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

Case No. ADJ1742598 (SDO 0321754)
Regular
May 02, 2011

JOSE G. HERNANDEZ vs. LABORERS INTERNATIONAL UNION OF NORTH AMERICA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's finding that the applicant did not sustain industrial injury to his heart, psyche, or internal organs. The Board found the applicant's medical expert's opinion to be unsubstantial as it was based on an incomplete and inaccurate medical history provided by the applicant. Conversely, the Board found the defendant's QME's well-reasoned and thorough medical opinions, which considered extensive non-industrial risk factors, constituted substantial evidence to support the WCJ's decision. Therefore, the applicant failed to meet his burden of proof for an industrial injury.

AOE/COEPetition for ReconsiderationQualified Medical Examiner (QME)substantial evidencemedical opinionindustrial injuryWCJlabor historycardiac diseasediabetes
References
Case No. ADJ2628913
Regular
Jan 02, 2014

BARRY BLAYLOCK vs. NEGHEBORN AUTO CENTER, dba NEBHEBORN LINCOLN MERCURY, et al

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding a finding of serious and willful misconduct. The applicant sustained a permanent and total disability due to lung damage caused by heavy workplace smoking, specifically by a coworker in an enclosed office. Despite repeated complaints and an emergency room visit, the employer knowingly permitted the violation of a workplace smoking prohibition. The Board found sufficient evidence of employer knowledge of the safety order and the resulting harm to the applicant.

Workers' Compensation Appeals BoardSerious and Willful MisconductLabor Code Section 4553Reconsideration DeniedPetition for ReconsiderationWCJ ReportCredibility FindingSerious and WillfulViolation of Safety OrderWorkplace Smoking Prohibition
References
Case No. ADJ3190249 (SFO 0500553)
Regular
Mar 24, 2010

Quintella Eutsey vs. CITY & COUNTY OF SAN FRANCISCO, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted removal, dismissing the defendant's petition for reconsideration. The Board found the prior administrative law judge's order improperly limited discovery into the applicant's psychiatric injury claim. The Board rescinded the previous order, allowing further deposition to explore the applicant's full medical history relevant to her psyche claim, as this is discoverable when a psychological injury is at issue. Both parties were admonished to conduct themselves professionally during future discovery.

removalpetition for reconsiderationdiscovery disputepsyche injurydeposition testimonyright lower extremityindustrial injurypersonal lifefamily lifepast history
References
Case No. ADJ9805248
Regular
Aug 30, 2017

FRANCISCO PEREZ vs. MASSIVE PRINTS, HARTFORD/ SENTINEL INSURANCE COMPANY

The Appeals Board granted reconsideration of the WCJ's award due to questions regarding the substantiality of the Qualified Medical Evaluator's (QME) opinion. The Board found the QME's report and deposition testimony unreliable due to an incorrect work history, inadequate examination, and potentially flawed application of disability rating guidelines. Consequently, the Board affirmed the original award but deferred issues of permanent disability, apportionment, and attorney fees, returning the case to the WCJ for further proceedings and potentially a new medical evaluation.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentAttorney FeesQualified Medical EvaluatorAgreed Medical ExaminerSubstantial EvidenceMedical Opinion
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ10968178
Regular
May 24, 2019

MIRNA GUERRA vs. KENNERLEY SPRATLING, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award finding applicant sustained bilateral wrist and hand injury AOE/COE. The WCAB found that neither the applicant's treating physician, Dr. Mirza, nor the defense qualified medical examiner, Dr. Roth, provided substantial medical evidence. Dr. Roth's report failed to address aggravation of any pre-existing condition by the applicant's work duties. Dr. Mirza's reports suffered from inconsistencies, inadequate medical history, and lack of reasoning. Therefore, the WCAB rescinded the award and returned the case to the WCJ for further record development.

AOE/COEPetition for ReconsiderationFindings of FactAward and OrderWCJbilateral wristsbilateral handscumulative traumaprimary treating physicianqualified medical examiner
References
Case No. ADJ8741844
Regular
Jan 14, 2014

CARLOS MIRANDA vs. PACIFIC EXCHANGE, HANOVER INSURANCE GROUP

The Appeals Board rescinded the prior finding of injury to the applicant's back, concluding it was not supported by substantial evidence. The Board found the medical report relied upon by the trial judge was based on an inaccurate and incomplete history provided by the applicant, inconsistent with other statements and undisputed trial evidence. Therefore, the applicant did not sustain an industrial injury to his back, and the case was returned for further proceedings on other alleged body parts.

WCABReconsiderationFindings of FactLabor CodeStatute of LimitationsIndustrial InjuryAOE/COESubstantial EvidenceInaccurate Medical HistoryIncomplete Medical History
References
Case No. ADJ3339526
Regular
Oct 14, 2008

Jeffrey Zajdel vs. CALIPATRIA STATE PRISON, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address the issue of apportionment of the applicant's permanent disability due to a heart and brain injury. The Board rescinded the prior decision that apportioned 50% of the disability to non-industrial factors, finding the medical opinion supporting apportionment speculative and not based on established legal principles. Consequently, the Board issued a new award for 100% permanent disability without apportionment and reinstated the applicant's attorney's fees based on this higher award.

WORKERS' COMPENSATION APPEALS BOARDJEFFREY ZAJDELCALIPATRIA STATE PRISONSTATE COMPENSATION INSURANCE FUNDADJ3339526VNO 0491968OPINION AND ORDER GRANTING RECONSIDERATIONSUPPLEMENTAL FINDINGS AND AWARDINDUSTRIAL INJURYHEART INJURY
References
Case No. ADJ252083 (NOR 0166266) ADJ3827633 (LAO 0784953) ADJ3395707 (LAO 0784956) ADJ629194 (LAO 0849490) ADJ2985386 (LAO 0784955) ADJ2625573 (LAO 0784951)
Regular
Apr 12, 2011

CLAUDIA DYER vs. BOEING/McDONNELL DOUGLAS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHARTIS INSURANCE

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the WCJ's findings of industrial injuries to the applicant's knees, neck, back, shoulders, hips, hands, and ankle across multiple dates. The Board found the WCJ's decision was supported by substantial evidence, specifically Dr. Nelson's well-reasoned medical opinions on causation and apportionment. CIGA's petition was also found deficient for failing to comply with procedural requirements for referencing the record. Finally, CIGA was estopped from asserting the statute of limitations defense due to the employer's knowledge of the injury and failure to provide notice of rights.

CIGAFremont InsuranceliquidationPetition for ReconsiderationJoint Findings and Awardindustrial injuryaircraft mechanickneesneckback
References
Case No. ADJ3288464 (LAO 0772800)
Regular
Mar 27, 2009

NACHUM SAGI vs. OLYMPIC HOLDING CORP., CIGA by its servicing facility BROADSPIRE CLAIMS SERVICES, SUPERIOR NATIONAL INSURANCE COMPANY in liquidation

The Workers' Compensation Appeals Board denied reconsideration of the applicant's petition. The denial was based on the WCJ's report, which found the applicant's testimony and reported medical history inconsistent and not credible. Specifically, the Board found that the Agreed Medical Evaluator's (AME) opinion did not constitute substantial evidence due to the flawed history provided by the applicant. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorSubstantial EvidenceVargas v. Atascadero State HospitalLabor Code section 5313CredibilityConflicting HistoriesMedical FileStipulated Award
References
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