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

Case No. ADJ10958168
Regular
Apr 09, 2019

LYN SAMUEL JEFFERS vs. GLENDALE ADVENTIST MEDICAL CENTER, ADVENTIST HEALTH

This case involves a worker's compensation applicant who claimed her left knee injury occurred when she fainted at work on February 8, 2017. Medical reports from her treating physicians documented acute left knee pain, a torn lateral meniscus, degenerative changes, and temporary total disability following the incident. The Workers' Compensation Appeals Board found the applicant's testimony credible, supported by medical evidence, and determined the injury arose out of and occurred in the course of employment. Therefore, the employer's petition for reconsideration was denied.

AOE/COEPrimary Treating PhysicianTemporary Total DisabilityPreponderance of the EvidenceSubstantial EvidenceWCJ CredibilityPetition for ReconsiderationLateral Meniscus TearDegenerative ChangesChondromalacia
References
Case No. ANA 394929
Regular
Aug 23, 2007

JOSE LUIS SILVA vs. EL MODENO GARDENS, INC., STATE COMPENSATION INSURANCE FUND, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied SCIF's petition for reconsideration regarding the cumulative injury award and exposure percentages. However, the Board granted Redwood's petition and amended the original award to include an additional two weeks of temporary disability for the applicant in May 2005 due to knee injections. The original findings regarding the cumulative injury to the stomach, extremities, and eyes, as well as the need for future medical care, were otherwise affirmed.

Workers' Compensation Appeals BoardCumulative InjuryLower ExtremitiesEyesStomachTemporary DisabilityFuture Medical CareExposureLiability ApportionmentPetition for Reconsideration
References
Case No. MON 318383
Regular
Nov 01, 2007

PETER FERINO vs. GLENN E. THOMAS DODGE, FARMERS INSURANCE EXCHANGE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award finding a right knee injury compensable as a consequence of an admitted back injury. The WCAB determined that while the need for knee surgery was supported by substantial medical evidence, the record lacked substantial medical evidence to establish industrial causation of the knee injury as a consequence of the back injury. The case was remanded for further development of the record on the issue of causation.

Compensable consequenceExpedited hearingIndustrial causationSubstantial medical evidenceReconsiderationFindings and AwardWorkers' Compensation Appeals BoardWCJDeclaration of ReadinessMedical treatment
References
Case No. RIV 42174
Regular
Jul 20, 2007

VICTOR LOPEZ vs. DOANE'S PET CARE, ROYAL SUNALLIANCE INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration to correct a clerical error regarding the temporary disability period. While affirming the finding of industrial injury to the back, leg, and psyche resulting in 86% permanent disability, the Board amended the temporary disability period to commence August 2, 2001, aligning it with the date of injury. The Board specifically noted they would not adopt the WCJ's comment regarding improper fax filing of the petition for reconsideration.

Victim LopezDoane's Pet CareRoyal Sunalliance Insurance Co.RIV 42174Petition for ReconsiderationFindings and Awardindustrial injurybackright legpsyche
References
Case No. ADJ6801375
Regular
Jul 13, 2010

MICHAEL DAVID HERNANDEZ vs. VINCE'S ITALIAN TO GO, PREFERRED EMPLOYERS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award. The WCAB found that the applicant was not entitled to medical treatment outside the employer's Medical Provider Network (MPN) for a meniscus transplant or graft. The applicant failed to follow the required procedures for obtaining a second and third opinion within the MPN before seeking treatment from an out-of-network physician. Therefore, the WCAB concluded there was no showing that treatment outside the MPN was justified under the relevant rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNFurther Medical TreatmentSports Medicine DoctorMedical Meniscus TransplantGraft ProcedureDr. Patrick O'MearaDr. John DeSantisSubspecialist
References
Case No. ADJ3843514
Regular
Sep 15, 2008

Ramona J. Ornelas vs. COUNTY OF SACRAMENTO

Reconsideration granted to address errors in permanent disability rating and apportionment. Matter returned for new rating considering walker use and clarifying apportionment.

RAMONA J. ORNELASCOUNTY OF SACRAMENTOADJ3843514SAC 0274104OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONLEFT MINOR SHOULDERLEFT MINOR WRISTBILATERAL KNEESPSYCHE
References
Case No. SJO 0262198
Regular
Aug 17, 2007

ANTHONY LAYTON vs. CITY OF SANTA CLARA

The Workers' Compensation Appeals Board granted reconsideration and reversed its prior decision, holding that the 1997 permanent disability rating schedule, not the 2005 schedule, applies to this case. This decision was based on two exceptions to the 2005 schedule's applicability: the treating physician indicated permanent disability before January 1, 2005, and the employer provided proper notice of rights before the 2005 schedule became effective. Consequently, the applicant's permanent disability is rated at 37% under the 1997 schedule, totaling $38,950.00.

Workers' Compensation Appeals BoardReconsideration2005 Schedule1997 ScheduleLabor Code Section 4660(d)ExceptionsTreating Physician ReportSection 4061 NoticePermanent Disability RatingPolice Officer
References
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
Case No. ADJ6974763
Regular
Nov 04, 2011

TradeY PRUITT vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

This case involves an inmate firefighter claiming industrial injury to her knees from a fall while on duty. The original award found temporary and permanent disability, but the defendant sought reconsideration. The appeals board granted reconsideration, rescinded the award, and returned the matter for further proceedings. This was due to the medical expert's report on apportionment not adhering to the current legal standards for causation as established by Senate Bill 899. The board emphasized that new apportionment requires physicians to determine the percentage of disability caused by the industrial injury versus other factors, which the prior report failed to do.

Labor Code Section 4658(d)Inmate FirefighterOccupational Code 492Occupational Group 460Permanent Disability IndemnityReconsiderationApportionmentCausationSenate Bill 899AMA Guides
References
Case No. ADJ10474797
Regular
Nov 13, 2017

Hernan Fuentes vs. STAFFMARK INVESTMENT, LLC, ACE AMERICAN INSURANCE COMPANY, CANNON COCHRAN

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior Findings and Order, and returned the case for further medical record development. The Board found the Qualified Medical Evaluator's (QME) report lacked substantial evidence due to the physician's apparent misunderstanding of workers' compensation principles and conflicting dates of maximum medical improvement. The applicant's primary treating physician's reports were also insufficient as they did not address a significant MRI finding of a re-tear. Therefore, a new medical evaluation from an Agreed Medical Examiner or a WCJ-selected physician is required to determine the applicant's entitlement to temporary disability indemnity.

Workers' Compensation Appeals BoardHernan FuentesStaffmark Investment LLCACE AMERICAN INSURANCE COMPANYCannon CochranADJ10474797San BernardinoPetition for ReconsiderationTemporary Disability IndemnityPrimary Treating Physician
References
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