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

Case No. ADJ8772254
Regular
Jul 20, 2017

Lorenzo Hernandez vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION, NORTH KERN STATE PRISON, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Lorenzo Hernandez's petition for reconsideration, upholding the original award of 24% permanent disability for a right shoulder injury. The applicant argued that a vocational expert's report should have rebutted the scheduled disability rating, but the Board found this report insufficient. Relying on *Ogilvie* and *Dahl*, the Board determined that an applicant's amenability to vocational rehabilitation precludes using vocational expert testimony to challenge a scheduled rating based on lost earning capacity. Therefore, the vocational expert's opinion was deemed not substantial evidence to overcome the QME's scheduled rating.

Workers' Compensation Appeals BoardPermanent DisabilityVocational ExpertQualified Medical EvaluatorScheduled RatingReconsiderationLabor Code §4660.1AMA Guides 5th EditionAmenability to Vocational RehabilitationDiminished Future Earning Capacity
References
3
Case No. ADJ8189392
Regular
Jan 19, 2015

KATHRYN JOHNSON vs. STATE OF CALIFORNIA DEPARTMENT OF DEVELOPMENTAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding an award of permanent total disability. The defendant argued the vocational rehabilitation expert's report lacked substantial evidence and failed to apportion the injury. The Board found the vocational expert's opinion that the applicant was not amenable to vocational rehabilitation and had a complete loss of earning capacity was supported by medical evidence. This analysis was unaffected by the *Dahl* decision, leading to the denial of the petition.

Petition for ReconsiderationFindings and AwardNotice of IntentionVocational Rehabilitation ExpertSubstantial EvidenceApportionmentPermanent Total DisabilityLoss of Earnings CapacityDahl holdingContra Costa County v. Workers' Comp. Appeals Bd.
References
2
Case No. ADJ9025732
Regular
Apr 07, 2023

ALBERT MATA vs. STATE OF CALIFORNIA - DEPARTMENT OF CORRECTIONS & REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding of 100% permanent total disability for the applicant, Albert Mata. The defendant argued that the applicant's vocational counselor's reports and medical reports did not constitute substantial evidence for total disability. However, the Board affirmed the Administrative Law Judge's decision, finding the vocational expert's opinions were substantial evidence, not based on speculation, and correctly applied California's 2005 Permanent Disability Rating Schedule for psychiatric impairments. Therefore, the Board concluded the applicant was precluded from vocational rehabilitation and participating in the labor force.

Permanent total disabilityPsychiatric injuryVocational Rehabilitation CounselorAmerican Medical Association GuidesGlobal Assessment of FunctioningPermanent Disability Rating ScheduleSubstantial evidencePetition for ReconsiderationAdministrative Law JudgeAgreed Medical Examiner
References
7
Case No. MISSING
Regular Panel Decision
Dec 21, 1995

In re Jordan Rehabilitation Service, Inc.

Jordan Rehabilitation Service, Inc., providing medical and vocational rehabilitative services, appealed a decision by the Unemployment Insurance Appeal Board. The Board assessed additional unemployment insurance contributions, finding that specialists hired by Jordan were employees, not independent contractors, between 1989 and 1991. The court reviewed whether there was substantial evidence to support the Board's conclusion of an employer-employee relationship. Key factors included Jordan's control over recruitment, screening, compensation, billing, and contractual restrictions on specialists. Ultimately, the court affirmed the Board's decision, determining that Jordan exercised sufficient overall control to establish an employer-employee relationship and thus was liable for the contributions.

Unemployment InsuranceEmployer-Employee RelationshipIndependent ContractorRehabilitation ServicesLabor LawSubstantial EvidenceControl TestJudicial ReviewAdministrative Law JudgeDepartment of Labor
References
8
Case No. MISSING
Regular Panel Decision
May 14, 2014

Forest Rehabilitation Medicine PC v. Allstate Insurance

Plaintiff Forest Rehabilitation Medicine PC sued defendant Allstate to recover $3,490 for no-fault medical benefits provided to assignor Tracy Fertitta. The core issue was the medical necessity of "Calmare pain therapy" (scrambler therapy), a novel treatment. The court conducted a bench trial, hearing expert testimony from both sides. Dr. Ayman Hadhoud, for the defense, argued the treatment was not medically necessary, not cost-effective, and essentially a form of physical therapy. Dr. Jack D’Angelo, for the plaintiff, countered that the therapy, though new, had FDA approval, was used by the military, and reduced the assignor's pain levels. Applying the Frye standard, the court found the evidence regarding Calmare scrambler therapy reliable and ruled it was medically necessary for Ms. Fertitta's pain management. Consequently, judgment was awarded to the plaintiff, Forest Rehabilitation Medicine PC, for $3,490 plus attorney's fees and interest.

