Updated Daily

Case Law Database

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

Case No. ADJ11451772

Regular

Apr 03, 2023

EDUARDO CASELIN HUERTA vs. MONTIE WAYNE SHEET METAL, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES, INC.

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration and deferred the issue of permanent disability. The Board affirmed the finding of temporary disability through August 9, 2020, based on medical opinions stating the applicant remained unable to work due to his urological condition. However, the Board requires the Administrative Law Judge to clarify how permanent disability ratings were calculated (addition versus combination) and to further analyze the applicability of Labor Code section 4660.1(c) to the applicant's sexual dysfunction and urological impairments. The Board took no position on the ultimate resolution of these permanent disability issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationTemporary DisabilityPermanent DisabilityLumbar SpineSexual DysfunctionUrological ImpairmentCombined Values ChartLabor Code Section 4660.1(c)Qualified Medical Evaluator

References

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

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

Case No. ADJ4118575 (MON 0342974)

Regular

May 26, 2010

MANUEL ORTIZ vs. TOWER INDUSTRIES, INC., SCIF INSURED INLAND EMPIRE

This case involves an applicant who sustained severe injuries in a riding accident, including multiple pelvic fractures and urological damage, requiring extensive surgeries. The applicant was awarded 100% permanent disability due to his constant pain, limited mobility, and functional impairments, including urinary incontinence and erectile dysfunction. The defendant appealed, arguing the 100% disability rating was not justified and disputing the findings of sleep disorder and erectile dysfunction. The Workers' Compensation Appeals Board affirmed the applicant's 100% permanent disability, finding the evidence supported total permanent disability based on the facts of his severe injury and ongoing functional limitations. The Board denied the defendant's petitions for reconsideration.

Workers' Compensation Appeals BoardPermanent Total DisabilityPetitions for ReconsiderationFindings and AwardAgreed Medical ExaminersLabor Code Section 4662Pelvis InjuryLower Extremity InjuryUrethra InjuryPsyche Injury

References

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

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

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

Case No. ADJ7713711

Regular

Mar 11, 2016

JULIANA MASTERS vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES

The Appeals Board denied reconsideration of the WCJ's decision, upholding the finding that applicant's sleep impairment, though present, was subsumed by the physical upper extremity impairments and thus not separately ratable. The Board found the Agreed Medical Examiner's opinion on sleep disorder impairment was not substantial evidence as it was predicated on pain already accounted for in the physical injury ratings per the AMA Guides. Therefore, the applicant's permanent disability rating remained at 69%. A dissenting opinion argued the Agreed Medical Examiner's opinion should be followed, as it addressed distinct impairments beyond pain and was supported by relevant case law.

Workers' Compensation Appeals BoardAmended Findings of Fact and AwardsIndustrial InjuryUpper ExtremitiesPsycheBook BinderSleep ImpairmentAMA GuidesPermanent DisabilityAgreed Medical Examiner

References

Case No. ADJ4397000

Regular

Jun 10, 2011

MARIA MERCEDES FELIX vs. SEA DWELLING CREATURES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that applicant Maria Mercedes Felix has 0% whole person impairment for her back injury and requires no further medical treatment. This decision was based on the opinion of a qualified medical evaluator (PQME) whose findings were consistent with a prior medical report. The PQME's report concluded that various diagnostic tests were normal and revealed no significant clinical findings, structural alterations, or neurological impairment. Crucially, the Appeals Board clarified that a 3% pain add-on for whole person impairment is legally permissible only to increase an already established impairment rating, which was not the case here as the initial rating was zero.

Workers' Compensation Appeals BoardReconsideration deniedExpert medical evidencePanel Qualified Medical Evaluator (PQME)American Medical Association Guides (AMA Guides)Permanent ImpairmentWhole Person Impairment (WPI)DRE Lumbar Category IMedical treatmentPain add-on

References

Case No. ADJ11065177

Regular

Apr 09, 2019

FRANK ROMANO vs. PROVIDENCE HEALTH AND SERVICES, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior award that found 4% permanent disability. The Board found the orthopedist's apportionment of lumbar spine impairment to nonindustrial daily activities to be unsubstantiated. Specifically, the doctor could not identify specific nonindustrial activities causing impairment or link them to the found impairment. Therefore, the Board awarded an unapportioned 7% permanent disability for the applicant's industrial lumbar spine injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanent DisabilityApportionmentSubstantial Medical EvidenceMedical OpinionLumbar Spine DRE Category IIWhole Person ImpairmentAMA GuidesMuscle Spasm

References

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Updated Daily

Case Law Database

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

Case No. ADJ11451772

Regular

Apr 03, 2023

EDUARDO CASELIN HUERTA vs. MONTIE WAYNE SHEET METAL, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES, INC.

References

Case No. MISSING

Regular Panel Decision

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

References

Case No. MISSING

Regular Panel Decision

Claim of Milner v. Country Developers, Inc.

References

Case No. ADJ4118575 (MON 0342974)

Regular

May 26, 2010

MANUEL ORTIZ vs. TOWER INDUSTRIES, INC., SCIF INSURED INLAND EMPIRE

References

Case No. ADJ3057272 (RDG 0125821)

Regular

Dec 03, 2010

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

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration

References

Case No. ADJ10243412

Regular

Jun 10, 2019

DEBRA LUX vs. COUNTY OF SANTA BARBARA

Workers' Compensation Appeals BoardApplicantDefendantPermissibly Self-InsuredAdministered by CORVELFirefighterIndustrial InjuryRight KneePermanent DisabilityWhole Person Impairment

References

Case No. ADJ7927652

Regular

Oct 25, 2016

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

WCABReconsiderationPsychiatric ImpairmentWhole Person ImpairmentGAF ScoreSleep DisorderSubstantial Medical EvidencePermanent DisabilityQualified Medical EvaluatorInsomnia

References

Case No. ADJ7713711

Regular

Mar 11, 2016

JULIANA MASTERS vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES

Workers' Compensation Appeals BoardAmended Findings of Fact and AwardsIndustrial InjuryUpper ExtremitiesPsycheBook BinderSleep ImpairmentAMA GuidesPermanent DisabilityAgreed Medical Examiner

References

Case No. ADJ4397000

Regular

Jun 10, 2011

MARIA MERCEDES FELIX vs. SEA DWELLING CREATURES, INC., STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ11065177

Regular

Apr 09, 2019

FRANK ROMANO vs. PROVIDENCE HEALTH AND SERVICES, SEDGWICK CLAIMS MANAGEMENT SERVICES

References

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