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

Case No. ADJ2778117 (RIV 0032584)
Regular
Dec 31, 2009

KEYIN MORALES vs. RALPHS GROCERY CO., SEDGWICK CLAIMS MANAGEMENT SERVICES

The WCAB granted the petition for reconsideration and amended the Findings and Award to find 18 1/2 percent permanent disability, after apportionment of 50 percent to applicant's non-industrial peripheral neuropathy.

ApportionmentPeripheral neuropathyCausationPermanent disabilityAgreed medical examinerWCJPetition for reconsiderationFindings and AwardWork restrictionsIndustrial injury
References
4
Case No. ADJ9509417
Regular
Apr 05, 2023

ELIZABETH ARBOGAST vs. CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed an award for further medical treatment and attorney fees for an applicant diagnosed with ovarian cancer, hernia, peripheral neuropathy, and colon issues sustained during her employment with the California Highway Patrol. The Board found the applicant's ovarian cancer to be an insidious and progressive disease, warranting a reservation of jurisdiction over permanent disability. This reservation allows for future determination of permanent disability if the condition worsens or recurs.

Workers' Compensation Appeals BoardCalifornia Highway Patrolmedically uninsuredState Compensation Insurance FundAdjudication NumberOpinion and Decision After ReconsiderationFindings and Awardworker's compensation administrative law judgeovarian cancerhernia
References
11
Case No. ADJ8878991
Regular
Jan 31, 2014

JAY SCHETTLER vs. ALLIED BEVERAGES, INC.; CYPRESS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of the administrative law judge's finding of injury. The applicant, a route salesman, claimed he stepped on glass, injuring his left foot, which was corroborated by medical records showing a cut and the applicant's delayed awareness due to diabetic neuropathy. Defense witness testimony also supported the applicant's claim of cutting his toe at work. The Board found the applicant's testimony credible and the medical evidence sufficient to establish the injury arose out of and in the course of employment.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Factterritory route salesmanmechanism of injurydiabetic neuropathycredibilitymedical recordsReport and Recommendationurgent care
References
1
Case No. ADJ11027267
Regular
Feb 03, 2023

LUIS ROSALES vs. IRELAND TILE AND STONE INC., SEDGWICK 14779 SAN DIEGO

This case involves an injured tile setter, Luis Rosales, who claimed lumbar radiculopathy stemming from an admitted industrial lumbar contusion. The Workers' Compensation Appeals Board denied reconsideration of a prior order, upholding a finding of 0% permanent disability. This decision was based on the Qualified Medical Examiner's (QME) reports, which the Board found to be substantial evidence. The Board specifically rejected the applicant's argument that the QME's opinions were inconsistent, clarifying that the QME found the sacral cyst unrelated to the lumbar contusion, not that the symptoms were unrelated to the cyst.

Petition for ReconsiderationQualified Medical ExaminerPQMEDr. Sonusupplemental reportsubstantial evidencelumbar contusionsacral cystradiculopathypermanent disability
References
2
Case No. MISSING
Regular Panel Decision

Newsome v. Astrue

Gordon C. Newsome challenged the Commissioner of Social Security's final determination denying him social security disability benefits. The Administrative Law Judge (ALJ) had found Newsome not disabled, attributing his impairments primarily to alcohol abuse and a temporary hip fracture. The District Court identified several legal errors by the ALJ, including improper assessment of neuropathy and DVT diagnoses, mischaracterization of a treating physician's report, and failure to adequately develop the record regarding the materiality of alcohol abuse to Newsome's physical limitations. Consequently, the Plaintiff's motion for judgment on the pleadings was granted, the Commissioner's cross-motion was denied, and the case was remanded to the ALJ for further proceedings consistent with the court's decision.

Social Security DisabilityAlcohol AbuseSeizure DisorderPancreatitisNeuropathyDeep Vein Thrombosis (DVT)Credibility AssessmentTreating Physician RuleRemandAdministrative Law Judge (ALJ)
References
54
Case No. MISSING
Regular Panel Decision

O'DELL v. Barnhart

Plaintiff William O'Dell sought disability insurance benefits due to carpal tunnel syndrome, ulnar neuropathy, and tendinitis, which he claimed prevented him from working since 1996. The Commissioner of Social Security, Jo Anne B. Barnhart, denied benefits, asserting O'Dell retained the residual functional capacity to perform other work. After an Administrative Law Judge and the Appeals Council upheld the denial, O'Dell initiated this review action in the District Court under 42 U.S.C. § 405(g). The District Court, presided over by Judge Larimer, affirmed the Commissioner's final determination, concluding that the ALJ's findings were supported by substantial evidence regarding O'Dell's capacity for other work in the national economy.

