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

Case No. ADJ1128865 (VNO 0244369), ADJ1909887 (VNO 0181430)
Regular
Jan 09, 2012

JOE NAVARRO vs. LOCKHEED MARTIN

The Workers' Compensation Appeals Board denied reconsideration of a decision regarding Joe Navarro's claims against Lockheed Martin. The Board adopted the Workers' Compensation Administrative Law Judge's report, which found Navarro to be an unreliable historian with significant symptom magnification. Consequently, the Board denied injury claims for heart and high blood pressure, and upheld a 27% permanent disability award for a psyche injury, based on the judge's credibility findings.

ADJ1128865ADJ1909887plastic parts fabricatorplastic parts fabricator supervisorcontinuous traumapsyche injurypermanent disabilitynon-industrial apportionmentcredible historiansymptom magnification
References
Case No. ADJ8383795
Regular
Jan 26, 2015

KEN LETT vs. EXPRESS EMPLOYMENT PROFESSIONALS; INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, Administered By SEDGWICH CLAIMS MANAGEMENT SERVICES

This case involves a defendant seeking reconsideration of an award finding the applicant sustained an industrial injury to his back, legs, and thigh. The majority of the Workers' Compensation Appeals Board (WCAB) denied reconsideration, upholding the WCJ's credibility finding of the applicant and the medical opinions supporting the injury. However, a dissenting commissioner argued the applicant's inconsistent testimony and failure to disclose prior back issues undermined his claim. The dissenting opinion asserted the applicant did not meet his burden of proving the injury arose out of and in the course of employment, citing medical evidence suggesting aggravation of a pre-existing condition and symptom magnification.

Petition for ReconsiderationIndustrial InjuryLow Back InjuryLeg InjuryThigh InjuryEmployment CausationCredibility DeterminationQualified Medical EvaluatorAggravation of Preexisting ConditionApportionment
References
Case No. ADJ237483
Regular
Nov 13, 2012

RAYEK J. FAHOUM vs. KAISER FOUNDATION HOSPITAL

The Workers' Compensation Appeals Board denied Rayek J. Fahoum's petition for reconsideration, upholding the findings of the Workers' Compensation Judge. The Judge's report found Fahoum sustained industrial injury to his neck and low back with secondary chronic pain syndrome, awarding 41% permanent disability. This decision relied on the opinions of the Agreed Medical Examiner and Dr. Renee Rinaldi, who concluded Fahoum experienced symptom magnification and that his condition was chronic pain syndrome, not fibromyalgia as claimed by Dr. Allen Salick. The Board extended great weight to the Judge's credibility findings regarding the medical opinions.

Workers' Compensation Appeals BoardReconsideration DeniedAgreed Medical ExaminerSubstantial Medical EvidenceFibromyalgiaChronic Pain SyndromeSymptom MagnificationOrthopedic InjuryLumbosacral StrainCervical Strain
References
Case No. ADJ3167944
Regular
Mar 21, 2011

NEFTALY HEREDIA vs. UNION TRANSPORTATION, INC., SEDGWICK CIAGA GLENDALE

This case involves a claim for workers' compensation benefits for a psychiatric injury allegedly sustained on June 18, 2001. The primary issue is whether the applicant's injury meets the "sudden and extraordinary employment condition" exception to the six-month employment requirement for psychiatric claims under Labor Code section 3208.3(d). The Appeals Board granted reconsideration, rescinded the previous award, and returned the matter for further proceedings. The Board found the Workers' Compensation Judge applied an incorrect "taint of fraud" standard and needs to re-evaluate whether the incident was truly uncommon, unusual, and unexpected. Furthermore, the Board directed the Judge to address issues of symptom magnification and malingering raised by the psychiatric reports.

