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

Case No. ADJ8008859
Regular
Nov 05, 2020

MADELINE CASACCA vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS and REHABILITATION, CTF SOLEDAD, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of a prior award. The Board found that the defendant failed to provide substantial evidence for apportionment of applicant's disability, as the QME's opinion lacked sufficient explanation of how non-industrial factors caused the disability. Additionally, the Board determined that the Labor Code section 4658(d)(3)(A) reduction in indemnity was inapplicable because the applicant had already returned to work in her regular position. Commissioner Lowe dissented, arguing that the QME's apportionment of 10% disability to non-industrial factors constituted substantial evidence.

Workers' Compensation Appeals BoardAdjudication NumberFindings and AwardPetition for ReconsiderationInjury AOE/COEPermanent Partial DisabilityLabor Code section 4658(d)(3)(A)Fifteen Percent ReductionOrthopedic Qualified Medical ExaminerApportionment
References
5
Case No. MISSING
Regular Panel Decision

In re Pinti

This case concerns an appeal from a decision by the Unemployment Insurance Appeal Board, which reversed a referee's decision and determined that emergency medical technicians (EMTs) working for an ambulance service employer were employees, not independent contractors, thus assessing the employer contributions. The central question for review was whether substantial evidence supported the board's conclusion regarding the employer-employee relationship. The court examined the record, noting factors such as EMTs' scheduling, payment structure, lack of business investment, and the employer's provision of liability and workers' compensation insurance. Despite some factors that could support a contrary finding, the court concluded that the board's determination was supported by substantial evidence. Consequently, the decision of the Unemployment Insurance Appeal Board was affirmed without costs.

Unemployment InsuranceEmployer-Employee RelationshipIndependent Contractor StatusEmergency Medical TechniciansSubstantial Evidence ReviewAppellate ReviewLabor Law ContributionsAmbulance Service IndustryWorkers' Compensation InsuranceBoard Decision Affirmation
References
5
Case No. MISSING
Regular Panel Decision

Pak v. Key Construction Management Corp.

This case concerns a stucco contractor, referred to as 'plaintiff', who suffered injuries after falling from an unsecured six-foot wooden ladder at a renovation job site. The plaintiff was attempting to cut wood that obstructed a window and was using a hand grinder when the ladder shifted and fell. The incident resulted in severe cuts to his left fingers and hand. The case proceeded against defendants Do Sang Kwon and Keum Ja Kwon under Labor Law § 240 (1). At trial, the jury found a violation of the Scaffold Law but concluded it was not a substantial factor in causing the plaintiff's injuries, leading to a judgment in favor of the defendants. The appellate court reversed this decision, holding that once a violation of Labor Law § 240 (1) and a fall directly resulting from an inadequate safety device are established, the violation is necessarily a substantial factor in causing the injury. The matter was remanded for a trial solely on the issue of damages.

Labor Law § 240(1)Scaffold LawWorkplace SafetyLadder AccidentDirected VerdictProximate CausationJury InterrogatoriesContributory NegligenceAppellate ReviewDamages Remand
References
20
Case No. ADJ2110739 (MON 0313927)
Regular
Oct 01, 2010

Rosalind Eskridge (Vallery) vs. TARGET STORES, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case returns to the trial level for a comprehensive re-analysis of applicant's permanent disability rating, specifically focusing on the Diminished Future Earning Capacity (DFEC) adjustment factor. The Board rescinded the prior award because the judge's decision did not fully adhere to the *Ogilvie* en banc decisions, which mandate a specific four-step analysis for rebutting the DFEC. The judge must now conduct a complete *Ogilvie* analysis, potentially developing the record further, to determine if the applicant's demonstrated earning loss and other relevant factors, including *Montana* factors, justify an individualized DFEC adjustment over the scheduled rating. The applicant bears the burden of proving that her evidence substantially overcomes the prima facie validity of the scheduled DFEC.

Workers' Compensation Appeals BoardDiminished Future Earning CapacityDFECPermanent Disability Rating Schedule2005 PDRSOgilvie analysisAgreed Medical ExaminerDisability Evaluation UnitDEUAgreed Medical Examiner
References
6
Case No. ADJ7200914
Regular
Jul 19, 2012

KENNETH WILLIAMS vs. THE BOEING COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend a previous award. The Board found that the applicant's primary treating physician's apportionment of 15% of the hip disability to non-industrial factors was based on substantial medical evidence, and should have been incorporated. This amendment reduced the applicant's permanent disability rating from 72% to 66%. The dissenting opinion argued that the physician's apportionment lacked sufficient detail to constitute substantial evidence.