Social Security ActDisability Insurance BenefitsResidual Functional CapacityTreating Physician OpinionAdministrative Law JudgeVocational Expert TestimonyCarpal Tunnel SyndromeUlnar NeuropathyTendinitisFederal District Court Review
References
6
Case No. 534831
Regular Panel Decision
Oct 12, 2023

In the Matter of the Claim of Susan Zuhlke

Susan Zuhlke appealed two decisions by the Workers' Compensation Board concerning a schedule loss of use (SLU) award for her right leg injuries. Zuhlke, a teacher, suffered right ankle and knee/tibia fractures in October 2018, later including fibular neuropathy. While a 25.8% SLU for her right foot was stipulated, a dispute arose over the right knee, with the Board ultimately affirming a 15% SLU based on the carrier's medical consultant's opinion and denial of reconsideration. The Appellate Division affirmed the Board's determination, finding substantial evidence supported the 15% SLU award for the right knee, consistent with impairment guidelines and prior Board decisions regarding tibial plateau fractures.

Workers' CompensationSchedule Loss of UseSLURight Leg InjuryTibial Plateau FractureFibular NeuropathyMaximum Medical ImprovementImpairment GuidelinesMedical OpinionsAppellate Review
References
9
Case No. MISSING
Regular Panel Decision

Claim of Delee v. Crouse Hinds Division of Cooper Industries

Claimant sustained a work-related back injury in 1991, resulting in a permanent partial disability and workers' compensation benefits. After being terminated and later finding new employment, she developed breast cancer, leading to neuropathy and cardiomyopathy from chemotherapy, preventing her return to work. The employer's carrier argued her current inability to work was solely due to cancer, not the back injury. The Workers’ Compensation Board reversed a Workers’ Compensation Law Judge's decision, continuing claimant's reduced earnings award. The Appellate Division affirmed, holding that supervening nonindustrial causes do not absolve an employer if the established permanent partial disability still contributes to reduced earning capacity, which is a factual determination for the Board, supported by substantial evidence in this case.

Workers' CompensationPermanent Partial DisabilityReduced EarningsSupervening Nonindustrial CausesCausationAppellate ReviewMedical OpinionBack InjuryChemotherapy ComplicationsBoard Findings
References
5
Case No. MISSING
Regular Panel Decision

Claim of Nickens v. Randstad

Claimant, employed by a temporary agency, suffered severe lumbar and sacral vertebrae fractures on October 7, 2003, when caught in a garbage truck's hydraulic lift. The employer and carrier argued he was gathering cans for personal use, a prohibited act. However, the Workers’ Compensation Law Judge (WCLJ) found the injury work-related, established an average weekly wage, and awarded temporary disability benefits. The carrier sought review from the Workers’ Compensation Board, contending they were denied cross-examination of claimant’s physicians, an opportunity to present a witness regarding the prohibited act, and cross-examination of claimant about his labor market attachment. The Board affirmed the WCLJ’s decision. The Appellate Division affirmed the Board's decision, finding no reversible error.

Workers' CompensationAccidental InjuryHydraulic Lift AccidentVertebrae FracturesTemporary EmploymentProhibited Act DefenseCross-Examination DenialLabor Market AttachmentWorkers' Compensation BoardAppellate Review
References
2
Case No. MISSING
Regular Panel Decision

Gonzalez v. Secretary of United States Department of Health & Human Services

Lydia Gonzalez, 72, sought Medicare reimbursement for her hospital stay from July 28 to August 19, 1981, following surgeries at Nassau Hospital for a sacral ulcer. The hospital's Utilization Review Committee and Physicians Review Organization determined she only required "custodial care," which is not covered by Medicare. Her discharge was delayed due to insanitary home conditions. After appeals to the New York Statewide Professional Standard Review Council and an Administrative Law Judge affirmed the denial, Gonzalez pursued legal action. The District Court granted the defendant's motion, affirming the Secretary's decision, finding that while the ALJ's reasoning was unclear, substantial evidence supported the conclusion that Gonzalez's extended hospital stay was due to non-medical "disposition problems" rather than a medical necessity for skilled nursing care.

Medicare benefitscustodial careskilled nursing careSocial Security Acthospital dischargemedical necessityadministrative reviewdenial of benefitsUtilization Review CommitteeAppeals Council
References
8
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