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

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. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. MON 0325089 MON 0325090
Regular
Oct 05, 2007

NORA MEDEARIS vs. COUNTY OF LOS ANGELES

This case concerns the denial of an applicant's petition for reconsideration of a workers' compensation award. The applicant sought further temporary disability benefits beyond the 104-week limit imposed by Labor Code § 4656(c)(1). The Workers' Compensation Appeals Board denied the petition, finding the applicant failed to prove equitable estoppel against the defendant's application of the statutory limit, despite the defendant's initial refusal to authorize shoulder surgery. The Board adopted the WCJ's reasoning that the applicant did not demonstrate reliance on any conduct by the defendant that prevented her from timely pursuing authorization for the surgery.

Workers' Compensation Appeals BoardNora MedearisCounty of Los AngelesPermissibly Self-InsuredMON 0325089MON 0325090Opinion and Order Denying Petition for ReconsiderationInterim Joint Findings and AwardCentral Services TechnicianIndustrial Injury
References
Case No. ADJ8639740
Regular
Jul 28, 2017

Jorge Lopez vs. DELTA HI-TECH INC, NOVA CASUALTY/HANOVER INSURANCE GROUP

The Workers' Compensation Appeals Board granted reconsideration to allow a lien claimant's claim for medical treatment. The Board found that the applicant's shoulder surgeries, performed by the lien claimant, were reasonable and necessary based on the opinions of multiple physicians, including the Agreed Medical Examiner. The case was returned to the WCJ for further proceedings to determine the exact amount owed to the lien claimant.

Industrial injuryNeck injuryBack injuryShoulder injuryLien claimantPetition for reconsiderationFindings and OrderSubstantial evidenceReasonably necessary treatmentShoulder surgeries
References
Case No. ADJ8039057
Regular
Jan 07, 2014

LAURIE CARRICO vs. LAW OFFICES OF STEPHEN BELGUM, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior finding that the defendant's utilization review (UR) was defective regarding the applicant's shoulder surgery. The WCAB clarified its jurisdiction, stating it can only determine UR timeliness. All other disputes regarding the UR decision, including its compliance with Labor Code section 4610, must be resolved through Independent Medical Review (IMR). Therefore, the case was returned to the trial level to complete the IMR process.

Workers' Compensation Appeals BoardLaurie CarricoLaw Offices of Stephen BelgumState Compensation Insurance FundADJ8039057San BernardinoOpinion and Decision After ReconsiderationFindings and Awardindustrial injuryshoulders
References
Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
Case No. ADJ7166686
Regular
Jul 24, 2012

RICHARD ANDERSON vs. JAGUAR/LANDROVER OF VENTURA, COMPWEST INSURANCE COMPANY

This case involves an applicant who suffered a stroke and subsequent 100% permanent disability following surgery for an industrial shoulder injury. The defendant sought reconsideration, arguing for apportionment to pre-existing conditions and challenging the attorney's fee calculation. The Appeals Board affirmed the 100% permanent disability finding, finding no basis for apportionment as the applicant's pre-existing conditions did not cause the disability itself. However, the Board modified the attorney's fee award, requiring commutation using a specific method and a 3% cost of living adjustment, finding the previously assumed 4.6% to be speculative.

Workers Compensation Appeals BoardRichard AndersonJaguar/Landrover of VenturaCompwest Insurance CompanyADJ7166686ReconsiderationFindings and AwardIndustrial InjuryBrain InjuryNeurological System
References
Case No. LBO 0370773, LBO 0377679, LBO 0377749
Regular
Oct 10, 2007

LULIO ARAUJO vs. THE QUEEN MARY, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The applicant sustained injuries to his right shoulder, left shoulder, and bilateral shoulders, resulting in a 23% permanent disability rating. The WCAB denied the applicant's petition for reconsideration, upholding the WCJ's decision to rate the permanent disability under the 2005 Schedule instead of the 1997 Schedule. This decision aligns with the appellate court's interpretation in *Vera v. Workers' Comp. Appeals Bd.* regarding when a report indicates permanent disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMaintenance WorkerIndustrial InjuryRight ShoulderLeft ShoulderBilateral ShouldersCumulative InjuryPermanent Disability
References
Case No. SFO 0425862 SFO 0425863
Regular
May 14, 2008

William Bishop vs. IGC POLYCOLD SYSTEMS, ROYAL & SUN ALLIANCE

This case involves a workers' compensation applicant claiming injury to his right shoulder and seeking a new vocational rehabilitation plan. The Appeals Board affirmed the WCJ's denial of a new vocational plan and the finding of no industrial injury to the right shoulder. However, they reversed the WCJ to award benefits resulting from right shoulder surgery, deeming it a consequence of the compensable left shoulder injury.

Workers' Compensation Appeals BoardReconsiderationVocational Rehabilitation PlanIndustrial InjuryRight ShoulderLeft ShoulderTemporary DisabilityQualified Medical EvaluationCausationNon-Industrial
References
Case No. ADJ7449806 ADJ7872169
Regular
Sep 16, 2014

JON CERRUTI vs. CITY OF HAYWARD

The applicant sustained an industrial shoulder injury, and the WCJ found the defendant's utilization review invalid and awarded surgery. The defendant sought reconsideration, asserting the issue was moot as the surgery was approved by Independent Medical Review (IMR). The Appeals Board granted reconsideration, rescinded the WCJ's award, and returned the case to the trial level. This action aims to facilitate the surgery based on the IMR determination, while preserving the WCJ's decision should the defendant fail to comply.

Workers' Compensation Appeals BoardUtilization ReviewFindings Order AwardPetition for ReconsiderationIndependent Medical ReviewLabor Code 4610.6(j)Medical NecessityMedically NecessaryRescindedReturned to Trial Level
References
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