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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ10084576
Regular
Oct 06, 2016

ROSE SMITH vs. MEGGITT SENSING SYSTEMS PLC, THE HARTFORD

This case involves Rose Smith's workers' compensation claim where the defendant, Meggit Sensing Systems and its insurer, The Hartford, seek reconsideration of an order allowing Smith to obtain medical treatment outside their Medical Provider Network (MPN). The Appeals Board denied the petition, affirming the WCJ's finding that the defendant's failure to authorize a requested third medical opinion constituted a denial of care. This denial entitled the applicant to seek treatment outside the MPN at the defendant's expense. The defendant argued the request was procedurally deficient and not a request for treatment, but the Board found the failure to respond to the RFA for a third opinion, in context, was a failure to provide reasonable medical treatment.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Request for Authorization (RFA)Petition for ReconsiderationDenial of Medical TreatmentThird Medical OpinionUtilization Review (UR)Primary Treating PhysicianCumulative TraumaLoss of Control
References
Case No. ADJ2645988
Regular
Nov 07, 2011

BRIAN PAGE vs. DREAM TEX CORPORATION, CAL. COMP. in liquidation by CIGA

The Workers' Compensation Appeals Board denied Brian Page's petition for reconsideration of the original decision. The Board adopted the judge's report, which found that Dr. Delamarter's reports were limited to a second opinion on surgery, not all issues, rendering his temporary disability opinions unsubstantial. The judge also upheld the defendant's entitlement to a $67,639 third-party credit from the applicant's civil settlement, finding no employer negligence proximately caused the injury. The Board found no basis for the applicant's claims of excess power or that the evidence did not justify the findings.

Workers' Compensation Appeals BoardBrian PageDream Tex CorporationCal CompCIGAADJ2645988Petition for ReconsiderationRemovalWorkers' Compensation Administrative Law JudgeOpinion on Decision
References
Case No. ADJ10680590 ADJ10680591
Regular
Dec 21, 2017

HYUNMI KIM vs. SHERRY PRECISION DENTAL ART, HARTFORD FIRE ISURANCE COMPANY

This case involves a worker, Hyunmi Kim, filing a second petition for reconsideration after her initial one was dismissed. The Appeals Board is treating her handwritten submission as a petition, but is dismissing it as successive and skeletal. The Board reiterates the rule that a party cannot file a second reconsideration petition if the first was unsuccessful, and any challenge must be via a writ of review. Furthermore, any discussion of a potential third-party credit issue in a prior opinion was not a final decision and thus not subject to reconsideration at this stage.

Successive petitionSkeletal petitionPetition for reconsiderationNewly aggrievedThird-party creditOpinion on decisionFinal determinationWrit of reviewAppeals BoardWorkers' compensation
References
Case No. ADJ7948651
Regular
May 09, 2016

Barbara Tom vs. CITY OF OAKLAND, JT2 INTEGRATED

This case involves a petition for reconsideration by the defendant, City of Oakland, following an award of permanent disability to applicant Barbara Tom. The defendant argued the Workers' Compensation Judge (WCJ) erred by not deferring to the Agreed Medical Evaluator's (AME) opinion and by not developing the record with the AME. The WCAB denied reconsideration, adopting the WCJ's report which found the AME's opinion deficient. The WCJ's report detailed how the primary treating physician's report was more persuasive and thoroughly reasoned, supporting the WCJ's findings over the AME's.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Primary Treating Physician (PTP)AMA GuidesPermanent Disability RatingCarpal Tunnel SyndromeSubstantial EvidenceWCJ OpinionMedical Opinion Deference
References
Case No. ADJ7507504; ADJ7507542
Regular
Jun 13, 2012

MARIA CARRILLO vs. HELP N TIME BBSI, CORVEL

The Workers' Compensation Appeals Board denied reconsideration of a decision allowing treatment outside the Medical Provider Network (MPN). The Board found that the defendant's MPN physician failed to provide reports, justifying the applicant's treatment elsewhere under Labor Code sections 4605 and 5402(c). The Board also noted that statutory provisions for second opinions or independent medical review were inapplicable as the applicant wasn't disputing diagnosis or treatment, but rather the MPN physician's inaction. The defendant's argument regarding treatment for unpled body parts was dismissed as pleadings could be conformed to proof.

Workers' Compensation Appeals BoardPetition for ReconsiderationMedical Provider Network (MPN)Independent Medical ReviewLabor Code Section 4616.6Labor Code Section 4605Labor Code Section 5402(c)Treating PhysicianSecond OpinionThird Opinion
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ3015289 (FRE 0242633)
Regular
Jan 06, 2012

SHARON LONG vs. KAISER FOUNDATION HOSPITALS administered by KAISER PERMANENTE

This case involves applicant Sharon Long's claim for workers' compensation benefits due to cumulative trauma sustained as a registered nurse for Kaiser Foundation Hospitals. The Workers' Compensation Appeals Board granted reconsideration, reversing the initial denial of industrial injury. The Board found that Dr. Dureza's opinion, which attributed 33% of applicant's injuries to cumulative trauma from her nursing duties, constituted substantial evidence of industrial causation. The Board remanded the case for further proceedings on orthopedic benefits and the psychiatric injury claim, deferring the EDD lien.

Workers' Compensation Appeals BoardKaiser Foundation HospitalsSharon LongIndustrial InjuryCumulative TraumaRegistered NurseNeck InjuryLow Back InjurySpine InjuryPsyche Injury
References
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