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

Case No. ADJ8814296
Regular
Feb 16, 2017

JANET WILDER vs. CAPRI GLOBAL MANAGEMENT, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the Findings and Award (F&A) concerning applicant Janet Wilder's work-related injuries. The WCAB affirmed the F&A's findings regarding the nature of the injuries and psychiatric disability but found the medical evidence supporting the cranial/trigeminal nerve impairment was not substantial. Consequently, the WCAB deferred the issues of permanent disability and attorney's fees, remanding the case to the WCJ for further proceedings to develop the record on those specific issues.

Workers Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgePermanent DisabilityApportionmentQualified Medical EvaluatorCranial Nerve ImpairmentFacial DisorderPsychiatric Disability
References
3
Case No. MISSING
Regular Panel Decision

the Claim of Brigandi v. Town & Country Linoleum & Carpet

This case involves an appeal by an employer and its compensation carrier against decisions made by the Workers’ Compensation Board. The decedent, a carpet layer, died from cardiac arrest during work, with an autopsy revealing underlying coronary atherosclerotic disease. His widow was awarded death benefits. The employer’s carrier sought reimbursement from the Special Disability Fund under Workers’ Compensation Law § 15 (8), asserting a preexisting permanent physical impairment. However, the Board determined that there was no evidence that the decedent’s heart condition hindered his job potential before his death, thus releasing the Special Disability Fund from liability and holding the compensation carrier responsible. The employer's subsequent application for reconsideration was denied by the Board, leading to these appeals. The appellate court affirmed the Board's decisions, concluding that the Board rationally found no proof that the decedent's heart disease impaired his job potential, a necessary condition for reimbursement under WCL § 15 (8) (d).

Special Disability FundPreexisting Permanent ImpairmentCardiac ArrestCoronary Atherosclerotic DiseaseDeath Benefits ClaimEmployer ReimbursementCarrier LiabilityBoard Decision ReviewAppellate AffirmationMedical Evidence Interpretation
References
2
Case No. MISSING
Regular Panel Decision

Claim of Milner v. Country Developers, Inc.

The Special Disability Fund appealed decisions by the Workmen’s Compensation Board which imposed liability on the Fund for a claimant's injuries. The Board found that the employer, Country Developers, continued to employ the claimant, a carpenter, with knowledge of his pre-existing permanent physical impairment, triggering liability under subdivision 8 of section 15 of the Workmen’s Compensation Law. The claimant suffered a fracture of the nose and a hip dislocation in 1964, having a history of three ruptured disc surgeries and other conditions. The appeal centered on whether the employer had sufficient knowledge of the claimant’s permanent condition. Testimony from the employer’s foreman, Mr. Pahlck, indicated awareness of the claimant's back issues, including wearing a back brace and being favored by co-workers. The court affirmed the Board’s decision, reiterating that employer knowledge is a question of fact for the Board, and its findings, if supported by substantial evidence, will not be disturbed.

Workers' Compensation LawSpecial Disability FundEmployer LiabilityPre-existing Permanent ImpairmentEmployer KnowledgeSubstantial EvidencePermanent Partial DisabilityFracture of NoseHip DislocationRuptured Discs
References
3
Case No. ADJ8738819
Regular
Jun 10, 2015

Stephanie MOTEN vs. CITY OF LOS ANGELES

This case involves a dispute over Stephanie Moten's permanent disability rating following a work injury. Both the applicant and defendant sought reconsideration of an award of 19% permanent disability. The Appeals Board found the Agreed Medical Evaluator's (AME) permanent disability ratings were not substantial evidence due to improper application of the AMA Guides and failure to properly analyze nerve impairment. Consequently, the Board deferred the issues of permanent disability and attorney's fees, returning the case to the trial level for further proceedings.

Workers' Compensation Appeals BoardStephanie MotenCity of Los AngelesTristar Risk ManagementOpinion and Decision After ReconsiderationPermanent DisabilityAmerican Medical Association GuidesAMA GuidesAgreed Medical EvaluatorAME
References
5
Case No. ADJ3582743 (STK 0215397)
Regular
Apr 11, 2014

KERI LARSEN vs. MODESTO IRRIGATION DISTRICT

This case concerns defendant Modesto Irrigation District's petition for reconsideration of a workers' compensation award. The Workers' Compensation Appeals Board granted reconsideration, finding the administrative law judge erred in using an incorrect impairment number for calculating permanent disability. The Board amended the award to reflect an 18% permanent disability rating, based on the agreed medical evaluator's opinion regarding lateral epicondylitis and decreased grip, not nerve entrapment. The Board also corrected the finding for future medical treatment to the right arm and elbow, aligning with the amended disability rating.

