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

Case No. ADJ10187704, ADJ10924724
Regular
May 17, 2018

STEVEN CASE vs. GOLDEN GATE BRIDGE HIGHWAY AND TRANSPORTATION DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to increase applicant's permanent disability rating for bilateral shoulder injury from 9% to 38%. The Board found the Agreed Medical Evaluator's (AME) alternative rating, based on strength loss, was substantial medical evidence and properly considered within the AMA Guides. The WCJ erred in applying an overly restrictive interpretation of "complex or extraordinary" cases for deviating from strict AMA Guides ratings. The AME's use of strength loss data from the AMA Guides, even for an age outside the specified range, was permissible under the *Almaraz-Guzman* line of cases when justified by clinical judgment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationAgreed Medical Evaluator (AME)permanent disability ratingbilateral shouldersorthopedic AMEAMA GuidesAlmaraz-Guzmanstrength loss index
References
20
Case No. ADJ3849676 (AHM 0147658) ADJ1948081 (AHM 0147721)
Regular
Feb 14, 2011

ROBERT LEON vs. RF DEVELOPMENT & BUSCH CORPORATION, LINCOLN GENERAL INSURANCE

In this workers' compensation case, the defendant sought reconsideration of a $37\%$ permanent disability award, arguing the physician's impairment rating improperly deviated from the AMA Guides. The Appeals Board granted reconsideration, finding the physician's justification for not strictly applying the Guides was insufficient and not based on substantial medical evidence. Specifically, the physician's reliance on subjective complaints and analogies to amputation were not adequately supported. The Board rescinded the award and remanded the case for a new rating strictly following the AMA Guides.

Workers' Compensation Appeals BoardRF Development & Busch CorporationLincoln General InsuranceAmerican Claims ManagementRobert LeonADJ3849676ADJ1948081ReconsiderationFindings and AwardIndustrial Injuries
References
2
Case No. ADJ9890148
Regular
Feb 02, 2017

Timothy Bedford vs. CITY OF LOS ANGELES

This Workers' Compensation Appeals Board case denies reconsideration of a permanent disability rating. The Board affirmed the use of Figure 15-19 of the AMA Guides, finding it permissible to use any chapter or method within the Guides that most accurately reflects impairment. The Agreed Medical Evaluator's opinion was deemed substantial, as he explained how Figure 15-19 was used to derive a more accurate rating based on the applicant's specific spinal condition. The decision also distinguished the current case from prior panel decisions regarding the application of the AMA Guides and work limitations.

AMA Guidespermanent disability ratingrebuttable presumptionwhole person impairmentAlmaraz/Guzman IIclinical judgmentagreed medical evaluator (AME)Figure 15-19functional losssurgical-grade disc herniations
References
7
Case No. ADJ6788177
Regular
May 13, 2015

GREGORY GREENE vs. CENTRAL PARKING SYSTEMS, SEDGWICK CMS

In this workers' compensation case, the Appeals Board denied the defendant's petition for reconsideration. The defendant challenged a $75\%$ permanent disability award, arguing the primary treating physician's rating improperly combined various lower extremity impairments, violating the AMA Guides. The Board found the WCJ's reliance on the physician's opinion was supported by substantial evidence, emphasizing the need for accurate, not mechanical, application of the Guides. A dissenting opinion argued the rating was not substantial evidence as it failed to follow proper *Almaraz-Guzman* procedures for deviating from strict AMA Guides application and advocated for remand.

Workers' Compensation Appeals BoardAmended Findings and AwardPetition for Reconsiderationindustrial injurypermanent disabilitylife pensionLabor Code section 4658 (d) increasesubstantial medical evidenceLabor Code section 4660 (b)(1)AMA Guides
References
4
Case No. ADJ285115 (STK 0203659)
Regular
May 17, 2010

ARTEMIO GONZALEZ vs. RANGEL DRYWALL, INC., STATE COMPENSATION INSURANCE FUND

The applicant sustained an admitted industrial injury to his left lower extremity, specifically a fractured ankle requiring surgery. The defendant sought reconsideration of the WCJ's award of 30% permanent disability, arguing the panel QME's reports lacked specific measurements and explanations required by the AMA Guides. The Appeals Board affirmed the WCJ's decision, finding the QME's deposition testimony, which provided detailed explanations and measurements, constituted substantial evidence. The Board clarified that while AMA Guides sections must be followed, physicians can use their clinical judgment and specific tables within the Guides as long as the basis is explained.

