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

Case No. ADJ6408456
Regular
May 17, 2010

KENNETH M. HOOVER vs. CITY OF POMONA

The Appeals Board granted reconsideration of the WCJ's award of 100% permanent total disability. The Board found that the WCJ's decision was not supported by substantial evidence, primarily due to deficiencies in Dr. Grodan's medical reporting regarding the applicant's skin and cardiovascular conditions. The matter was returned to the trial level for further development of the record and a new decision. The Board confirmed the application of the 1997 Permanent Disability Rating Schedule and the admission of Dr. Shirman's report.

WORKERS' COMPENSATION APPEALS BOARDADJ6408456KENNETH M. HOOVERCITY OF POMONAreconsiderationFindings and Award and Orderworkers' compensation administrative law judgeWCJMay 172010
References
Case No. ADJ10007434
Regular
Sep 23, 2016

RUSSELL RASMUSSEN vs. CITY OF PETALUMA, REDWOOD EMPIRE MUNICIPAL INSURANCE FUND

This case concerns a firefighter's claim for a carotid pseudoaneurysm, which the original judge found work-related based on a QME's opinion. The employer sought reconsideration, arguing the QME's opinion lacked substantial evidence as it was speculative and not based on a history of trauma. The Board granted reconsideration, finding the QME's opinion impermissibly speculative. Ultimately, the Board amended the award to exclude the pseudoaneurysm as an industrial injury, reducing the permanent disability award.

Workers' Compensation Appeals BoardCity of PetalumaRussell RasmussenIndustrial cumulative traumaCardiac palpitationsCarotid pseudoaneurysmBattalion ChiefQualified Medical EvaluatorSubstantial medical evidencePetition for Reconsideration
References
Case No. ADJ1793931 (OAK 0336568)
Regular
Apr 12, 2010

MICHAEL KESTEL vs. CAPITOL BUICK PONTIAC GMC, ZENITH, REPUBLIC INDEMNITY

This case concerns an appeal regarding the applicant's permanent disability rating for upper extremity injury. The defendants contended that the original $24\%$ rating was improperly calculated, specifically challenging the inclusion of grip loss as a factor. The Appeals Board found the Agreed Medical Evaluator's opinion on grip loss to be speculative and not substantial evidence under the *Almaraz II* decision. Consequently, the Board granted reconsideration, amended the award to $16\%$ permanent disability, and affirmed the remainder of the original findings.

AMEAgreed Medical EvaluatorAMA Guidespermanent disability ratingWPIwhole person impairmentgrip lossupper extremity impairmentAlmaraz IIsubstantial evidence
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. ADJ7791984
Regular
Nov 26, 2012

PATRICK VIDAL vs. NESTLE WATERS INC., ACE AMERICAN INSURANCE COMPANY

This Workers' Compensation Appeals Board decision denies both applicant and defendant's petitions for reconsideration. The Board affirmed the administrative law judge's finding of $33\%$ permanent disability after apportionment, finding the Agreed Medical Evaluator's (AME) opinion on apportionment was based on expertise and constituted substantial evidence. The Board rejected defendant's claim that surgery was not medically necessary and thus not compensable. One Commissioner dissented on the apportionment issue, arguing the AME's opinion was speculative and lacked sufficient explanation.

Workers' Compensation Appeals BoardPatrick VidalNestle Waters Inc.ACE American Insurance Companypermanent disabilityapportionmentAgreed Medical Evaluator (AME)Dr. Calderonesubstantial evidencespeculative
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. ADJ1142998 (RDG 0118288)
Regular
Aug 18, 2009

STEVE REYNOLDS vs. WYCKOFF LOGGING, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB had previously rescinded a finding that avascular necrosis was not a compensable consequence of the applicant's injury, finding the relied-upon medical opinion speculative. The defendant argues the WCJ correctly favored the opinion of Dr. Glancz over Dr. Barber. The WCAB denied reconsideration, reaffirming that Dr. Glancz's opinion was not substantial evidence due to repeated questioning of the injury mechanism, while Dr. Barber's opinion was persuasive and based on a complete history. Therefore, the WCAB maintained its prior decision that Dr. Barber's opinion constituted substantial evidence supporting the applicant's claim.

Avascular necrosiscompensable consequencesubstantial evidencemedical opinionworkers' compensation administrative law judgereconsiderationfindings and ordermedical treatmentindustrial basissubstantial evidence
References
Case No. ADJ4072860 (AHM 0083472) ADJ2211265 (AHM 0083473)
Regular
Feb 28, 2012

DARLYN PIPER vs. DANKA OFFICE IMAGING, ZURICH NORTH AMERICA, LIBERTY MUTUAL INSURANCE COMPANY

This case involves cross-petitions for reconsideration of an award for applicant's industrial injuries. The Board denied the applicant's petition and granted the defendant's, clarifying that Zurich North America is solely liable. The Board affirmed the WCJ's decision, amending the award to reflect the applicant's election against Zurich and allowing Zurich to seek contribution from Liberty Mutual. A dissenting opinion argued that the apportionment of permanent disability was speculative and unsupported by substantial medical evidence.

Workers' Compensation Appeals BoardDarlyn PiperDanka Office ImagingZurich North AmericaLiberty Mutual Insurance CompanyADJ4072860ADJ2211265permanent disabilitycumulative traumacustomer service technician
References
Case No. ADJ9785802
Regular
Aug 16, 2017

Edix PORTILLO vs. BRIMCO, LLC, AIG, administered by HELMSMAN MANAGEMENT

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of the WCJ's Findings of Fact. The applicant sought reconsideration of the finding that he did not sustain injury arising out of and in the course of employment (AOE/COE) for his right foot, constipation, IBS, and internal/external hemorrhoids. The Board adopted the WCJ's reasoning, finding that the medical evidence supporting the applicant's claims was speculative. Specifically, the applicant's chosen physician's opinions were considered less credible than those of the employer-appointed QMEs, who found no substantial medical issues.

AOE/COEPetition for ReconsiderationWCJQualified Medical Evaluator (QME)substantial evidencemedical opinionNSAIDsconstipationIBShemorrhoids
References
Case No. ADJ10815502
Regular
Oct 04, 2018

ROSA LORENA VALENCIA vs. BARCELINO CONTINENTAL CORP., AMTRUST NORTH AMERICA

This case concerns defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision awarding temporary total disability (TTD) benefits to the applicant. The defendant disputes the TTD award beyond June 1, 2017, arguing the medical evidence does not support ongoing disability. The WCAB denied reconsideration, adopting the WCJ's report and finding medical evidence indicated the applicant had not reached maximum medical improvement and required further treatment before her condition could be deemed permanent and stationary. However, the dissenting opinion argued the medical opinions were speculative and insufficient to support indefinite TTD, recommending the case be returned for further development of the record on the applicant's TTD status.

Workers' Compensation Appeals BoardPetition for ReconsiderationTemporary Total DisabilityPermanent and StationaryMaximal Medical ImprovementMedical TreatmentPsychiatric TreatmentCognitive-Behavioral TherapyQualified Medical ExaminerFindings and Award
References
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