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

Case No. ADJ7348149
Regular
Mar 18, 2019

CELINE ROUYA vs. SAVE MART SUPERMARKETS, CORVEL CORPORATION

The applicant appeals the WCJ's decision denying injury to psyche and other body parts, arguing the WCJ erred by not addressing her harassment claim and finding the personnel actions were in good faith. The Appeals Board granted reconsideration to further study the issues, noting discrepancies in witness testimony and insufficient medical opinions on causation. The case is returned to the WCJ for further proceedings to develop the record, including obtaining clarified medical opinions on causation and further testimony. The dissenting commissioner would affirm the WCJ's decision, finding the personnel actions were legal and non-discriminatory, and applicant's harassment claims were not supported by objective evidence.

Workers' Compensation Appeals BoardCeline RouyaSave Mart SupermarketsCorvel CorporationADJ7348149ReconsiderationPsychiatric InjuryPharmacy TechnicianHarassmentNational Origin
References
5
Case No. ADJ8657415
Regular
Oct 06, 2017

Oliver Boutte IV (Deceased) vs. U.S. XPRESS ENTERPRISES, LIBERTY MUTUAL INSURANCE COMPANY

This Workers' Compensation Appeals Board case involved a petition for reconsideration filed by U.S. Xpress Enterprises and Liberty Mutual Insurance Company. The defendants argued that the medical report relied upon by the Workers' Compensation Judge (WCJ) was not substantial evidence, specifically regarding the timing of the employee's death from a pulmonary embolus. The Board denied the petition, adopting the WCJ's report which found the physician's opinion to be substantial medical evidence based on adequate examination and reasoning. The Board concluded the WCJ properly found this opinion more persuasive than the opposing medical opinion.

Oliver Boutte IVU.S. Xpress EnterprisesLiberty Mutual Insurance CompanyADJ8657415Petition for ReconsiderationWorkers' Compensation Appeals Boardsubstantial evidencemedical opinionpulmonary embolusreasonable medical probability
References
3
Case No. ADJ9447222
Regular
Jun 23, 2015

Gloria Gutierrez vs. Moonlight Companies, Zenith Insurance Company

The Appeals Board denied the applicant's petition to disqualify the Administrative Law Judge (WCJ). The applicant alleged the WCJ formed an unqualified opinion on the merits of the case. While the WCJ initially dismissed the claim based on a misunderstanding of the law, he later rescinded the dismissal and scheduled further proceedings. The Board found no evidence the WCJ formed an unqualified opinion and believes he can render a fair hearing.

Petition for disqualificationWorkers' Compensation Appeals BoardWCJunqualified opinionmerits of actionLabor Code section 3600(a)(10)post-termination defensereporting of injuriesCode of Civil Procedure section 641(f)Order Rescinding Dismissal
References
0
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
1
Case No. ADJ10870145, ADJ8277957
Regular
Jan 30, 2023

CARLOS LOPEZ vs. PORTERVILLE SHELTERED WORKSHOP, MANUFACTURERS ALLIANCE INSURANCE COMPANY, AMERICAN CLAIMS MGMT., TREE & SIERRA MGMT., SIERRA MGMT., CIGA, INTERCARE HOLDINGS, ULLICO CASUALTY COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant sustained cumulative trauma injury while employed by both Sierra Management and Porterville Sheltered Workshop. This decision was based on the WCJ adopting the opinion of Dr. Bernhard, which was found to be substantial evidence despite conflicting medical opinions. The Board affirmed that a single physician's considered opinion can suffice as substantial evidence, even if it contradicts other medical findings. The Petitioner's arguments regarding the WCJ's reasoning and conflicting medical opinions were rejected.

ADJ10870145ADJ8277957Petition for ReconsiderationWorkers' Compensation Appeals BoardWCJ Report and Opinionsubstantial evidencephysician opinioncumulative injuryCIGAManufacturers Alliance Insurance Company
References
2
Case No. ADJ10282606, ADJ10283736
Regular
Feb 06, 2019

DARLENE BATTLE vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded the WCJ's previous findings and awards in both consolidated cases, ADJ10282606 and ADJ10283736. The primary issue concerned the determination of permanent disability for the applicant's right knee injury, specifically whether the medical opinion of Dr. Glousman was substantial evidence. The Board found Dr. Glousman's report lacked sufficient explanation for his impairment ratings according to AMA Guides, and the WCJ improperly supplemented this opinion. Consequently, the matter was returned to the trial level for further proceedings and new decisions by the WCJ.

