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

Case No. ADJ8558787
Regular
Apr 11, 2017

Mario Diaz vs. The Gainey Vineyard, Crump & Forster, United States Fire Insurance

This case involves Mario Diaz's workers' compensation claim for a lumbar spine injury. The Appeals Board granted reconsideration to amend the award, finding the agreed medical examiner's apportionment to pre-existing spondylolisthesis was not sufficiently justified. The Board also corrected the permanent disability rating calculation, utilizing the examiner's 34% whole person impairment instead of the initial 45% regional impairment, ultimately awarding 48% permanent disability without apportionment.

WCABapportionmentpermanent disabilityspondylolisthesisdegenerative disc diseaseAgreed Medical ExaminerAMEEscobedoAlmaraz-GuzmanWhole Person Impairment
References
Case No. ADJ1534094 (ANA 0371141), ADJ2039233 (ANA 0370928), ADJ1431772 (ANA 0388738), ADJ3092100 (ANA 0388739)
Regular
Feb 10, 2012

ROLANDO ALVARADO-CRUZ vs. SPRING INDUSTRIES, INC., ZURICH INSURANCE COMPANY

This case involves a workers' compensation applicant seeking reconsideration of a permanent disability award. The applicant argued against the administrative law judge's (WCJ) apportionment of 25% of the disability to pre-existing spondylolisthesis and the method of calculating the final award. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, agreeing that apportionment should be applied after adjustments for age and occupation, but otherwise affirmed the WCJ's findings. Consequently, the applicant's permanent disability award was increased to 21% for both the specific and cumulative trauma injuries.

Workers' Compensation Appeals BoardRolando Alvarado-CruzSpring IndustriesZurich Insurance CompanyFindings and AwardAdministrative Law JudgeMachinistPillow StufferSpecific InjuryCumulative Trauma Injury
References
Case No. ANA 0329574
Regular
Sep 21, 2007

Martina Gonzalez, Ocegueda vs. ST. JOHN KNITS, ARGONAUT INSURANCE COMPANY

The Appeals Board granted reconsideration and overturned the WCJ's decision, finding the WCJ erred in calculating average weekly earnings and relying on an incomplete medical report for apportionment. The case is returned to the trial level to recalculate average weekly earnings and revisit permanent disability and apportionment issues, considering recent legislative changes regarding pre-existing conditions. The Appeals Board noted that the prior medical report failed to address the applicant's spondylolisthesis and that apportionment rules have changed, eliminating the "old rules" regarding pathology.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryLow BackAbdomenRight LegPsycheTotal Permanent DisabilityApportionment
References
Case No. ADJ4523497 (AHM 0062594) ADJ488115 (AHM 0062669)
Regular
Jan 09, 2014

Anthony Becker vs. American Drug Stores, Broadspire

The Workers' Compensation Appeals Board denied reconsideration of a decision that apportioned 25% of the applicant's permanent spinal disability to non-industrial factors. The applicant argued that the Agreed Medical Examiner established his permanent total disability was solely due to surgeries for industrial cumulative trauma. However, the Board found the defendant met its burden of proof for apportionment, as the AME's testimony supported that the applicant's pre-existing spondylolisthesis contributed to the need for two-level spinal surgery. The Board adopted the WCJ's report and affirmed the original award.

WCABPetition for ReconsiderationJoint Findings and AwardCumulative TraumaApportionmentNon-industrial factorsAgreed Medical Examiner (AME)Escobedo v. MarshallsSpondylolisthesisPreexisting developmental anomaly
References
Case No. LAO 0859960, LAO0836589, LAO 0859995
Regular
Feb 13, 2008

ALBERTO SERNA vs. H.M.S. HOST, GALLAGHER BASSETT SERVICES, INC.; LIBERTY MUTUAL INSURANCE, ACE USA

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's argument that the applicant's back injury involved multiple cumulative trauma periods, not a single one. The Board found ambiguity in the Agreed Medical Examiner's findings regarding the number and dates of these traumas. Therefore, the case is remanded to the Agreed Medical Examiner for a supplemental report to clarify whether one or more cumulative trauma injuries occurred, and the specific permanent disability attributable to each.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and AwardAgreed Medical EvaluatorCumulative TraumaDate of InjuryPermanent DisabilityTemporary DisabilityLabor Code 5500.5Labor Code 3208.1
References
Case No. ADJ11608819
Regular
Mar 29, 2023

