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

Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
Case No. ADJ10870145, ADJ8277957
Regular
Jan 30, 2023

CARLOS LOPEZ vs. PORTERVILLE SHELTERED WORKSHOP, MANUFACTURERS ALLIANCE INSURANCE COMPANY, AMERICAN CLAIMS MGMT., TREE & SIERRA MGMT., SIERRA MGMT., CIGA, INTERCARE HOLDINGS, ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant sustained cumulative trauma injury while employed by both Sierra Management and Porterville Sheltered Workshop. This decision was based on the WCJ adopting the opinion of Dr. Bernhard, which was found to be substantial evidence despite conflicting medical opinions. The Board affirmed that a single physician's considered opinion can suffice as substantial evidence, even if it contradicts other medical findings. The Petitioner's arguments regarding the WCJ's reasoning and conflicting medical opinions were rejected.

ADJ10870145ADJ8277957Petition for ReconsiderationWorkers' Compensation Appeals BoardWCJ Report and Opinionsubstantial evidencephysician opinioncumulative injuryCIGAManufacturers Alliance Insurance Company
References
2
Case No. ADJ9709726
Regular
Jun 25, 2015

LAURA NUNEZ vs. SUTTER PACIFIC MEDICAL FOUNDATION, SUTTER HEALTH

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the finding of industrial injury AOE/COE for thoracic outlet syndrome, arguing it wasn't an issue for trial and the medical evidence was insufficient. The Board found that thoracic spine injury was an issue and that Dr. Avery's opinion provided substantial medical evidence to support the thoracic outlet syndrome finding. Any potential defects in the original WCJ opinion were cured by the WCJ's subsequent report.

Thoracic outlet syndromeAOE/COEPetition for Reconsiderationsubstantial medical evidenceG. James Avery M.D.Steven Bratman M.D.industrial injuryapportionmentWCJlabor code 5313
References
1
Case No. ADJ8657415
Regular
Oct 06, 2017

Oliver Boutte IV (Deceased) vs. U.S. XPRESS ENTERPRISES, LIBERTY MUTUAL INSURANCE COMPANY

This Workers' Compensation Appeals Board case involved a petition for reconsideration filed by U.S. Xpress Enterprises and Liberty Mutual Insurance Company. The defendants argued that the medical report relied upon by the Workers' Compensation Judge (WCJ) was not substantial evidence, specifically regarding the timing of the employee's death from a pulmonary embolus. The Board denied the petition, adopting the WCJ's report which found the physician's opinion to be substantial medical evidence based on adequate examination and reasoning. The Board concluded the WCJ properly found this opinion more persuasive than the opposing medical opinion.

Oliver Boutte IVU.S. Xpress EnterprisesLiberty Mutual Insurance CompanyADJ8657415Petition for ReconsiderationWorkers' Compensation Appeals Boardsubstantial evidencemedical opinionpulmonary embolusreasonable medical probability
References
3
Case No. ADJ9539091
Regular
Sep 23, 2016

MARY RAMSGARD vs. PACIFIC VINEYARD COMPANY, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board denied reconsideration, affirming the WCJ's finding that applicant's L3-4 back injury was not industrially caused, based on Dr. Sharma's opinion. Dr. Sharma's opinion was found to be substantial evidence, utilizing the correct legal standard of reasonable medical probability and supported by the applicant's pre-existing back issues. The Board also upheld the 20% apportionment of permanent disability to non-industrial causes, finding it supported by credible evidence, including prior medical reports and applicant's inconsistent testimony. Applicant's petition failed as her contentions regarding the medical opinion's legal theory and factual basis were not substantiated.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeApplicantDefendantPacific Vineyard CompanyInsurance Company of the WestPermanent DisabilityApportionment
References
10
Case No. ADJ869205 (SAC 0294976) ADJ302322 (SAC 0354178)
Regular
Oct 11, 2010

Patricia Rush vs. The Permanente Medical Group; Athens Administrators Concord

This case involves Patricia Rush claiming cumulative trauma injuries to her knees and back, among other body parts, against The Permanente Medical Group. The Workers' Compensation Appeals Board granted reconsideration because the Administrative Law Judge's findings of industrial causation for knee injuries lacked substantial medical evidence, with conflicting and uncertain Qualified Medical Evaluator opinions. The Board rescinded the prior findings and ordered further development of the medical record, suggesting an Agreed Medical Examiner or a court-appointed physician to resolve the causation issue for the knee injuries. The matter is returned to the trial level for a new final determination after the record is further developed on all issues, including injury causation.