Workers' Compensation Appeals BoardPermanent DisabilityAMA GuidesQualified Medical EvaluatorSubstantial EvidenceApportionmentReconsiderationFindings and AwardMedical OpinionCorrectional Officer
References
7
Case No. ADJ7877096
Regular
Jan 23, 2017

OGANES KARDZHYAN vs. DR. PEPPER SNAPPLE GROUP, CHARTIS INSURANCE CO./AIG CLAIM SERVICES

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, finding the WCJ failed to address the substantiality of Dr. Pietruszka's opinion regarding industrial causation for psoriatic arthritis, diabetes, and headaches. The Board amended the WCJ's findings to include previously established injuries and returned the matter for further proceedings. The WCJ is directed to consider Dr. Pietruszka's opinion and develop the record on orthopedic injuries. This decision is not final and allows for future reconsideration of the WCJ's new ruling.

Petition for ReconsiderationMedical OpinionPsoriatic ArthritisDiabetesHeadachesIndustrially CausedSubstantial Medical EvidenceDevelop the RecordOrthopedic InjuriesPsyche
References
2
Case No. ADJ7207861
Regular
May 06, 2011

STEVE TORDINI vs. JAMES DIEDRICH, PREFERRED EMPLOYERS INS. CO.

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contention that the WCJ erred in relying on the treating physician's opinion over the PQME's regarding permanent disability and apportionment. The Board found the treating physician's opinion unsubstantiated, as it included unqualified legal conclusions and improperly utilized AMA Guides criteria for apportionment. Consequently, the WCAB rescinded the prior award and returned the case for a new decision, directing the WCJ to base findings on the PQME's report. A dissenting opinion argued that both medical opinions were flawed and recommended further medical development.

PQMEWCJWPIapportionmentLabor Code sections 46634664Almaraz IIAMA GuidesDRE Lumbar Category IVdisc protrusion
References
4
Case No. VNO 400907, VNO 400906
Regular
Jan 24, 2008

JORGE ESCOBEDO vs. WESTLAKE INN RESTAURANT & HOTEL, CALIFORNIA INDEMNITY INSURANCE COMPANY, SIERRA INSURANCE GROUP

This Workers' Compensation Appeals Board case involves applicant Jorge Escobedo seeking benefits for injuries presumed compensable under Labor Code section 5402. The Appeals Board affirmed the Administrative Law Judge's (WCJ) decision, finding that the defendant failed to rebut the presumption of injury and that applicant's injuries did not require further medical treatment or result in temporary disability, largely based on the WCJ's adverse credibility finding. A dissenting opinion argued that the WCJ's findings on no treatment or disability improperly abrogated the 5402 presumption and suggested appointing a "regular physician" to resolve conflicting medical opinions.

ReconsiderationRebuttable presumptionCompensabilityLabor Code 5402Medical treatmentTemporary disabilityPermanent disabilityApportionmentAttorney's feesSubstantial evidence
References
4
Case No. ADJ7781219
Regular
Nov 19, 2019

CHARLES SINCLAIR vs. RICHARD J. DONOVAN CORRECTIONAL FACILITY; Legally Uninsured; administered by STATE COMPENSATION INSURANCE FUND/ STATE CONTRACT SERVICES

This case involves Charles Sinclair, a Licensed Vocational Nurse, who sustained an injury to his hands, wrists, and upper extremities on December 21, 2010, resulting in complex regional pain syndrome. The WCJ found Sinclair to be 100% permanently disabled based on the opinions of treating physicians Dr. Baker and Dr. Pelton, and vocational expert Enrique Vega, despite conflicting opinions from other medical examiners. The defendants petitioned for reconsideration, arguing a lack of substantial evidence and insufficient apportionment to prior injuries. The Board denied reconsideration, upholding the WCJ's findings and adopting the WCJ's report, which found the defendant failed to meet their burden of proof regarding apportionment.

Complex Regional Pain SyndromeVocational ExpertApportionmentSubstantial EvidenceAgreed Medical ExaminerQualified Medical ExaminerPermanent DisabilitySynergistic EffectPain ManagementCredibility Determination
References
4
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