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

Case No. ADJ1448881 (VNO 0460995), ADJ1459734 (VNO 0385398)
Regular
Jan 19, 2011

CLEMENTE MEJIA vs. PACIFIC MAT, INC., STATE COMPENSATION INSURANCE FUND, CIGA for FREMONT

The Appeals Board admitted Dr. Capen's November 10, 2009 report into evidence and affirmed the WCJ's Amended Joint Findings and Award. SCIF's petition for reconsideration primarily argued that Dr. Capen's report was not substantial evidence for apportionment, but the Board found SCIF waived this argument by not raising it explicitly. The majority concluded Dr. Capen's November 10, 2009 report provided substantial evidence for apportionment, affirming the WCJ's findings. One Commissioner dissented, finding the report was not substantial evidence and that further development of the record was needed.

Workers' Compensation Appeals BoardAmended Joint Findings and AwardWCJindustrial injurypermanent disabilityapportionmentState Compensation Insurance Fund (SCIF)CIGAliquidationCambridge
References
6
Case No. MISSING
Regular Panel Decision

Feliciano v. Colvin

Plaintiff Carmen Feliciano sought judicial review of a final decision by the Commissioner of Social Security denying her application for Supplemental Security Income. Both the plaintiff and defendant moved for judgment on the pleadings. The court examined whether the Commissioner's decision, which concluded the plaintiff was not disabled under the Social Security Act, was supported by substantial evidence. The court considered new evidence submitted to the Appeals Council, including a report from the plaintiff's treating physician, but found it inconsistent with other substantial evidence, such as reports from three consulting physicians. Ultimately, the court concluded that the Administrative Law Judge's decision was supported by substantial evidence. Consequently, the defendant's motion for judgment on the pleadings was granted, and the plaintiff's cross-motion was denied, leading to a final judgment for the defendant.

Social SecuritySupplemental Security IncomeDisability BenefitsJudicial ReviewAdministrative Law JudgeAppeals CouncilResidual Functional CapacityLight WorkSubstantial EvidenceTreating Physician Rule
References
13
Case No. ADJ13220426
Regular
Mar 10, 2023

MARICELA RODRIGUEZ vs. SOFT GEL TECHNOLOGIES, INC., CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES, INC.

The Workers' Compensation Appeals Board denied reconsideration of an amended findings and award, upholding the Workers' Compensation Judge's (WCJ) decision. The Board deferred to the WCJ's credibility determinations, finding no substantial evidence to overturn them. The WCJ's report, which was adopted by the Board, concluded that the applicant's arguments regarding the substantiality of medical evidence and claims for additional body parts were not raised at trial. The Board also affirmed that a single physician's opinion can constitute substantial evidence, even if it conflicts with other medical opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationsubstantial medical evidencephysician's opinionbilateral wristscarpal tunnel syndromeneck injuryback injuryupper extremity injury
References
2
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
5
Case No. ADJ16048168
Regular
Feb 13, 2023

OMAR A. ATILANO vs. BURKETT'S POOL PLASTERING, INC., CALIFORNIA CONTRACTORS NETWORK, AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board denied a petition for reconsideration, upholding the original decision. The Board gave great weight to the Workers' Compensation Judge's credibility determination, finding no substantial evidence to warrant overturning it. The judge's report addressed the defendant's arguments that the Qualified Medical Evaluator's (QME) opinion lacked substantial evidence, finding consistency in the injury history and that the QME's report was indeed substantial evidence. The Board also concluded that a prior work release was not material to the temporary disability awarded from a later date, affirming the original award.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationGarza v. Workmen's Comp. Appeals Bd.PQME Sclafanitemporary disabilityExpedited Findings of FactOrdersand Awardsubstantial evidence
References
3
Case No. ADJ7264915
Regular
Jul 15, 2013

ANA GONZALES vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

This case involves an applicant who sustained industrial psychiatric injury but whose orthopedic claims were denied due to insufficient medical evidence. The Appeals Board denied the applicant's petition for reconsideration, finding the applicant failed to present substantial medical evidence of industrial causation for her orthopedic complaints. A dissenting commissioner argued that the primary medical evaluator's report was deficient and lacked substantial evidence, warranting further development of the record on orthopedic injuries and other claims. The dissent emphasizes the Board's duty to ensure substantial justice, suggesting it should have ordered further investigation on the denied orthopedic issues.

