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

Case No. ADJ8121071
Regular
Aug 19, 2016

BINH NGUYEN vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board granted reconsideration, affirming the award of temporary total disability benefits. However, the Board amended the decision regarding permanent disability apportionment. The Board found Dr. Halbridge's opinion of 20% non-industrial apportionment for pre-existing cervical spondylosis to be substantial evidence. Consequently, the applicant's permanent disability was reduced to 13%, reflecting this apportionment.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings and AwardTemporary Total DisabilityPermanent DisabilityApportionmentQualified Medical Evaluator (PQME)Dr. Neil J. Halbridgeorthopedic surgerycumulative trauma
References
Case No. ADJ15875626
Regular
Jun 30, 2025

Evyette Gaines vs. Riverside University Health System

Defendant sought reconsideration of the April 11, 2025 Findings, Award, and Orders (FA&O), where the WCJ found the reporting of PQME, Dr. Albert Simpkins, to be substantial medical evidence, with the exception of apportionment. Applicant, Evyette Gaines, was found to have sustained injury AOE/COE to the cervical spine, lumbar spine, and psyche, resulting in 38% permanent disability. Defendant contended that Dr. Simpkins' apportionment findings constituted substantial medical evidence and that the WCJ misapplied legal precedents. After considering the petition and the WCJ's report, the Appeals Board denied the Petition for Reconsideration.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrdersQualified Medical EvaluatorPQMEAlbert SimpkinsApportionmentSubstantial Medical EvidenceAOE/COECervical Spine
References
Case No. ADJ700838 (SRO 0096054) ADJ414827 (SRO 0096056) ADJ178893 (SRO 0096055)
Regular
Mar 21, 2019

Margaret Knapp vs. Department of Social Services, In-Home Supportive Services, York Risk Services Group, Inc.

This case concerns a workers' compensation claimant seeking increased benefits for new and further permanent disability stemming from three prior back/spine injuries. The Appeals Board ultimately modified the original judge's award, finding the claimant's combined industrial disability after reopening is 52% after apportioning 30% to non-industrial factors. This results in a revised total permanent disability award of $47,982.50, with credit for prior payments. The Board also increased the attorney's fee to 15% of the new and additional benefits due to the complexity of the case.

SB 899apportionmentnew and further disabilitycumulative injurypermanent disabilitystipulated awardagreed medical evaluatorvocational rehabilitationmedical treatmentindustrial injury
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
Case No. ADJ4052373 (VNO 0479552) ADJ4287846 (VNO 0479554)
Regular

AURELIO BOBADILLA vs. HIGH DESERT DAIRY, STATE COMPENSATION INSURANCE FUND, SUBSEQUENT INJURIES BENEFIT TRUST FUND

Reconsideration granted; rescinding the Findings and Award of October 30, 2008, and the Order of November 12, 2008; matter returned to trial level for further development of the medical record.

Subsequent Injuries Benefit Trust Fundpermanent disabilityapportionmentindustrial injurypre-existing disabilitymedical evidencefurther developmentreconsiderationLabor Code Section 4751orthopedic surgeon
References
Case No. ADJ11406698
Regular
Feb 03, 2020

JOSE MORENO vs. GREEN VALLEY LABOR INC., STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the WCJ's finding that the applicant sustained a back injury arising out of and occurring in the course of employment. The Board found that the Qualified Medical Examiner's (QME) reports provided substantial evidence for injury AOE/COE based on the "reasonable probability" standard. However, the Board found the QME's apportionment opinion lacked the necessary reasoning and detail to be considered substantial evidence. Therefore, the WCJ's findings regarding AOE/COE and the lack of substantial evidence for apportionment were upheld.

AOE/COEPetition for ReconsiderationQualified Medical ExaminerQMECumulative traumaPermanent disabilityApportionmentSubstantial evidenceWorkers' Compensation Appeals BoardWCJ
References
Case No. SAL 103035
Regular
Jul 20, 2007

CARLOS CONTRERAS vs. NATURAL SELECTION FOODS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a decision apportioning 30% of the applicant's permanent disability to a pre-existing, non-industrial condition. The applicant's injury aggravated this DISH syndrome, and the Board found the Agreed Medical Examiner's opinion supporting apportionment constituted substantial evidence. The Board also rejected the applicant's argument that the judge improperly relied on an unadmitted report, as the relevant information was summarized within an admitted medical report.

DISH SyndromeDisseminated Idiopathic Skeletal HyperostosisspondylosisApportionmentSB 899Labor Code Section 4663Agreed Medical Examinerpermanent disabilitynon-industrial conditionaggravation
References
Case No. ADJ10920646
Regular
Jun 17, 2019

RICHARD CISNEROS vs. KENNERLEY SPRATLING INC., TWIN CITY FIRE INSURANCE COMPANY/THE HARTFORD

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding the applicant sustained a work-related low back and right shoulder injury on or about May 30, 2016, and that the claim was not time-barred. The defendant argued the date of injury was unsupported by evidence and the claim was past the statute of limitations. The Board rescinded the award, finding inconsistencies in the record regarding whether the injury was specific or cumulative and the applicant's knowledge of its work-relatedness. The case is returned to the WCJ for further proceedings, including potentially obtaining new medical evaluations to clarify the injury date and statute of limitations issues.

Workers' Compensation Appeals BoardRichard CisnerosKennerley Spratling Inc.Twin City Fire Insurance CompanyThe HartfordOpinion and Order Granting Petition for ReconsiderationDecision After ReconsiderationFindings and AwardAdministrative Law JudgeWCJ
References
Case No. RIV 42174
Regular
Jul 20, 2007

VICTOR LOPEZ vs. DOANE'S PET CARE, ROYAL SUNALLIANCE INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration to correct a clerical error regarding the temporary disability period. While affirming the finding of industrial injury to the back, leg, and psyche resulting in 86% permanent disability, the Board amended the temporary disability period to commence August 2, 2001, aligning it with the date of injury. The Board specifically noted they would not adopt the WCJ's comment regarding improper fax filing of the petition for reconsideration.

Victim LopezDoane's Pet CareRoyal Sunalliance Insurance Co.RIV 42174Petition for ReconsiderationFindings and Awardindustrial injurybackright legpsyche
References
Case No. ADJ12705097
Regular
Sep 21, 2022

FRED BROYLES vs. ATLAS VAN LINES, ARCH INSURANCE, GALLAGHER BASSETT SERVICES

In Broyles v. Atlas Van Lines, the WCAB denied the defendant's petition for reconsideration, affirming the finding of 29% permanent disability. The Administrative Law Judge and the Board found that the Qualified Medical Evaluator (QME) properly utilized the Almaraz/Guzman principles to deviate from a strict AMA Guides rating. The QME's analogy to a hernia condition was deemed substantial evidence for assessing the applicant's impairment due to limitations on lifting and its impact on daily living activities. The Board concluded the QME adequately explained the departure from the standard rating and provided sufficient reasoning for the alternative assessment.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 4660.1(d)scheduled ratingprima facie evidencerebuttableMilpitas Unified School Dist. v. Workers' Comp. Appeals Bd.Almaraz-Guzman IIIwhole person impairment (WPI)AMA Guides
References
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