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

Case No. ADJ3744023
Regular
May 15, 2009

JOSEPH CRABTREE vs. MITCHELL BERMAN CABINET MAKER, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of an award finding an industrial injury to the applicant's abdomen/groin (hernia) and a resulting peripheral nerve injury causing 24% permanent disability. The defendant argued the peripheral nerve injury was not supported and the disability rating was incorrect due to misapplication of the AMA Guides. The Board denied reconsideration, adopting the judge's report and finding that the medical evidence supported the peripheral nerve injury and the AMA Guides were correctly applied. The Board found the agreed medical evaluator's conclusions were well-reasoned and supported by the evidence.

Workers Compensation Appeals BoardIndustrial InjuryHerniaPeripheral Nerve InjuryPermanent DisabilityAgreed Medical Evaluator (AME)AMA GuidesPetition for ReconsiderationMedical EvidenceWCJ
References
4
Case No. ADJ900432 (SAC 0323091)
Regular
Dec 30, 2011

MARLENE COPUS vs. NORTH SACRAMENTO ELEMENTARY SCHOOL DISTRICT

This case involves a dispute over the necessity of spinal surgery for an applicant who sustained a cumulative trauma injury to her neck and back. While the applicant's treating physician recommended surgery, a second opinion physician disagreed, citing a lack of nerve root compression. The Appeals Board found that the medical evidence was insufficient to determine the necessity of surgery, particularly in light of ACOEM Practice Guidelines which generally recommend against surgery without nerve root compression. Therefore, the Board rescinded the prior award and remanded the case to appoint an independent physician to evaluate the applicant and determine the reasonableness and necessity of the proposed surgery.

Workers' Compensation Appeals BoardMarlene CopusNorth Sacramento Elementary School Districtcumulative traumaspinal surgerynerve root impingementcervical stenosisDr. OrisekDr. GregoriusACOEM Practice Guidelines
References
4
Case No. SAL 0103596
Regular
Jan 07, 2008

CHRISTIE GAYNES vs. GRANITE ROCK COMPANY, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration. The applicant sought to have a medical evaluation by an anesthesiologist or neurologist, arguing the chosen Agreed Medical Evaluator (AME), an orthopedist, lacked the necessary expertise for her specific nerve pain. The Board found the petition untimely and upheld the WCJ's recommendation for dismissal.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Compelling AttendanceMedical EvaluationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)WCJReport and RecommendationDismissed PetitionTimeliness
References
0
Case No. ADJ3361459
Regular
Oct 15, 2012

Christiane Flynn vs. YOLANDA'S OF VENTURA, AMERICAN HOME ASSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration and amended its prior decision regarding Christiane Flynn's injury. The applicant sustained injuries including right shoulder, brachial nerve, upper extremities, thoracic outlet syndrome, complex regional pain syndrome, psyche, and fibromyalgia. Her permanent disability was found to be 100% total, entitling her to weekly indemnity payments. A substantial attorney fee of $47,451.89 was deemed reasonable and ordered payable.

Christiane FlynnYolanda's of VenturaAmerican Home AssuranceAIG Claim ServicesADJ3361459VEN 0112129ReconsiderationAdministrative Law JudgeWaitressOccupational Group 322
References
0
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. 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. ADJ9 989540
Regular
Apr 13, 2016

FELIX GARCIA vs. EUREST FINE DINING, NATIONAL UNION FIRE INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the applicant's petition for removal, upholding the administrative law judge's decision to allow a Qualified Medical Evaluator (QME) panel in neurology. The applicant argued this was prejudicial as his primary treating physician was a chiropractor, but the Board found he failed to demonstrate irreparable harm. The WCJ's report, which the Board adopted, noted that a neurologist was best qualified to evaluate potential radicular pain and nerve conduction studies. Therefore, removal was deemed an extraordinary remedy not warranted in this case.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorPrimary Treating PhysicianSpecialtyChiropracticNeurologyIndustrial InjuryRadicular PainEMG/NCS
References
4
Case No. ADJ6997281
Regular
Dec 10, 2010

SKYLER DAUSMAN vs. MENDOCINO SOLID WASTE AUTHORITY, YORK INSURANCE SERVICE GROUP, INC.

The Workers' Compensation Appeals Board denied Skyler Dausman's Petition for Reconsideration. The applicant failed to serve defense counsel, but this defect was cured by counsel's voluntary filing of an answer. The Board adopted the judge's report, which found that Dr. Allems' and Dr. Khasigian's reports constituted substantial evidence supporting the denial of permanent disability and further medical treatment for injuries beyond the applicant's low back. Ultimately, the Board found no industrial injury to the abdomen, nerve damage, or hernia, and upheld the defendant's credit for overpaid temporary disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationPropria PersonaYork Insurance Service GroupInc.Report and RecommendationPermanent DisabilityTemporary DisabilityMedical TreatmentSelf-Procured Medical Treatment
References
1
Case No. RIV 0079075
Regular
Apr 14, 2008

JOSEPH VIGARI vs. ARNOLD PALMER'S RESTAURANT, EMPLOYER'S COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board overturned a prior finding, ruling that the applicant's nerve compression injury resulting from back surgery was a compensable consequence of the original admitted industrial injury, not a new and independent injury. Therefore, the applicant is not entitled to further temporary disability indemnity beyond the 104-week limit established by Labor Code section 4656(c)(1) for the original injury. The Board clarified that the "compensable consequences" doctrine applies, and certain cited cases regarding vocational rehabilitation do not alter this principle for temporary disability claims.

Compensable Consequences DoctrineLabor Code section 4656(c)(1)Temporary Disability IndemnityNew and Independent InjuryBack SurgeryNerve CompressionLateral Femoral Cutaneous NerveVocational RehabilitationStatute of LimitationsPetition for Reconsideration
References
9
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
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