Workers' Compensation Appeals BoardModesto Irrigation DistrictKerri Larsenpermanent disability ratingAMA GuidesAlmarez-Guzmanstraight ratingReport And Recommendation On Petition For ReconsiderationAgreed Medical EvaluatorAME
References
5
Case No. ADJ14669607
Regular
Apr 10, 2023

DOUGLAS HERB vs. COUNTY OF LOS ANGELES, SEDGWICK CLAIMS MANAGEMENT SERVICES, INCORPORATED

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original finding that the applicant sustained industrial injuries to his internal system and head, causing 71% permanent disability. The defendant argued the Agreed Medical Evaluator's (AME) report regarding head injury and sleep issues lacked substantial medical evidence. The Board found the AME's report to be substantial, as it was not speculative, based on adequate examination, and explained its reasoning. Furthermore, the Board found the AME's method of analogizing the applicant's headaches to trigeminal neuralgia for impairment rating was permissible and accurately reflected the applicant's activities of daily living deficits.

GERDirritable bowel syndromehypertensionheadachessleep disturbancepermanent partial disabilityapportionmentmedical treatmentattorney's feeAgreed Medical Evaluator
References
13
Case No. 2018 NY Slip Op 07810
Regular Panel Decision
Nov 15, 2018

Matter of Maunder v. B & B Lbr. Co.

Claimant, Elizabeth A. Maunder, appealed a decision by the Workers' Compensation Board that denied her a schedule loss of use (SLU) award for her arms, related to occupational disease and cubital tunnel syndrome. Her treating orthopedic surgeon, Nathan Everding, opined a 25% SLU for each elbow after revision surgery, despite previous awards for her hands. The Board found Everding's testimony and reports insufficient and inconsistent with the New York State Guidelines for Determining Permanent Impairment, noting his inability to explain the percentage or identify required 'elbow defects' for ulnar nerve entrapment. The Appellate Division affirmed the Board's decision, emphasizing the Board's prerogative to accept or reject medical evidence and the claimant's burden to prove facts supporting her claim, which was not met under the guidelines.

Schedule Loss of UseSLU AwardCubital Tunnel SyndromeBilateral WristsOccupational DiseaseWorkers' Compensation Board DecisionMedical Evidence InsufficiencyPermanent Impairment GuidelinesUlnar Nerve EntrapmentElbow Defects
References
11
Case No. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
1
Case No. ADJ10243412
Regular
Jun 10, 2019

DEBRA LUX vs. COUNTY OF SANTA BARBARA

This case involves an injured firefighter seeking workers' compensation for a right knee injury. The defendant sought reconsideration of a finding of 17% permanent disability, arguing the administrative law judge erred by combining range of motion and diagnosis-based impairments, and by not apportioning the diagnosis-based impairment. The Appeals Board denied reconsideration, finding the medical evaluator adequately explained the departure from standard AMA Guides methodology for rating the combined impairments. The Board also affirmed no apportionment of the diagnosis-based impairment as no substantial evidence showed non-industrial factors contributed to the need for surgery.

Workers' Compensation Appeals BoardApplicantDefendantPermissibly Self-InsuredAdministered by CORVELFirefighterIndustrial InjuryRight KneePermanent DisabilityWhole Person Impairment
References
5
Case No. ADJ7927652
Regular
Oct 25, 2016

Bozenna Kasperowicz vs. Metropolitan State Hospital, State Compensation Insurance Fund

This case involves an industrial injury to the applicant, a psychiatric technician, sustained on June 14, 2011, from a patient strike to the head. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over psychiatric impairment and a sleep disorder rating. The WCAB affirmed the original award but reduced the permanent disability rating from 76% to 70% by excluding the sleep dysfunction impairment. The WCAB found Dr. O'Brien's opinion on psychiatric impairment more persuasive than conflicting medical evaluations and determined Dr. Matos's opinion on sleep impairment lacked substantial medical evidence due to staleness.

WCABReconsiderationPsychiatric ImpairmentWhole Person ImpairmentGAF ScoreSleep DisorderSubstantial Medical EvidencePermanent DisabilityQualified Medical EvaluatorInsomnia
References
0
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