Workers' Compensation Appeals BoardArtemio GonzalezRangel DrywallState Compensation Insurance FundPermanent DisabilityMedical TreatmentConstruction WorkerQualified Medical ExaminerAMA GuidesPermanent Impairment
References
2
Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
Significant
Feb 03, 2009

Mario Almaraz, Joyce Guzman vs. Environmental Recovery Services (a.k.a. ENVIROSERVE), State Compensation Insurance Fund, Milpitas Unified School District, Permissibly Self-Insured, Keenan & Associates, Adjusting Agent

The Appeals Board held that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable by showing that an impairment rating based on the AMA Guides would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability.

AMA Guidesrebuttable presumptionpermanent disability rating2005 Scheduleimpairment determinationmedical opinionevidentiary standardequitable awardvocational specialistsactivities of daily living
References
61
Case No. 2018 NY Slip Op 00588 [158 AD3d 866]
Regular Panel Decision
Feb 01, 2018

Matter of Jelic (Ama Research Labs. Inc.--Commissioner of Labor)

Vera Jelic, a laboratory technician, was terminated from AMA Research Laboratories Inc. due to repeated tardiness and absenteeism. She filed for unemployment insurance benefits, which were initially granted by the Department of Labor and affirmed by an Administrative Law Judge and the Unemployment Insurance Appeal Board. The employer appealed, arguing that Jelic's actions constituted disqualifying misconduct. The Appellate Division, Third Department, affirmed the Board's decision, finding that while the employer had cause for termination, Jelic's conduct did not demonstrate a willful and wanton disregard of the employer's interest to rise to the level of disqualifying misconduct. The court noted that disciplinary actions occurred after a work-related injury and that Jelic was not given an opportunity to correct her behavior prior to termination.

Unemployment InsuranceDisqualifying MisconductTardinessAbsenteeismEmployment TerminationWillful and Wanton DisregardSubstantial EvidenceAppellate DivisionLabor LawEmployer Interest
References
6
Case No. ADJ6757080
Regular
Jul 23, 2012

GRACE AOKI vs. CITY OF TORRANCE

This case concerns a library page's permanent disability rating for a right shoulder injury. The agreed medical evaluator combined ratings for loss of motion and weakness/grip strength, exceeding AMA Guides limitations for combining such impairments. The Appeals Board found the physician's report insufficient to rebut AMA Guide standards or explain the combined rating. Consequently, the permanent disability award was reduced from 46% to 20%.

Workers' Compensation Appeals BoardGrace AokiCity of TorrancePermissibly Self-InsuredReconsiderationJoint Findings and AwardPermanent DisabilityAgreed Medical EvaluatorSeymour L. AlbanPetition for Reconsideration
References
1
Case No. ADJ1932557 (SJO 0267873)
Regular
Mar 20, 2009

JOHN VLCEK vs. THE HOME DEPOT, permissibly self-insured

This case involves an admitted industrial knee injury where the applicant disputed the awarded 4% permanent disability. The Appeals Board granted reconsideration to address how diminished future earning capacity (DFEC) and AMA Guides impairments are rebutted under the 2005 Schedule. The Board is returning the case to the trial level to allow the judge and parties to apply recent en banc decisions in *Ogilvie* and *Almaraz*. These decisions clarify the methods for rebutting the DFEC and AMA Guides portions of the permanent disability rating schedule.

Workers' Compensation Appeals BoardReconsiderationPermanent DisabilityDiminished Future Earning CapacityDFECAMA Guides2005 ScheduleOgilvieAlmarazPanel Qualified Medical Evaluator
References
3
Case No. ADJ1679104 (LBO 0387820)
Regular
Aug 26, 2010

GUADALUPE FREGOSO vs. INTEGRAL DESIGN CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a permanent disability rating for an applicant injured on August 1, 2006. The defendant argued the rating was erroneous because the administrative law judge (WCJ) instructed the disability evaluator to rate the treating physician's report without referencing the AMA Guides. The Appeals Board denied the petition, finding that the WCJ's instructions were based on the physician's opinion, which complied with the AMA Guides, and the evaluator's rating followed those instructions. The Board also corrected a clerical error regarding the attorney fee calculation.

WORKERS' COMPENSATION APPEALS BOARDReconsiderationFindings and Awardtemporary disabilitypermanent disabilityapportionmentnon-industrial causesindustrial injurynecklow back
References
1
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