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

Case No. ADJ1142998 (RDG 0118288)
Regular
Aug 18, 2009

STEVE REYNOLDS vs. WYCKOFF LOGGING, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration of a prior Workers' Compensation Appeals Board (WCAB) decision. The WCAB had previously rescinded a finding that avascular necrosis was not a compensable consequence of the applicant's injury, finding the relied-upon medical opinion speculative. The defendant argues the WCJ correctly favored the opinion of Dr. Glancz over Dr. Barber. The WCAB denied reconsideration, reaffirming that Dr. Glancz's opinion was not substantial evidence due to repeated questioning of the injury mechanism, while Dr. Barber's opinion was persuasive and based on a complete history. Therefore, the WCAB maintained its prior decision that Dr. Barber's opinion constituted substantial evidence supporting the applicant's claim.

Avascular necrosiscompensable consequencesubstantial evidencemedical opinionworkers' compensation administrative law judgereconsiderationfindings and ordermedical treatmentindustrial basissubstantial evidence
References
1
Case No. ADJ948816 (SFO 0499481)
Regular
Mar 07, 2013

Edwin Suarez vs. Barrett Business Services, Inc.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award finding $100\%$ permanent total disability and psychiatric injury. The WCAB found the vocational expert's opinion regarding permanent disability was unsubstantial, and Dr. Goldfield's psychiatric opinion was questionable due to reliance on a previously rescinded heart injury finding. Consequently, the WCAB deferred the issues of psychiatric injury, permanent disability, and attorney fees, returning the case to the trial level for further proceedings. However, the WCAB affirmed the findings of injury to the lumbar and cervical spine and upper extremities, and awarded temporary disability and future medical treatment.

WCABPetition for ReconsiderationFindings and AwardIndustrial InjuryLumbar SpineCervical SpineUpper ExtremitiesPsychiatric InjuryPermanent Total Disability2005 Schedule for Rating Permanent Disability
References
0
Case No. ADJ3081269 (SFO 0470357) ADJ1573718 (SFO 0503030)
Regular
May 20, 2019

ANGELICA RICHARD vs. KWAN HENMI ARCHITECTURE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, AMERICAN MOTORISTS INSURANCE COMPANY, BROADSPIRE, ROBERT LEWIS CONSTRUCTION COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a workers' compensation claim where the Workers' Compensation Appeals Board (WCAB) granted reconsideration to further study the issues. The WCAB affirmed the original findings and award, giving significant weight to the Administrative Law Judge's (ALJ) credibility determination based on witness observation. They also reiterated that a single physician's opinion can be substantial evidence, even if it conflicts with other medical opinions. Ultimately, the WCAB found no substantial evidence to overturn the ALJ's decision.

Workers' Compensation Appeals BoardReconsiderationWCJ credibility determinationSubstantial evidencePhysician opinionJoint Findings Award OrderCalifornia Insurance Guarantee AssociationAmerican Motorists Insurance CompanyLiquidated insurerBroadspire
References
2
Case No. ADJ6945712
Regular
Nov 29, 2011

CLAY WELDON vs. WALLACE KUHL & ASSOCIATES, U.S. FIDELITY AND GUARANTEE COMPANY

The Workers' Compensation Appeals Board (WCAB) reversed an award of spinal surgery for applicant Clay Weldon. The WCAB found that the Agreed Medical Examiner (AME), Dr. Bruce McCormack, provided substantial medical evidence that the surgery was not reasonable or appropriate at this time. Dr. McCormack's opinion, based on the ACOEM Guidelines and his examination, concluded there was no instability or radiculopathy justifying surgery. The WCAB found the WCJ's reasoning for disregarding the AME's opinion insufficient and therefore rescinded the award.

Workers' Compensation Appeals BoardFindings and Awardindustrial injuryspinal surgeryAgreed Medical ExaminerACOEM Guidelinesutilization reviewsubstantial medical evidenceradiculopathysegmental instability
References
3
Case No. ADJ4303386 (LBO 0318793)
Regular
Jun 17, 2013

HI ROCKY HWANG vs. VAN WATERS \& ROGERS, ZURICH NORTH AMERICA, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) rescinded the prior award of temporary total disability benefits, finding that the Administrative Law Judge (WCJ) erred in awarding benefits "to date and continuing." The WCAB relied on Agreed Medical Evaluator (AME) Dr. Green's opinions establishing that the applicant's neck condition was permanent and stationary as of July 7, 2005. Because of the ambiguity regarding the applicant's shoulder condition and whether he ever returned to work, the WCAB returned the matter to the WCJ for further proceedings, specifically recommending a supplemental opinion from Dr. Green.

