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

Case No. ADJ8734628 ADJ9086734
Regular
Aug 12, 2016

PATRICIA CRUZ MALDONADO vs. WHITE MEMORIAL MEDICAL CENTER, ADVENTIST HEALTH

This case involves White Memorial Medical Center's petition for reconsideration of a Joint Findings and Award finding that applicant Patricia Cruz Maldonado sustained lumbar spine injuries arising out of and occurring in the course of employment as a registered nurse. The defendant argued the findings were erroneous due to alleged inconsistencies in applicant's testimony and a lack of substantial medical evidence for a cumulative injury. The Workers' Compensation Appeals Board denied the petition, upholding the Administrative Law Judge's credibility determinations and finding substantial medical evidence, specifically from Dr. Edwin Haronian, supporting the cumulative trauma injury. The Board emphasized that the WCJ observed the witness and considered all admitted evidence, and that deposition testimony not offered into evidence could not be relied upon.

WCABPetition for ReconsiderationJoint Findings and AwardWCJcredibility determinationsubstantial medical evidencecumulative traumalumbar spineregistered nurseprimary treating physician
References
5
Case No. ADJ7948355
Regular
May 12, 2015

Sara Thomas vs. West Anaheim Medical Center, Hartford Accident Indemnity Company, Corvel, Stanbridge College, Farmers Insurance Exchange

This case denies Sara Thomas's petition for reconsideration of a prior ruling. The Appeals Board found that Thomas failed to meet her burden of proof to establish an industrial injury to her back. Despite her testimony about a specific mechanism of injury, the medical evidence did not support this causation. The Board also rejected her argument that the record should have been further developed, noting she had ample time to obtain supportive medical evidence.

Workers' Compensation Appeals BoardSara ThomasWest Anaheim Medical CenterHartford Accident Indemnity CompanyCorvelStanbridge CollegeFarmers Insurance ExchangeADJ7948355Petition for ReconsiderationIndustrial Injury
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The claimant appealed a Workers' Compensation Board decision that rescinded her reduced earnings awards, contending that there was sufficient medical evidence of a continuing causally related disability.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
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
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. ADJ7452091
Regular
Aug 14, 2013

JULIA PLEASANT vs. PACIFIC ALLIANCE MEDICAL CENTER, SAFETY NATIONAL CASUALTY CORPORATION

The Workers' Compensation Appeals Board denied Pacific Alliance Medical Center's petition for reconsideration. The Board adopted the findings of the Administrative Law Judge (WCJ), who found the applicant credible and her injuries supported by substantial medical evidence. The WCJ determined the applicant's psychiatric injury stemmed from cumulative trauma, not personnel actions. The defendants failed to present sufficient contrary evidence to overturn the original findings and award.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedWCJGarza v. Workmen's Comp. Appeals Bd.Agreed Medical ExaminerOrthopedicsPsychiatryApportionmentCumulative Trauma
References
1
Case No. MISSING
Regular Panel Decision

Palmer v. State University of New York Upstate Medical University

The claimant, an orthopedic hand surgeon, developed cervical radiculopathy and degenerative disc disease due to the physical strain of performing hand surgery and filed for workers' compensation benefits. His claim was controverted by the State University of New York Upstate Medical University and its carrier, as well as the Research Foundation of New York and its carrier. The Workers' Compensation Board determined that the claimant was a dual employee of both the University and the Foundation and that his condition constituted a causally related occupational disease. The University and its carrier appealed this decision. The appellate court affirmed the Board's findings, concluding there was substantial evidence to support both the dual employment status and the existence of a recognizable link between the claimant's condition and the distinctive features of his occupation.

Occupational DiseaseCervical RadiculopathyDegenerative Disc DiseaseDual EmploymentWorkers' Compensation BenefitsHand Surgery StrainMedical OpinionAppellate ReviewCausationEmployer Liability
References
8
Case No. ADJ1850137
Regular
Aug 14, 2012

CARMEN GARCIA vs. MISSION HOSPITAL REGIONAL MEDICAL CENTER, SEDGWICK CMS

Here's a summary of the case for a lawyer, in four sentences: The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration, upholding the judge's decision that found no permanent disability. The applicant argued the judge improperly relied on Dr. Cook's medical reports, which she claimed lacked substantial evidence and admissibility. However, the Board adopted the judge's report, emphasizing the weight given to credibility findings and noting that Dr. Cook's reports were supported by other physicians' findings and subrosa video evidence. This video demonstrably challenged the applicant's claims of limitations, contradicting her testimony about needing wrist supports for routine activities.

Workers' Compensation Appeals BoardMission Hospital Regional Medical CenterSedgwick CMSReconsiderationLabor Code section 5313Smales v. Workers' Comp. Appeals Bd.Garza v. Workmen's Comp. Appeals Bd.CredibilitySupplemental PetitionSummary of Evidence
References
2
Case No. ANA 0393414
Regular
May 27, 2008

REBECCA CHRISTENSEN vs. NEWPORT-MESA UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award because the medical evidence was insufficient to support the 45% permanent disability rating. The Board found that the judge's reliance on combining subjective pain complaints with objective findings, without proper medical expert guidance, and the rating specialist's application of instructions were not supported by substantial medical evidence. The case is returned to the trial level for further development of the medical record.

Workers' Compensation Appeals BoardSpecial Education Bus DriverIndustrial InjuryRight ShoulderRight ArmPermanent Disability RatingAMA GuidesRotator Cuff RepairArthroplastyMumford Procedure
References
4
Case No. MISSING
Regular Panel Decision

Claim of Martone v. Niagara Frontier Transportation Authority-Metro

In 2005 and 2007, a bus driver (claimant) suffered work-related neck and back injuries. Initially, a Workers’ Compensation Law Judge found him permanently totally disabled. However, the Workers’ Compensation Board modified this, determining he had a permanent partial disability with a 75% loss of wage-earning capacity based on medical evidence and other factors. The claimant appealed this decision, arguing a lack of substantial evidence for the partial disability finding. The Appellate Division affirmed the Board's decision, noting medical reports indicating submaximal efforts, high medication dosages, symptom magnification, and the ability to ambulate, which supported the finding of partial disability. The court also upheld the 75% loss of wage-earning capacity, finding it supported by substantial evidence after considering the claimant's impairment, work restrictions, age, education, and work experience.

Permanent Partial DisabilityWage-Earning CapacityChronic Pain SyndromeLumbar Spine SurgeryMedical EvidenceSubmaximal EffortsSymptom MagnificationAppellate ReviewBoard DecisionMedical Treatment Guidelines
References
2
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