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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ7166686
Regular
Jul 24, 2012

RICHARD ANDERSON vs. JAGUAR/LANDROVER OF VENTURA, COMPWEST INSURANCE COMPANY

This case involves an applicant who suffered a stroke and subsequent 100% permanent disability following surgery for an industrial shoulder injury. The defendant sought reconsideration, arguing for apportionment to pre-existing conditions and challenging the attorney's fee calculation. The Appeals Board affirmed the 100% permanent disability finding, finding no basis for apportionment as the applicant's pre-existing conditions did not cause the disability itself. However, the Board modified the attorney's fee award, requiring commutation using a specific method and a 3% cost of living adjustment, finding the previously assumed 4.6% to be speculative.

Workers Compensation Appeals BoardRichard AndersonJaguar/Landrover of VenturaCompwest Insurance CompanyADJ7166686ReconsiderationFindings and AwardIndustrial InjuryBrain InjuryNeurological System
References
Case No. VNO 0509254
Regular
Apr 17, 2008

CAROL LEVENSON vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves a claim for bilateral hearing loss and tinnitus allegedly caused by noise exposure during firearms training. The Appeals Board found the opinion of the Agreed Medical Evaluator, Dr. Grossan, to be substantial evidence, concluding that the applicant's conditions were not work-related. Consequently, the Board denied the applicant's claim for hearing loss and tinnitus, awarding only reimbursement for medical-legal liens.

Workers' Compensation Appeals BoardRemovalTemporary DisabilityFindings and AwardLicensing Program AnalystBilateral Hearing LossFirearms TrainingShooting RangeTinnitusQualified Medical Evaluator (QME)
References
Case No. ADJ8954364
Regular
Jul 06, 2015

MARK FINNEY vs. ZURICH INSURANCE, PATRIOT RISK SERVICES

This Workers' Compensation Appeals Board case, ADJ8954364, involved applicant Mark Finney seeking reconsideration of a decision that denied permanent impairment from a left eye injury. Finney argued he had developed glaucoma and sustained vision loss due to the injury. The Workers' Compensation Judge found no substantial evidence that the glaucoma was caused by the injury, nor was there sufficient evidence of specific vision loss as defined by the AMA Guides. Therefore, the petition for reconsideration was denied, upholding the original decision that while future complications could arise, there was no current permanent impairment.

Petition for ReconsiderationDeniedPermanent ImpairmentLeft Eye InjuryGlaucomaVision LossAMA GuidesPrimary Treating PhysicianBilateral Vision LossMyopic Astigmatism
References
Case No. ADJ6692520
Regular
Jul 20, 2010

CRYSTAL VOS vs. STEVEN CHANG, DDS, ZENITH INSURANCE COMPANY

This case affirms a WCJ's decision finding the applicant sustained a 12% permanent disability. The applicant sought reconsideration, arguing the WCJ erred by limiting rebuttal evidence to "wage loss" rather than "loss of long-term earning capacity" and denying costs for a vocational expert. The Appeals Board, relying on precedent from *Ogilvie v. City and County of San Francisco*, held that the vocational expert's opinion was not substantial evidence to rebut the permanent disability rating. Therefore, the WCJ's denial of the vocational expert's costs was also affirmed.

Workers' Compensation Appeals BoardSupplemental Findings and Awardindustrial injurypermanent disabilityvocational expertwage lossloss of long-term earning capacitydiminished future earning capacity (DFEC)2005 Permanent Disability Rating ScheduleOgilvie v. City and County of San Francisco
References
Case No. ADJ3842696 (SAL 0105756) ADJ4430006 (SAL 0111994)
Regular
Apr 23, 2010

JOSE VILLA vs. CHALONE WINE GROUP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ZENITH INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to allow the California Insurance Guarantee Association (CIGA) reimbursement for its bill review expenses. The Board found that bill review costs are an essential and necessary part of adjusting medical claims, akin to "incurred losses" as defined by the Uniform Statistical Reporting Plan. This decision amends a prior ruling that excluded such expenses, recognizing their role in controlling medical overpayments. The parties are now to adjust the specific amount of reimbursement for these expenses.