No-Fault InsuranceMedical NecessityCalmare Pain TherapyScrambler TherapyNovel TreatmentFrye StandardExpert TestimonyPain ManagementFDA ApprovalCervical Radiculopathy
References
14
Case No. ADJ7399938 ADJ7068967
Regular
Jun 23, 2015

OLENA GARCIA vs. RESIDENCE INN, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PENNSYLVANIA

The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further development of the record. The initial award found permanent total disability based on a vocational expert's opinion, but the Board found this opinion lacked substantial medical evidence. Specifically, the medical expert's supplemental report was not based on a current evaluation, and the vocational expert's conclusions, relying on that report, were therefore also flawed. The matter is remanded to allow for a current medical evaluation and reassessment of vocational rehabilitation and diminished earning capacity.

Workers' Compensation Appeals BoardPermanent Total DisabilityJoint Findings and AwardVocational ExpertSubstantial EvidenceScheduled RatingFunctional Capacity EvaluationAgreed Medical ExaminerApportionmentModified Work
References
0
Case No. ADJ11184599, ADJ11184523
Regular
Feb 24, 2020

Gregory White vs. Sky 2 Collision Corporation, Illinois Midwest Insurance Company, Inc., National Casualty Company

The Workers' Compensation Appeals Board denied Gregory White's petition for reconsideration of a $47\%$ permanent disability award. White argued he was permanently totally disabled due to vocational limitations, but the Board found substantial evidence supported his ability to benefit from vocational rehabilitation. The Board affirmed the Administrative Law Judge's finding that White was not permanently totally disabled and that his vocational expert's report was less persuasive than the defense vocational expert's. Issues regarding vocational costs were deferred pending a separate petition.

Cumulative traumaSpecific injuryLow back injuryLumbar spineBacterial infectionStreptoccocusLaminectomyPermanent disabilityVocational rehabilitationQualified injured worker
References
4
Case No. ADJ1909369 (LAO 0760509)
Regular
Mar 24, 2010

SANTOS MORALES vs. ASSOCIATED ROOFERS, INC., CENTRE INSURANCE COMPANY, RISK ENTERPRISE 600 BREA

The Workers' Compensation Appeals Board granted reconsideration of a prior award concerning applicant Santos Morales' industrial injuries. The Board found the applicant's petition timely and that the Workers' Compensation Judge (WCJ) miscalculated the life pension. The case is returned to the trial level for further proceedings and a new decision, as the WCJ must revisit permanent disability, apportionment, and the costs of the vocational rehabilitation expert in light of controlling legal precedent. The WCJ should re-evaluate the vocational rehabilitation expert's costs based on the Appeals Board's en banc decisions in *Costa I* and *II*.

Workers' Compensation Appeals BoardIndustrial InjuryPsycheCervical SpineShoulder InjuryPermanent Partial DisabilityDisability IndemnityLife PensionVocational Rehabilitation ExpertReconsideration
References
5
Case No. MISSING
Regular Panel Decision

Grady v. AHRC NYC New Projects, Inc.

Michael Grady and Judith Grady, plaintiffs in this action, sought damages for personal injuries Michael sustained in a work-related accident. Fourth-party defendant Nead Electric moved to vacate the plaintiffs' note of issue and certificate of readiness for trial, seeking further discovery and a vocational rehabilitation examination. Nead argued that the plaintiff's late expert disclosure, quantifying economic losses at $1.5 million, constituted unusual circumstances justifying additional pretrial proceedings. Defendant/third-party plaintiff AHRC NYC New Projects, Inc. supported Nead's motion. The plaintiffs opposed, citing untimeliness and potential prejudice. The court granted Nead's motion, finding the late expert disclosure of economic damages to be unusual and unanticipated circumstances. The court ordered the plaintiff to comply with discovery and undergo a vocational rehabilitation examination.

Discovery disputeNote of issueCertificate of readinessVocational rehabilitationExpert disclosureEconomic lossPersonal injuryWork-related accidentCPLR 3101Vacate note of issue
References
7
Case No. ADJ8782107
Regular
Apr 03, 2019

Salvador Sainz vs. Svenhards Swedish Bakery, Federal Insurance Company, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involved applicant Salvador Sainz seeking reconsideration of a 57% permanent disability award for a 2012 back and psyche injury. Sainz argued he was totally disabled due to his vocational ineligibility for rehabilitation, but the Board denied his petition. The Board adopted the WCJ's reasoning that Sainz's vocational expert's opinion was not persuasive and conflicted with the medical evidence and defendant's vocational expert. Therefore, the original award of 57% permanent disability was affirmed.

Workers Compensation Appeals BoardSalvador SainzSvenhard's Swedish BakeryFederal Insurance CompanySedgwick Claims Management ServicesADJ8782107Petition for Reconsiderationpermanent disabilityvocational rehabilitationvocational evaluator
References
1
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