MINERVA DE BARTOLO vs. SOUTHERN CALIFORNIA PIZZA COMPANY dba PIZZA HUT, ATHENS ADMINISTRATORS

The Appeals Board overturned the WCJ's decision, finding that the applicant did sustain an injury AOE/COE to her lumbar spine, despite the WCJ's credibility findings against the applicant. The Board determined that the applicant's claim was not barred by Labor Code section 3600(a)(10) due to existing medical records showing a lumbar spine issue prior to termination and the date of knowledge of industrial causation occurring after her employment ended. The issue of injury to other body parts and all other issues were deferred.

AOE/COEWorkers' Compensation Appeals BoardReconsiderationFindings of FactOrderWCJLabor Code Section 3600(a)(10)PQMECausationSubstantial Evidence
References
Case No. OAK 294681
Regular
Nov 14, 2007

SCOTT SIMPSON vs. GEO OPTIONS, INC., EARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision regarding permanent disability apportionment, finding substantial medical evidence supported a 50% apportionment to pre-existing conditions. The Board also upheld the WCJ's finding of unreasonable delay in medical treatment, justifying a penalty against the defendant. A minor clerical error in the award regarding penalty references was corrected.

Workers' Compensation Appeals BoardScott SimpsonGeo Options Inc.Hartford Insurance CompanyOAK 294681Opinion and Decision After Reconsiderationpermanent disabilityapportionmentspondylolisthesisqualified medical examiner
References
Case No. ADJ4475762
Regular
Aug 14, 2015

GARY WHITLEY vs. EAST BAY MUNICIPAL UTILITY DISTRICT

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. This affirmed the finding that the applicant sustained a permanent total disability due to a back injury from April 10, 2006, with no apportionment to prior conditions. The Board found that medical reports from Drs. Gravina and Lieberman regarding apportionment to other conditions lacked substantial evidence. Consequently, the applicant's unemployability, as supported by multiple experts, established a 100% loss of earning capacity.

WCABADJ4475762OAK 0347942Petition for ReconsiderationWCJ ReportApportionmentSpondylolisthesisAnkle InjuryPermanent DisabilityAMA Guides
References
Case No. ADJ470132 (GOL 0100305), ADJ1890831 (GOL 0100306)
Regular
Sep 20, 2010

KAREN MCCORMICK vs. PACIFIC CAPITAL BANCORP, STATE COMPENSATION INSURANCE FUND, ST. PAUL TRAVELERS

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied SCIF's petition for reconsideration, affirming the WCJ's findings. The Board found Dr. Scheinberg's medical reports admissible and that applicant sustained an industrial injury to her lumbar spine on October 22, 2001, with permanent disability rated under the 1997 PDRS. The Board also rejected SCIF's Statute of Limitations defense and its claims regarding cumulative trauma and apportionment. SCIF's contentions regarding Dr. Scheinberg's reports, the lumbar spine injury, cumulative trauma, statute of limitations, PDRS application, and apportionment were all denied.

WCABSCIFAMELabor Code section 4628Statute of LimitationsWCAB Rule 104581997 PDRSpermanent disabilityapportionmentcumulative trauma
References
Case No. ADJ7291550
Regular
May 05, 2015

TRAVIS BOYER vs. PAN PACIFIC PETROLEUM, NATIONAL UNION FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to reverse a prior award finding industrial injury. The WCAB held that the Qualified Medical Evaluator's (PQME) opinion was not substantial evidence as it lacked sufficient reasoning and was based on inconsistent applicant history. The Board concluded the applicant failed to meet the burden of proof to establish injury arising out of and in the course of employment. Therefore, the prior award was rescinded, and the applicant was found to have not sustained an industrial injury.

Workers' Compensation Appeals BoardPan Pacific PetroleumNational Union Fire Insurance CompanyTravis Boyerlumbar spinearising out of and in the course of employment (AOE/COE)statute of limitationsPanel Qualified Medical Evaluator (PQME)Dr. Khosrow Tabaddorsubstantial evidence
References
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