CIGACalifornia Insurance Guarantee Associationbill review expensesincurred lossesloss adjustment expensemedical cost containmentuniform statistical reporting planinsolvency insurancecovered claimsLabor Code
References
Case No. ADJ1643143 (SRO 0122410)
Regular
May 25, 2010

JUAN ESCUTIA vs. NICK LERAS WATER TRUCKS, et al.

The Workers' Compensation Appeals Board affirmed a prior decision holding the State Compensation Insurance Fund (SCIF) liable for reimbursement to the California Insurance Guarantee Association (CIGA). CIGA, adjusting claims for an insolvent insurer, sought reimbursement for various administrative expenses, including bill review, court reporter fees, and opposing counsel fees incurred while administering an injured worker's claim. The Board found these costs, particularly bill review expenses, were part of "incurred losses" under the California Workers' Compensation Uniform Statistical Reporting Plan and thus reimbursable. This decision establishes that CIGA can recover such administrative costs from a solvent insurer when adjusting claims for an insolvent carrier.

CIGASCIFBill ReviewIncurred LossesLoss Adjustment ExpensesInsurance Code Section 1063.1(c)(9)Labor Code Section 5500.5(e)California Workers' Compensation Uniform Statistical Reporting PlanReconsiderationFindings and Orders
References
Case No. ADJ6581535
Regular
Nov 15, 2017

Angel Mendez vs. Maple Dairy, Zenith Insurance Company

The Workers' Compensation Appeals Board denied Angel Mendez's petition for reconsideration. Mendez sought a finding of $100\%$ permanent disability, arguing total loss of use of his dominant right upper extremity. The Board affirmed the WCJ's prior award of $75\%$ permanent disability, finding no presumption of total disability for the loss of use of only one hand. The evidence did not support a finding of total loss of use of the upper extremity.

Petition for ReconsiderationPermanent Disability ApportionmentVocational EvidenceDominant Upper ExtremityLoss of UsePresumption of Permanent Total DisabilityLabor Code Section 4662(a)(2)Substantial EvidenceLeBoeuf v. Workers' Comp. Appeals Bd.Dairy Worker
References
Case No. ADJ360205 (LBO 0384980)
Regular
Aug 05, 2010

Gurdev Malhotra vs. STATE OF CALIFORNIA, DEPARTMENT OF DEVELOPMENTAL SERVICES FAIRVIEW; Legally Uninsured, CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's advisory opinion concerning permanent disability rating for grip loss. Defendant argued the WCJ erred by allowing rating for grip loss when range of motion was present, and that the QME's reports did not support grip loss rating. The Board rescinded the WCJ's findings, remanding the case for further proceedings to ensure the WCJ follows the established process for issuing rating instructions based on substantial medical evidence, as clarified in *Blackledge v. Bank of America*. The ultimate determination of permanent disability requires a proper QME opinion and subsequent rating instructions from the WCJ.

Workers' Compensation Appeals BoardGurdev MalhotraState of California Department of Developmental ServicesLegally UninsuredContract ServicesPermanent Disability RatingGrip LossAMA GuidesQualified Medical EvaluatorQME
References
Case No. ADJ8782360
Regular
Jun 01, 2018

Eldridge Taylor vs. California Department of Corrections and Rehabilitation, STATE COMPENSATION INSURANCE FUND

The California Workers' Compensation Appeals Board denied a petition for reconsideration, affirming a prior award to Eldridge Taylor. The award included permanent disability for cumulative trauma injuries, sleep disorder, and hearing loss. The employer argued the sleep disorder rating was subsumed by orthopedic pain, the hearing loss lacked substantial evidence, and the WCJ failed to properly apportion non-industrial factors. The Board adopted the WCJ's report, finding sufficient medical evidence for the sleep disorder and hearing loss. The dissenting opinion argued the sleep disorder award should be rescinded as it stemmed solely from industrial pain already rated.

Workers' Compensation Appeals BoardEldridge TaylorCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8782360Cumulative TraumaCorrectional OfficerParole OfficerSleep Disorder
References
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