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

Case No. ADJ916057 (SAC 0345461)
Regular
Oct 15, 2009

JEANETTE LA PORTA vs. STATE COMPENSATION INSURANCE FUND, Permissibly Self-Insured

The Appeals Board grants reconsideration, amends the WCJ's order, and returns the matter for further proceedings. The petition for reconsideration is granted, paragraph one of the prior order is rescinded, and paragraph two is affirmed.

WCABReconsiderationOrthopedics panelTAR syndromeMedical expertiseCausationPermanent disabilityPrognosisChiropractorQualified Medical Examiner
References
Case No. ADJ3447268 (RDG 0130805)
Regular
Mar 08, 2010

BRUCE MCCUNE vs. SENTRY PLUMBING, CALIFORNIA INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a prior decision finding that Bruce McCune sustained a cumulative industrial injury to his bilateral knees. The Board found the claim was not barred as a post-termination claim because pre-termination medical records showed the injury, nor was it time-barred as the applicant demonstrated disability and knowledge of industrial causation within the limitations period. The Board did, however, amend the original award to explicitly state McCune did not sustain injury to his back and lower extremities. Consequently, the applicant is awarded all reasonable and necessary benefits for the knee injury.

Cumulative TraumaPost-Termination ClaimStatute of LimitationsLabor Code Section 3600(a)(10)Labor Code Section 5412Compensable DisabilityKnowledge of Industrial CausationPre-Termination Medical RecordsMeniscal TearsChondromalacia Patella
References
Case No. ADJ2183666 (RDG 0113898) ADJ2837745 (RDG 0113903)
Regular
Sep 17, 2008

RONALD TYLER vs. REDDING LUMBER TRANSPORT, STATE COMPENSATION INSURANCE FUND

The Board denied the defendant's reconsideration request regarding an admitted industrial injury to the applicant's lungs and respiratory system. The defendant argued for a lower permanent disability rating, claiming a misunderstanding of a stipulation regarding a prior 10% permanent disability award. The Board affirmed the original decision, finding the stipulation regarding the prior 10% award to be binding and unpersuasive of the defendant's interpretation.

WCABRedding Lumber TransportState Compensation Insurance FundRonald TylerADJ2183666ADJ2837745industrial injurylungsrespiratory systempulmonary system
References
Case No. ADJ1476075 (BAK 0146452)
Regular
May 17, 2011

IMELDA CANALES vs. KATHYOUN SABETAIN, M.D., STATE FARM INSURANCE COMPANIES

The Workers' Compensation Appeals Board dismissed the Petition for Reconsideration because it was filed against an interlocutory order, not a final decision, and therefore not subject to reconsideration under Labor Code section 5900. The Board also denied the petition for removal, finding no showing of substantial prejudice or irreparable harm as required by regulation and case law. The Board further admonished the petitioner for omissions and misstatements in their petition's statement of facts. Consequently, the petition was dismissed and removal was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalInterlocutory OrdersFinal OrdersSubstantive RightsLiabilityAgreed Medical Examiner (AME)Lien ClaimantUtilization Review (UR)
References
Case No. ADJ6786767
Regular
Sep 30, 2011

PAMELA SMITH vs. HYATT REGENCY, NEW HAMPSHIRE INSURANCE COMPANY

This case involves a defendant's Petition for Reconsideration and Removal related to a workers' compensation claim for cumulative back injury. The Workers' Compensation Appeals Board dismissed the Petition for Reconsideration, finding the WCJ's order to further develop the record was not a final, appealable decision. The Board also denied the Petition for Removal, as the defendant failed to demonstrate significant prejudice or irreparable harm. The WCJ's decision to reject medical opinions from Dr. Kaplan due to inconsistencies and lack of substantial evidence was upheld, supporting the need for further record development.

WCABPetition for ReconsiderationPetition for RemovalDismissalDenialCumulative traumaBack injuryPastry chefTemporary disabilitySubstantial evidence
References
Case No. GOL 0089200
Regular
Mar 21, 2008

YOLANDA MARQUEZ vs. COMP USA, AIG, AMERICAN INT'L CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a decision that apportioned 75% of the applicant's disability to non-industrial factors based on the Agreed Medical Examiner's (AME) opinion. The Board found that the AME's apportionment might have been based on the cause of the injury rather than the cause of the disability, which is an incorrect legal standard. Therefore, the Board deferred the issues of permanent disability, apportionment, and attorney's fees and returned the case to the trial level for further development of the record on apportionment.

