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

Case No. ADJ9414071 ADJ10133403
Regular
Aug 13, 2018

Kevin McCoy vs. State of California - Pleasant Valley State Prison

This case involves an appeal regarding the permanent disability ratings for a correctional officer's right ankle and respiratory system (Valley Fever) injuries. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case to the WCJ for further proceedings. The Board found that the Agreed Medical Examiner's (AME) ankle impairment rating was properly calculated, but the Qualified Medical Examiner's (QME) report on the respiratory injury did not sufficiently explain its deviation from strict AMA Guides application. The Board emphasized that medical evaluators must adhere to the AMA Guides or clearly justify any deviations to ensure substantial evidence.

WCABPleasant Valley State Prisonlegally uninsuredState Compensation Insurance FundKevin McCoyADJ9414071ADJ10133403permanent disabilityright anklerespiratory system
References
Case No. ADJ6652737
Regular
Nov 16, 2017

ANTRON LEE vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION, PLEASANT VALLEY STATE PRISON, legally uninsured, administered by STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration, rescinded the previous decision, and returned the case to the trial level for further proceedings. The Board found the deposition transcript of the Agreed Medical Examiner, Dr. Markovitz, should have been admitted into evidence. Crucially, the record lacked substantial evidence to determine the date(s) of injury for the applicant's Valley Fever and alleged heart condition. Additionally, the Board noted Valley Fever likely qualifies for the Labor Code Section 3212.10 pneumonia presumption.

Valley FeverCoccidioidomycosisPresumptionLabor Code Section 3212.10Date of InjuryCumulative TraumaAgreed Medical Examiner (AME)ReconsiderationPetitionPermanent Partial Disability
References
Case No. ADJ7857198
Regular
Jan 28, 2019

RANULFO CRUZ, (Deceased) vs. HALL MANAGEMENT CORPORATION, EVEREST NATIONAL INSURANCE, administered by AMERICAN CLAIMS MANAGEMENT, and COMPANION PROPERTY AND CASUALTY INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a decision awarding benefits to the estate of Ranulfo Cruz, a deceased farm laborer. The applicant's death was attributed to Coccidiomycosis (Valley Fever) and meningitis, contracted through exposure during his employment. The WCAB adopted the findings of the administrative law judge, who relied heavily on the medical opinion of Dr. Noriega, the panel QME. Dr. Noriega opined that the decedent's occupational duties, involving soil disruption in an endemic region, presented a statistically greater risk of exposure than non-work activities, establishing industrial causation.

Workers' Compensation Appeals BoardRanulfo CruzHall Management CorporationEverest National InsuranceCompanion Property and Casualty InsuranceADJ7857198Petition for ReconsiderationDeniedWCJ reportsubstantial evidence
References
Case No. ADJ940068
Regular
Jun 22, 2010

JUAN GUZMAN vs. PEAK HARVESTING, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior order finding that applicant Juan Guzman did not sustain an industrial injury. Guzman claimed he contracted Valley Fever due to his agricultural employment in 2002. The Board adopted the Workers' Compensation Judge's report, which found defendant's medical expert's opinion more credible. This expert concluded that the incubation period of Valley Fever, and the applicant's symptom onset in 2006, made an industrial exposure in 2002 unlikely. The Board found applicant failed to prove a connection between his condition and his employment, and did not demonstrate a dormant infection originating from his work.

CoccidioidomycosisValley FeverPetition for ReconsiderationIndustrial InjuryMedical EvidenceIncubation PeriodDormant InfectionPro PerStipulations and IssuesFindings and Order
References
Case No. ADJ8211363
Regular
Sep 23, 2014

LUIS GONZALES vs. ROBERT HEELY CONSTRUCTION, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of an award finding cumulative trauma injury to the applicant's lungs from Valley Fever. The WCJ reserved jurisdiction over final permanent disability, deeming the disease insidious and potentially reoccurring, despite the applicant's current stable condition. The Board affirmed the WCJ's decision, citing medical evidence of potential relapse and the precedent allowing jurisdiction reservation for insidious progressive diseases. A dissenting opinion argued the medical evidence did not support classifying Valley Fever as insidious and progressive in this case, and thus jurisdiction should not have been reserved beyond the statutory limit.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardcumulative trauma injuryValley Fevercoccidioidomycosisinsidious progressive diseasepermanent disabilityreservation of jurisdictionAgreed Medical Examiner
References
Case No. BAK 0141141
Regular
Mar 07, 2008