Workers' Compensation Appeals BoardPermanente Medical GroupAthens Administratorscumulative trauma injurykneesbackshouldershandswristsindustrial causation
References
0
Case No. ADJ2270634 (VNO 0521616)
Regular
Aug 03, 2018

SHEVON THOMAS vs. POMONA VALLEY HOSPITAL MEDICAL CENTER, Administered by ADMINSURE, INC., SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns an applicant seeking benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF) following a 2005 industrial injury that resulted in a 69% permanent disability and a substantial settlement. The applicant's claim for SIBTF benefits was denied because she failed to establish a prior "labor disabling" permanent disability that existed before the 2005 injury. The Appeals Board upheld the denial, finding that the applicant's evidence of prior symptoms, including a doctor's speculative impairment ratings, lacked substantial medical evidence and did not meet the strict requirements for establishing a pre-existing, labor-disabling condition. The Board emphasized that post-injury medical opinions, especially those based on hypotheticals and inadequate history, cannot retroactively establish a prior disability for SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFlabor disablingpermanent partial disabilityLabor Code section 4751SB 899apportionmentpreexisting disabilityAMA Guides impairment ratingsretrospective prophylactic work restrictions
References
8
Case No. ADJ79 96674
Regular
Mar 24, 2016

ARLZENIA HASLEY vs. EL CENTRO REGIONAL MEDICAL CENTER

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Removal, which sought to invalidate the medical evidence of the Agreed Medical Examiner (AME), Dr. Luros. The WCAB found that removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. The defendant's arguments regarding flawed medical opinions and the AME's unavailability can be addressed through standard appeal procedures. Furthermore, the defendant filed a supplemental pleading without prior permission, which was disregarded by the Board.

Petition for RemovalArlzenia HasleyEl Centro Regional Medical CenterTriStar Risk ManagementWCABWCJsubstantial prejudiceirreparable harmreconsiderationsupplemental pleading
References
2
Case No. ADJ3625445 (AHM 0123968)
Regular
Mar 01, 2010

DAVID ROMAN vs. REGENTS, UNIVERSITY OF CALIFORNIA, Permissibly Self-Insured, Adjusted By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn a finding of 5% permanent disability after apportionment for a neck injury, arguing the medical examiner's opinion was not substantial evidence and that treatment couldn't be apportioned. The Board found the administrative law judge's reliance on the medical examiner's opinion, which attributed the worsening condition to pre-existing degenerative arthritis, was supported by substantial evidence. The Board also clarified that further medical treatment was awarded, but surgery specifically would be considered non-industrial due to the apportionment finding.

Workers Compensation Appeals BoardPermanent DisabilityApportionmentQualified Medical ExaminerSubstantial EvidenceIndustrial InjuryNeck InjuryReconsiderationWCJMMI
References
9
Case No. ADJ3803076
Regular
Mar 01, 2018

REBECCA MUNAR vs. POMONA UNIFIED SCHOOL DISTRICT, CORVEL CORPORATION

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board adopted the Administrative Law Judge's report, which found that the applicant sustained a continuous trauma injury to her bilateral knees. This finding was supported by substantial medical evidence, specifically the opinion of Dr. Akmakjian, which the Board found persuasive. The Board reiterated that one physician's opinion can constitute substantial evidence, even if it conflicts with other medical opinions.

Workers' Compensation Appeals BoardPetition for Reconsiderationsubstantial evidencephysician opinionindustrial injurybilateral kneesleft hipcontinuous traumaslip and fallspecific injury
References
1
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