Workers Compensation Appeals BoardYolanda MarquezCOMP USAAIGAmerican International Claims ServicesFindings and Awardindustrial injurypermanent disabilityapportionmentAgreed Medical Examiner (AME)
References
Case No. GOL 97477, GOL 97480, GOL 97481
Regular
Apr 18, 2008

MARY PRILEPINE vs. MEDTRONIC PS MEDICAL, INC., ESIS/EMPLOYERS SELF-INSURANCE SERVICE

This case involves an applicant who sustained multiple industrial injuries to her forearms, back, neck, wrists, hands, and elbows over several years. The Workers' Compensation Appeals Board granted reconsideration to apply the recent *Benson* decision, which modified the application of the *Wilkinson* rule for combining permanent disability awards. Consequently, the Board deferred findings on permanent disability and apportionment for further development of the record in light of *Benson*'s causation-based approach.

Petition for ReconsiderationPermanent Disability Rating ScheduleWilkinsonApportionmentCausationBensonTylerMcCluneMcDuffieWCJ
References
Case No. ADJ1649220
Regular
Aug 19, 2009

ERIC LUND vs. CALIFORNIA DEPARTMENT OF FORESTRY (STATE COMPENSATION INSURANCE FUND) LAKEPORT FIRE PROTECTION DISTRICT (FASIS), CLEARLAKE OAKS FIRE PROTECTION DISTRICT (FASIS)

This case involves a firefighter claiming industrial injury to his jaw and tonsil cancer, with the initial finding supporting the presumption of injury. The defendant sought reconsideration, arguing that the WCJ improperly relied on medical opinions obtained after discovery closure and in violation of physician selection procedures. The Appeals Board granted reconsideration, rescinded the initial findings, and returned the matter for further proceedings due to procedural errors in admitting key medical evidence. The Board emphasized that evidence obtained after discovery closure and potentially exceeding applicant's rights under Labor Code section 4062.1(e) should not have been admitted.

Labor Code section 3212.1squamous cell carcinomatonsil cancerlymph node cancerfirefighter injurycumulative injurypresumption of injuryrebutted presumptionLabor Code section 4062.1panel QME
References
Case No. ADJ6820138, ADJ6820197
Regular
Oct 03, 2011

AMELIA MENDOZA vs. HUNTINGTON HOSPITAL, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case involves Amelia Mendoza's deceased applicant seeking reconsideration of a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB had previously overturned an administrative law judge's finding of death benefits due to an industrial injury, instead finding only an industrial injury to the applicant's left arm on a specific date, not resulting in death. The applicant argued the prior decision was erroneous, citing WCJ credibility, objective medical evidence of internal injury, and the treating physician's reports. The WCAB denied the petition for reconsideration, reaffirming its prior decision that the applicant's industrial injury did not result in death and that no attorney's fees could be awarded from available funds.

AMELIA MENDOZAHUNTINGTON HOSPITALSEDGWICK CLAIMS MANAGEMENT SERVICESINC.ADJ6820138ADJ6820197Petition for ReconsiderationOpinion and OrderWCJindustrial injury
References
Case No. ADJ7946529
Regular
May 15, 2012

FELICIANO ESPINOZA vs. INTERGEM, ARGONAUT INSURANCE COMPANY

The Appeals Board granted reconsideration because the initial award of temporary disability was based on a chiropractor's report deemed not substantial evidence, due to unclear examination methods including a potential phone-only consultation. The Board found this evidence insufficient to support the temporary disability period awarded. Consequently, the Board rescinded the prior award and returned the case to the WCJ to further develop the medical record. This includes potentially obtaining supplemental reports or deposing the agreed medical examiner regarding the applicant's period of total temporary disability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary DisabilityIndustrial InjurySubstantial EvidenceMedical OpinionFurther Development of RecordWCJEdward Komberg D.C.
References
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