Briant Certuche vs. TRANS-SYSTEMS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded the previous decision, finding insufficient consideration of whether the applicant's Valley Fever infection was industrially caused or solely due to living in the San Joaquin Valley. The case is returned to the trial level for further development of the medical record, specifically to address the relative likelihood of environmental versus occupational exposure. This decision acknowledges that employment need only be a contributory cause for injury compensability.

Workers' Compensation Appeals Boardindustrial injuryValley Fevercoccidiomycosisproximate causeoccupational exposuregeographic endemicmedical-legal expertsubstantial evidencecontributing cause
References
Case No. FRE 0245256
Regular
Jun 05, 2007

FRE 27 XYZZX vs. BUTTON TRANSPORTATION INC., STATE COMPENSATION INSURANCE FUND

The applicant sought reconsideration of an approved Compromise and Release agreement concerning his cumulative injury claim for Valley Fever. He alleged fraud based on misrepresentation of his job title and work environment by the defendant and its adjuster. The Appeals Board dismissed the petition for reconsideration because it was filed significantly outside the statutory 20-day deadline, rendering it untimely.

Valley FeverCoccidioidomycosisCompromise and ReleasePetition for ReconsiderationTimelinessJurisdictionOrder Approving Compromise and ReleaseIndustrial InjuryTruck DriverDispatcher
References
Case No. ADJ1036120 (SDO 0330367)
Regular
Jul 08, 2013

JESSE SUMABAT vs. CALIFORNIA HIGHWAY PATROL

This case concerns whether the applicant's valley fever is an "insidious, progressive disease" for which jurisdiction over permanent disability can be reserved. The WCAB granted reconsideration, rescinded the initial award, and returned the matter to the trial level. This is because the medical evidence regarding the progressive nature of the applicant's condition was contradictory and required further development. The Board emphasized that the determination of a progressive disease must be supported by substantial medical evidence stating medical probability.

Valley FeverCoccidioidomycosisProgressive DiseaseInsidious DiseasePermanent DisabilityJurisdiction ReservationJackson DoctrineGeneral Foundry ServiceRuffin CaseMedical Probability
References
Case No. SAC 0332085
Regular
Aug 04, 2008

ROCKY GRIMES vs. ENVIROCON, CIGNA

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the finding that the applicant sustained an industrial injury due to Valley Fever, as the defendant failed to timely deny the claim and did not present sufficient evidence to rebut the presumption of injury. The Board also dismissed the applicant's petition for reconsideration, stating that the applicant was not aggrieved by a final order, as the WCJ ruled in their favor regarding the industrial injury. The defendant was admonished for attempting to introduce new evidence after discovery had closed without proper acknowledgment.

Workers Compensation Appeals BoardIndustrial InjuryValley FeverCoccidioidomycosisLungsProstateTesticlesBrainHipsKnees
References
Case No. ADJ3399165 (SDO 0332865)
Regular
Sep 27, 2012

DAVID GARCIA vs. WESTERN TILE & CARPET, INC.; TONY DELANZO dba T.D. TILE; GOLDEN EAGLE INSURANCE COMPANY, Administered by LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for removal and denied his petition for reconsideration. The WCAB found that the applicant's claim for a compensable industrial injury to his lungs and respiratory system, including Valley Fever, was not supported by substantial medical evidence. The WCAB adopted the workers' compensation judge's report, which found the applicant not credible, and noted that the applicant's petition exceeded page limits and contained unprofessional attacks on the judge. The WCAB admonished the applicant's counsel and indicated potential sanctions for future violations.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationWCJcompensable industrial injurylungsrespiratory systemdisseminated coccidioidomycosismeningitisValley Fever
References
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