Agreed Medical EvaluatorTemporary Total DisabilityPermanent and StationaryLabor Code Section 4656(c)Continuous Temporary Total DisabilityPetition for ReconsiderationFindings and AwardMedical Records ReviewDeposition TranscriptIndustrial Injury
References
8
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
0
Case No. ADJ1124701 (OAK 0304697)
Regular
Jan 25, 2010

GENE THOMAS vs. SLEEP TRAIN MATTRESS CENTER, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision favoring the applicant's spinal surgery, finding that proper procedural steps were not followed. The employer's utilization review (UR) had denied the surgery, but neither party followed the required second-opinion process under Labor Code section 4062(b). The WCAB returned the case to the trial level, allowing the employer ten days from receipt of the decision to object to the surgery and initiate the second-opinion process. This decision aligns with the WCAB's en banc ruling in *Cervantes*, which clarified the procedures for handling spinal surgery disputes after UR denials.

Workers' Compensation Appeals BoardUtilization ReviewLabor Code section 4062(b)Spinal SurgerySecond OpinionCervantes v. El Aguila Food ProductsACOEM GuidelinesExperimental TreatmentEn Banc DecisionAdministrative Director Rules
References
4
Case No. ADJ2653468 (LBO 0389795), ADJ7229862, ADJ9578758, ADJ10137164
Regular
Apr 28, 2017

MUKESH SINGH vs. STATE OF CALIFORNIA

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision awarding high permanent disability ratings to Mukesh Singh based on a vocational expert's opinion that he couldn't compete in the labor market. The WCAB found the expert's opinion insufficient because it failed to adequately address the impact of non-industrial factors and the applicant's ability to participate in vocational rehabilitation. Consequently, the WCAB amended the decision to use scheduled permanent disability ratings for each of the applicant's three injuries, allowing for apportionment among them. This adjustment corrects an improper use of the Combined Values Chart for combining distinct injuries and aligns the award with existing legal precedent on rebutting scheduled ratings.

Workers' Compensation Appeals BoardLegally UninsuredJoint Findings and AwardPetition for ReconsiderationPermanent DisabilityScheduled RatingsApportionmentVocational ExpertSubstantial EvidenceLeBoeuf Rule
References
6
Case No. ADJ9513119
Regular
Aug 01, 2018

JOHN CALLANAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded the trial judge's take-nothing order due to insufficient factual and legal development regarding the applicant's psychiatric and internal injuries. The WCAB determined that further evidence is required to address causation and "actual events" of employment for the psychiatric claim, as well as to clarify opinions on specific versus cumulative trauma for both the psychiatric and internal injury claims. The matter was returned to the trial level for further proceedings and a new decision by the workers' compensation judge, with the WCAB expressing no final opinion on any substantive issue. The appeals board also noted potential issues with the good faith personnel action defense and the apportionment of impairment versus injury.

Workers' Compensation Appeals BoardPsychiatric InjuryActual Events of EmploymentCumulative TraumaSpecific InjuryGood Faith Personnel ActionPanic AttackAnxietyInternal System InjuryDyspepsia
References
11
Case No. ADJ9399845
Regular
Sep 26, 2016

VICENTE ESTRADA vs. MMK PACIFIC PETROLEUM, HANOVER INSURANCE GROUP

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review a prior award finding applicant sustained injury arising out of and occurring in the course of employment (AOE/COE) to his neck, low back, and right knee. The WCAB found the Agreed Medical Evaluator's (AME) opinion unpersuasive due to flawed reasoning regarding applicant's ability to continue working, and further found the treating physicians' opinions lacked substantial medical evidence, partly due to incomplete history and insufficient specialization. Consequently, the WCAB rescinded the prior award and returned the matter to the trial level for further proceedings, including the potential appointment of a new physician to examine the applicant. Applicant's own petition for reconsideration was dismissed as untimely.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardInjury AOE/COEPermanent DisabilityFuture Medical TreatmentAgreed Medical EvaluatorSubstantial Medical EvidenceCausationApportionment
References
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