WCABPetition for ReconsiderationFindings and Orderindustrial injurypsychelow backneckright shoulderright wristright elbow
References
11
Case No. MISSING
Regular Panel Decision
Apr 14, 2017

Smith v. Berryhill

Ritchie Smith sought judicial review of the Commissioner of the Social Security Administration's decision denying him disability benefits, arguing the decision used incorrect legal standards and lacked substantial evidence regarding his ability to perform substantial gainful activity. The court examined extensive medical evidence from numerous physicians and Smith's own testimony concerning his physical and mental impairments. The hearing officer previously determined that despite severe impairments, Smith retained the residual functional capacity to perform sedentary work. The court affirmed the Commissioner's decision, concluding that the hearing officer applied the correct legal standards, and the findings, including the assessment of Smith's credibility and daily activities, were supported by substantial evidence in the record.

Disability Benefits AppealSocial Security Disability InsuranceSupplemental Security IncomeResidual Functional CapacityMedical OpinionsTreating Physician RuleClaimant CredibilitySedentary Work CapacityPhysical ImpairmentsMental Health Impairments
References
11
Case No. MISSING
Regular Panel Decision

Diaz v. Secretary of the Department of Health & Human Services

The plaintiff sought judicial review of a final determination by the Secretary of Health and Human Services, which had denied her claim for disability insurance benefits under the Social Security Act. The District Court addressed the plaintiff's arguments that the Administrative Law Judge (ALJ) failed to properly weigh the opinion of her treating chiropractor, Dr. Sadigh, and that the determination lacked substantial supporting evidence. Citing circuit precedent, the court affirmed that a treating chiropractor's opinion on disability diagnosis and impairment should be binding unless contradicted by substantial evidence. After a thorough review of various medical reports, the court concluded that the evidence presented did not substantially contradict Dr. Sadigh's consistent findings of the plaintiff's total disability. Consequently, the court granted the plaintiff's motion for judgment on the pleadings and remanded the case for the calculation of benefits.

Disability Insurance BenefitsSocial Security ActTreating Physician RuleChiropractor Opinion WeightSubstantial Evidence ReviewFederal Rule of Civil Procedure 12(c)Administrative Law Judge (ALJ)Medical ReportsLumbar RadiculopathyCervical Disc Syndrome
References
7
Case No. ADJ10620323
Regular
May 14, 2019

EDWARD ZOZOSKY vs. INTERSTATE DISTRIBUTOR CO.; XL INSURANCE COMPANY, Administered by SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board affirmed a finding that Edward Zozosky sustained a right shoulder injury arising out of and in the course of employment, despite conflicting evidence regarding a forceful braking event. The Board found that medical reports from Dr. Kupfer and Dr. Zardouz constituted substantial evidence supporting the injury AOE/COE. While the defendant presented testimony and evidence questioning the mechanics of the alleged forceful stop, the Board gave deference to the administrative law judge's credibility determination of the applicant. However, one Commissioner dissented, arguing that the applicant failed to present substantial evidence of an industrial injury, emphasizing the lack of corroborating medical history and applicant's credibility issues.

AOE/COEhard braking eventOnGuard systemABS brakesrotator cuff capsule sprainindustrial aggravationQMEmedical opinioncredibility determinationsubstantial evidence
References
0
Case No. MISSING
Regular Panel Decision
May 20, 2010

Claim of Cary v. Salem Central School District

The claimant appealed a Workers' Compensation Board decision that rescinded her reduced earnings awards, contending that there was sufficient medical evidence of a continuing causally related disability. The WCLJ had initially awarded reduced earnings and classified the claimant as permanently partially disabled due to a 2003 accident, but the Board later found insufficient medical evidence and rescinded the awards. The appellate court reversed the Board's decision, concluding that substantial evidence, including numerous reports from treating physicians and the carrier's own medical expert, supported a continuing disability. The court ruled that gaps in the submission of medical reports alone did not constitute substantial evidence to support the recision of the reduced earnings awards, and remitted the matter for further proceedings.

Reduced Earnings AwardsMedical Evidence SufficiencyContinuing DisabilityTreating Physician ReportsWorkers' Compensation LawAppellate DivisionBoard Decision ReversalPermanent Partial DisabilityCausally Related DisabilityMedical Report Gaps
References
1
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