Workers' Compensation Appeals BoardKenneth WilliamsThe Boeing Companyaircraft mechaniccumulative injurypermanent disabilityapportionmentPhilip A. SobolM.D.orthopedist
References
2
Case No. ADJ7056105
Regular
Jan 10, 2014

VIRGINIA VALDES vs. LOUIS VUITTON US MANUFACTURING, TRAVELERS PROPERTY CASUALTY COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision, rescinding the administrative law judge's finding of 69% permanent disability and no apportionment. The Board found the treating physician's disability analysis substantial evidence but his apportionment opinion and a consulting physician's report lacked substantiality. The case was returned to the judge for re-rating, applying apportionment as opined by defense medical examiners and a new rating for the applicant's internal conditions, considering pre-existing factors.

Almaraz-GuzmanSB 899ApportionmentCausationPermanent DisabilityWhole Person ImpairmentTreating PhysicianQualified Medical ExaminerFindings of FactAward & Order
References
5
Case No. ADJ10332854
Regular
Jun 19, 2017

RALPH SWASEY vs. EL DORADO UNION HIGH SCHOOL DISTRICT

This case involves a worker's compensation claim for industrial injury to the left elbow and shoulder. The Appeals Board granted reconsideration, affirming the chosen occupational group but increasing the permanent disability award from 21% to 23%. This increase occurred because the Qualified Medical Evaluator's apportionment of 10% to non-industrial factors was not supported by substantial medical evidence. Specifically, the doctor's reasoning for attributing disability to diabetes and arthritis was conclusory and did not adequately explain how these factors contributed to permanent disability rather than just healing time.

Petition for ReconsiderationOccupational Group Number 390ApportionmentMedical TreatmentPermanent DisabilityQualified Medical EvaluatorSubstantial Medical EvidenceLabor Code 4663Labor Code 4664Industrial Injury
References
4
Case No. ADJ8701916
Regular
Jan 30, 2015

CHRISTOPHER RICE vs. CITY OF JACKSON, Permissibly Self-Insured, Adjusted by YORK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration to review the administrative law judge's apportionment of the applicant's permanent disability. The applicant, a police officer injured on the job, argued that the Qualified Medical Evaluator's apportionment to genetic factors was not supported by substantial evidence. The Board agreed, finding that apportionment to immutable genetic factors was impermissible and that the QME's opinion lacked sufficient reasoning on the specific causation of the disability. Consequently, the Board amended the decision to defer the issue of permanent disability and returned the matter for an unapportioned award.

Workers' Compensation Appeals BoardChristopher RiceCity of JacksonYork Services GroupCumulative traumaNeck injuryPolice officerPermanent disabilityApportionmentPanel Qualified Medical Evaluator (QME)
References
0
Case No. ADJ1224504 (MON 0254221)
Regular
Jun 30, 2010

ALEX JOHNSON vs. CITY OF LOS ANGELES, Permissibly Self-Insured

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the trial judge's finding of no apportionment for the applicant's knee disability. The WCAB rescinded the prior decision and returned the case for further proceedings and a new decision. This was based on the deposition testimony of the Agreed Medical Evaluator (AME), Dr. Sohn, which provided substantial medical evidence for apportionment. Dr. Sohn's opinion addressed the increase in disability due to industrial factors versus non-industrial factors such as weight and the natural progression of arthritis, consistent with apportionment statutes.

ApportionmentAgreed Medical Evaluator (AME)Permanent DisabilityReconsiderationFindings and AwardWCJSubstantial Medical EvidenceContinuous TraumaReopenCourt of Appeal
References
1
Case No. ADJ6886026
Regular
Aug 14, 2012

DOUG LENTZ vs. HENRY MECHANICAL, LINCOLN GENERAL INSURANCE

The Workers' Compensation Appeals Board granted reconsideration for both the applicant and defendant, remanding the case for further proceedings. The Board found that the vocational expert's testimony regarding 100% permanent disability was not substantial evidence due to its failure to account for apportionment of non-industrial factors. Conversely, the Board found the psychiatric QME's opinion to be substantial, properly addressing non-industrial causes. The case is returned to the trial level to address the applicant's due process objection to rating instructions and to reconsider permanent disability, apportionment, and attorney fees.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityApportionmentQualified Medical ExaminerIndustrial InjuryVocational ExpertDue ProcessDiscoveryMedical Treatment
References
3
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