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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
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. ADJ3699477 (OAK 0345390)
Regular
Jul 05, 2011

GARY TOMEI vs. BAY ALARM COMPANY, TRAVELERS PROPERTY AND CASUALTY INSURANCE COMPANY

This case involves an applicant seeking authorization for cervical surgery, which was denied based on the treating physician's request not being properly formatted per AD Rule 9792.6(o). The Appeals Board granted reconsideration, finding the initial denial was due to the applicant's attorney adding a notation to the physician's report instead of the physician clearly marking it as a spinal surgery authorization request. The Board rescinded the original award, deferring the cervical surgery issue and ordering an expedited second opinion from a designated orthopedic surgeon or neurosurgeon.

Workers' Compensation Appeals BoardGary TomeiBay Alarm CompanyTravelers Property and Casualty Insurance CompanyADJ3699477Opinion and Order Granting Reconsiderationcervical surgerylumbar spineAdministrative Director Rule 9792.6(o)treating physician
References
Case No. ADJ3918602 (SAC 0330507) ADJ272371 (SAC 0354775)
Regular
Apr 05, 2010

THOMAS MELTON vs. COUNTY OF SACRAMENTO, SHERIFF'S DEPARTMENT

In this workers' compensation case, the defendant sought reconsideration of an award for spinal surgery recommended by the applicant's treating physician, Dr. Montesano. The defendant argued the administrative law judge should have favored the opinion of Dr. Reynolds, an agreed medical examiner. The Appeals Board denied reconsideration, finding Dr. Montesano's opinion constituted substantial evidence supporting the award. The Board affirmed the judge's discretion to choose among conflicting medical reports.

Workers' Compensation Appeals BoardJoint Findings and AwardPermissibly Self-InsuredDeputy SheriffIndustrial InjuryLow BackSpinal SurgeryTreating PhysicianAgreed Medical ExaminerSecond Opinion Physician
References
Case No. ADJ900432 (SAC 0323091)
Regular
Dec 30, 2011

MARLENE COPUS vs. NORTH SACRAMENTO ELEMENTARY SCHOOL DISTRICT

This case involves a dispute over the necessity of spinal surgery for an applicant who sustained a cumulative trauma injury to her neck and back. While the applicant's treating physician recommended surgery, a second opinion physician disagreed, citing a lack of nerve root compression. The Appeals Board found that the medical evidence was insufficient to determine the necessity of surgery, particularly in light of ACOEM Practice Guidelines which generally recommend against surgery without nerve root compression. Therefore, the Board rescinded the prior award and remanded the case to appoint an independent physician to evaluate the applicant and determine the reasonableness and necessity of the proposed surgery.

Workers' Compensation Appeals BoardMarlene CopusNorth Sacramento Elementary School Districtcumulative traumaspinal surgerynerve root impingementcervical stenosisDr. OrisekDr. GregoriusACOEM Practice Guidelines
References
Case No. ADJ7908543
Regular
Nov 13, 2012

JOSE RIVAS vs. CALIFORNIA CARPET, LLC, ICW GROUP

In Rivas v. California Carpet, LLC, the Appeals Board granted the defendant's Petition for Removal, rescinding a prior award of spinal surgery. The WCJ had improperly excluded the second opinion physician's report as untimely. The Board found the applicant waived his objection to the report's untimeliness by not raising it until after the examination. The case was returned to the trial level for reconsideration of the surgery's necessity, including the second opinion report.

Petition for RemovalFindings and AwardSpinal SurgeryPrimary Treating PhysicianSecond Opinion PhysicianLabor Code Section 4062(b)Timeliness ObjectionWaiverExpedited HearingMedical Unit
References
Case No. LAO 0822431
Regular
Apr 15, 2008

HOWARD J. SHERMAN vs. ENTERTAINMENT PARTNERS, CONTINENTAL CASUALTY COMPANY

This case involves a defendant seeking reconsideration of an order compelling spinal surgery for an applicant's admitted 2001 industrial back injury. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, upholding the original order. The WCAB found that both the applicant's treating physician and a court-appointed second opinion physician agreed on the necessity of the surgery, and that the industrial injury was a contributing factor to the current need for surgery.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderApplicantDefendantIndustrial InjuryBack InjuryLocation ScoutSpinal SurgeryTreating Physician
References
Case No. ADJ7117844
Regular
Dec 05, 2011

Tommy Robison vs. CITY OF MARICOPA

The Workers' Compensation Appeals Board denied reconsideration of an award of spinal surgery for Tommy Robison. The employer argued the award was improper because the Spinal Surgery Second Opinion (SSSO) report was untimely and they had implicitly agreed to an Agreed Medical Evaluator's (AME) opinion. The Board found the employer failed to prove a timely objection to the treating physician's recommendation or timely Utilization Review at the hearing. Therefore, the treating physician's recommendation for surgery was controlling, despite the tardiness of the SSSO report, and an AME's opinion did not waive the SSSO process.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeny ReconsiderationSpinal SurgeryAgreed Medical EvaluatorSecond Opinion EvaluatorTimelinessLabor CodeUtilization ReviewTreating Physician
References
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