIEDMONT LUMBER & MILL COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns the application of Labor Code section 4658(d) to an injury occurring on May 10, 2004, after Senate Bill 899's enactment. The Appeals Board affirmed the WCJ's finding that because the employer did not offer a return-to-work plan for at least 12 months, the permanent disability indemnity payable from 60 days after the P&S date must be increased by 15%. This ruling clarifies that SB 899's provisions apply prospectively from its enactment date to injuries not specifically excluded by the legislation.

Labor Code section 4658(d)SB 899permanent disability awardpermanent and stationary datereturn to workjob offerweekly conversion schedulemedical-legal reporttreating physician's reporttemporary disability indemnity
References
Case No. OAK 0325086
Regular
Sep 11, 2007

KENNETH GMEINER vs. CONTRA COSTA COUNTY FIRE PROTECTION DISTRICT

The Workers' Compensation Appeals Board dismissed the employer's petition for reconsideration as premature, but granted removal to address the judge's improper deferral of a permanent disability decision. The judge had vacated submission, citing uncertainty about the validity of the 2005 Permanent Disability Rating Schedule (PDRS) based on a pending case. The Board ruled that deferring a decision on permanent disability due to an unresolved legal issue concerning the PDRS's validity prejudiced the parties and violated the mandate for expeditious adjudication.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and Order Vacating SubmissionPermanent Disability Rating ScheduleSB 899Boughner v. CompUSAInc.Costa v. HardyAdministrative Director
References
Case No. SAC 0326274
Significant

JANELLE SCHEFTNER, Applicant vs. RIO LINDA SCHOOL DISTRICT, Permissibly Self-Insured

The Appeals Board affirmed the WCJ's decision, holding that the new apportionment statutes enacted by SB 899 do not apply to cases where an order of submission for decision existed prior to the new law's enactment on April 19, 2004.

SB 899apportionmentexisting ordersubmission orderreconsiderationJanelle ScheftnerRio Linda School DistrictWCJDr. NijjarDisability Evaluation Unit
References
Case No. OAK 0297895, OAK 0326228
En Banc
Dec 13, 2007

Dianne Benson vs. The Permanente Medical Group, Athens Administrators

The Appeals Board holds that the rule from Wilkinson v. Workers’ Comp. Appeals Bd., allowing a combined disability award for successive injuries, is no longer generally applicable after SB 899 reforms, mandating that apportionment must be based on causation for each separate injury.

SB 899Wilkinson ruleApportionmentCausationPermanent disabilityCumulative traumaSpecific injurySuccessive injuriesAgreed Medical ExaminerEn banc decision
References
Case No. SAC 323226
Significant
Feb 01, 2005

Marilyn Simi vs. SAV-MAX FOODS, INC; Springfield Insurance Company

The Appeals Board held that for injuries occurring prior to January 1, 2005, Labor Code section 4062, as it existed before its amendment by SB 899, continues to provide the procedure for obtaining AME and QME medical-legal reports in cases involving represented employees.

Workers' Compensation Appeals BoardEn BancRemovalDefense Qualified Medical ExaminationSB 899Labor Code Sections 40614062Pre-2005 InjuriesAgreed Medical EvaluationMedical-Legal Reports
References
Case No. GRO 0029816, GRO 0029817
Significant

Marlene Escobedo vs. Marshalls, CNA Insurance Co.

The Appeals Board affirmed the WCJ's decision to apportion 50% of the applicant's permanent disability to a preexisting degenerative arthritis, holding that Labor Code section 4663, as amended by SB 899, permits apportionment based on causation from non-industrial factors supported by substantial medical evidence.

SB 899apportionmentcausationpermanent disabilitypreexisting arthritismedical evidencesubstantial evidenceLabor Code section 4663compensable consequenceQME
References
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