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Case Law Database

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

Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
Case No. ADJ8734628 ADJ9086734
Regular
Aug 12, 2016

PATRICIA CRUZ MALDONADO vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

This case involves White Memorial Medical Center's petition for reconsideration of a Joint Findings and Award finding that applicant Patricia Cruz Maldonado sustained lumbar spine injuries arising out of and occurring in the course of employment as a registered nurse. The defendant argued the findings were erroneous due to alleged inconsistencies in applicant's testimony and a lack of substantial medical evidence for a cumulative injury. The Workers' Compensation Appeals Board denied the petition, upholding the Administrative Law Judge's credibility determinations and finding substantial medical evidence, specifically from Dr. Edwin Haronian, supporting the cumulative trauma injury. The Board emphasized that the WCJ observed the witness and considered all admitted evidence, and that deposition testimony not offered into evidence could not be relied upon.

WCABPetition for ReconsiderationJoint Findings and AwardWCJcredibility determinationsubstantial medical evidencecumulative traumalumbar spineregistered nurseprimary treating physician
References
5
Case No. ADJ9556841
Regular
Aug 15, 2016

SOFIA RIOS vs. TULARE REGIONAL MEDICAL CENTER, ALPHA FUND

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of an award to Sofia Rios. The Board found that the Qualified Medical Evaluator did not engage in ex parte communication by sending a questionnaire and that his reports constituted substantial medical evidence. The employer's arguments that the doctor relied on personal anecdotes and an inaccurate assessment of lift team availability were rejected. The Board affirmed the original award based on the substantial evidence in the medical reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorEx Parte CommunicationSubstantial Medical EvidenceLabor Code Section 5909TollingReasonable Medical ProbabilityInadequate Medical HistoriesCausation Analysis
References
5
Case No. ADJ2270634 (VNO 0521616)
Regular
Aug 03, 2018

SHEVON THOMAS vs. POMONA VALLEY HOSPITAL MEDICAL CENTER, Administered by ADMINSURE, INC., SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns an applicant seeking benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF) following a 2005 industrial injury that resulted in a 69% permanent disability and a substantial settlement. The applicant's claim for SIBTF benefits was denied because she failed to establish a prior "labor disabling" permanent disability that existed before the 2005 injury. The Appeals Board upheld the denial, finding that the applicant's evidence of prior symptoms, including a doctor's speculative impairment ratings, lacked substantial medical evidence and did not meet the strict requirements for establishing a pre-existing, labor-disabling condition. The Board emphasized that post-injury medical opinions, especially those based on hypotheticals and inadequate history, cannot retroactively establish a prior disability for SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFlabor disablingpermanent partial disabilityLabor Code section 4751SB 899apportionmentpreexisting disabilityAMA Guides impairment ratingsretrospective prophylactic work restrictions
References
8
Case No. MISSING
Regular Panel Decision

Claim of Lachowicz v. Albany Medical Center Hospital

The case involves an appeal by the employer and its carrier from a Workmen's Compensation Board decision. The Board determined that the claimant, a machinist's helper, contracted pulmonary tuberculosis as an occupational disease due to exposure on contaminated equipment at the employer hospital. The central issue was whether there was substantial evidence to support this finding. The court noted evidence of the claimant working in contagious wards and repairing equipment like suction machines used for tuberculosis patients. Despite arguments about sterilization, the Board accepted the claimant's account of "dirty" machines, and with substantial medical evidence of causal relationship, the court affirmed the Board's decision.

Occupational DiseaseTuberculosisMachinist's HelperHospital WorkerContaminated EquipmentCausal RelationshipWorkmen's Compensation BoardAppealSubstantial EvidenceMedical Opinion Conflict
References
3
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
11
Case No. MISSING
Regular Panel Decision
May 20, 2010

Claim of Cary v. Salem Central School District

The claimant appealed a Workers' Compensation Board decision that rescinded her reduced earnings awards, contending that there was sufficient medical evidence of a continuing causally related disability. The WCLJ had initially awarded reduced earnings and classified the claimant as permanently partially disabled due to a 2003 accident, but the Board later found insufficient medical evidence and rescinded the awards. The appellate court reversed the Board's decision, concluding that substantial evidence, including numerous reports from treating physicians and the carrier's own medical expert, supported a continuing disability. The court ruled that gaps in the submission of medical reports alone did not constitute substantial evidence to support the recision of the reduced earnings awards, and remitted the matter for further proceedings.

Reduced Earnings AwardsMedical Evidence SufficiencyContinuing DisabilityTreating Physician ReportsWorkers' Compensation LawAppellate DivisionBoard Decision ReversalPermanent Partial DisabilityCausally Related DisabilityMedical Report Gaps
References
1
Case No. ADJ8070183 ADJ9326618
Regular
Feb 17, 2016

CARLOS VASQUEZ vs. TRINET, AMERICAN HOME ASSURANCE

This case involves a defendant seeking reconsideration of a prior Board decision that found applicant sustained new and further disability from a January 7, 2009 injury and allowed further development of the medical record for a cumulative trauma claim. The defendant argued the treating physicians' reports were not substantial evidence for new and further disability and that there was insufficient evidence to reopen the cumulative trauma claim. The Board denied reconsideration, reaffirming its prior decision based on substantial medical evidence, and noting that the absence of an officially designated primary treating physician does not invalidate the relied-upon medical opinions. The Board further clarified that an Agreed Medical Examiner can be used for further evaluation of the cumulative trauma claim.

Workers' Compensation Appeals BoardPetition for ReconsiderationNew and Further DisabilityCumulative Trauma InjuryJoint Findings of Fact and OrderSubstantial EvidenceAgreed Medical ExaminerQualified Medical EvaluatorPrimary Treating PhysicianNon-Substantial Evidence
References
2
Case No. MISSING
Regular Panel Decision

Claim of Hicks v. Hudson Valley Community College

A claimant, a data analyst coordinator, sought workers' compensation benefits for bilateral carpal tunnel syndrome, alleging it was caused by keyboarding duties. A Workers’ Compensation Law Judge (WCLJ) found prima facie medical evidence and established occupational disease, notice, and causal relationship, precluding the carrier's medical expert's deposition due to untimely filing. The Workers’ Compensation Board affirmed this decision. On appeal, the employer and carrier contended the preclusion was an abuse of discretion and the claim establishment lacked substantial evidence. The Appellate Division affirmed the Board's decision, finding no abuse of discretion in precluding the evidence due to dilatory filing and that the Board's determination of carpal tunnel syndrome was supported by substantial evidence, despite conflicting medical opinions, which the Board has the prerogative to resolve.

Carpal Tunnel SyndromeOccupational DiseaseWorkers' Compensation BenefitsMedical EvidenceDeposition PreclusionSubstantial EvidenceAppellate ReviewAbuse of DiscretionWaiver of RightsData Entry
References
4
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
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