Sudden and extraordinary employment conditionLabor Code section 3208.3(d)psychiatric injuryQualified Medical Evaluator (QME)symptom magnificationmalingeringpreponderance of the evidenceindustrial injuryamended findings and awardreconsideration
References
Case No. STK 166227
Regular
Jan 25, 2008

Celestino Aguilar-Maldonado vs. GALLO WINERY, Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of the finding that he did not sustain new and further psychological disability. The Board found that substantial evidence, including expert opinions from Drs. Mendel and Panzarella, did not support a finding of compensable psychiatric injury, noting significant exaggeration of symptoms by the applicant. Furthermore, the Board concluded that any psychological issues predated the original stipulated award and thus did not constitute "new and further" disability.

Workers' Compensation Appeals BoardNew and Further DisabilityPsyche InjuryBack InjuryStipulations with Request for AwardPetition to ReopenQualified Medical Examiner (QME)Symptom MagnificationMalingeringPredominant Cause
References
Case No. ADJ2434971 (OAK 0238163)
Regular
Dec 02, 2010

ANA RODRIGUEZ vs. SHERATON PALACE HOTEL, TOKIO MARINE

The Workers' Compensation Appeals Board denied reconsideration of a finding that the applicant, Ana Rodriguez, did not sustain new and further permanent disability subsequent to a 1997 stipulated award. The judge found her testimony regarding increased orthopedic and psychiatric symptoms to be not credible. Medical evidence from Dr. Edington indicated no orthopedic increase in disability since the award, and the psychiatric disability became permanent and stationary concurrently with the orthopedic condition. Therefore, the judge concluded there was no "new and further" disability as defined by Labor Code Section 5410.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedCredibility FindingGarza v. Workers' Comp. Appeals Bd.Stipulated AwardPetition to ReopenNew and Further DisabilityOrthopedic DisabilityPsychiatric Disability
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ9374444
Regular
Sep 14, 2015

JOSE LIZAMA vs. NEAL TRUCKING, INC.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board affirmed the finding that the applicant sustained a back injury arising out of and in the course of employment, deferring the extent of injury. This decision was based on the finding that the defendant's relied-upon Qualified Medical Evaluator's report lacked substantial medical evidence due to an incomplete history and contradictory conclusions. The Board adopted the WCJ's report, finding the applicant's testimony credible regarding the injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Facttruck driverback injuryarising out of and in the course of employmentPanel Qualified Medical Evaluatorsubstantial medical evidencereasonable medical probabilityaccurate history
References
Case No. ADJ2552674 (STK 0182074), ADJ2434993 (LAO 0814353), ADJ815249 (STK 0199201)
Regular
Jan 24, 2012

CARLOS GASCA vs. HOWARD MARTIN FARMS, CIGA through its servicing facility INTERCARE INSURANCE for PAULA INSURANCE, in liquidation, CALIFORNIA INDEMNITY

The Workers' Compensation Appeals Board rescinded the prior award and remanded the case for further proceedings. The Board found that Dr. Abelow's medical opinion lacked substantial evidence due to factual inaccuracies and assumptions, particularly regarding the applicant's injury causation and apportionment. Additionally, Dr. Kimmel's psychiatric opinion failed to meet legal causation standards, deferring to orthopedic findings. The lien claimant's contentions will be reviewed anew by the WCJ upon remand.

Workers' Compensation Appeals BoardCarlos GascaHoward Martin FarmsCIGAIntercare InsurancePaula InsuranceCalifornia IndemnityJoint Findings and AwardAdministrative Law JudgeReconsideration
References
Case No. ADJ402883 (AHM 0141473)
Regular
May 20, 2013

MARIA GLOTZBACH vs. LOS ANGELES COUNTY METROPOLITAN TRANSIT AUTHORITY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant alleged fraud, claiming an agreed medical examiner was bribed and that she did not receive formal ratings properly. The Board adopted the WCJ's report, which found no evidence of bribery and that service of documents was proper. The WCJ's report detailed the extensive medical evaluations and the applicant's unsubstantiated claims of fraud and improper service.

GlotzbachLos Angeles County Metropolitan Transit AuthorityPermissibly Self-InsuredPetition for ReconsiderationWorkers' Compensation Appeals BoardWCJ ReportService of ProcessBus OperatorAgreed Medical ExaminerAME
References
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