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

Case No. ADJ4397000
Regular
Jun 10, 2011

MARIA MERCEDES FELIX vs. SEA DWELLING CREATURES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that applicant Maria Mercedes Felix has 0% whole person impairment for her back injury and requires no further medical treatment. This decision was based on the opinion of a qualified medical evaluator (PQME) whose findings were consistent with a prior medical report. The PQME's report concluded that various diagnostic tests were normal and revealed no significant clinical findings, structural alterations, or neurological impairment. Crucially, the Appeals Board clarified that a 3% pain add-on for whole person impairment is legally permissible only to increase an already established impairment rating, which was not the case here as the initial rating was zero.

Workers' Compensation Appeals BoardReconsideration deniedExpert medical evidencePanel Qualified Medical Evaluator (PQME)American Medical Association Guides (AMA Guides)Permanent ImpairmentWhole Person Impairment (WPI)DRE Lumbar Category IMedical treatmentPain add-on
References
2
Case No. 2016-01-0139
Regular Panel Decision
Mar 03, 2023

Brown, Binnie v, Whole Foods Markets, Inc.

Bonnie Brown, an employee of Whole Foods, sought psychiatric evaluation for impairment and ongoing treatment for a mental injury allegedly stemming from a 2015 spinal injury. Whole Foods opposed, arguing a lack of authorized referral and unproven work-relatedness of the mental injury. The Court acknowledged the problem of obtaining mental impairment assessments when only non-physician providers (psychologists) have been authorized, citing Tennessee law that limits impairment ratings to physicians. Consequently, the Court found no mechanism to compel Whole Foods to provide a psychiatrist panel solely for impairment assessment. However, based on Ms. Brown's credible testimony and corroborating medical records, the Court ruled that she would likely prevail in establishing her need for ongoing psychological care. The Court ordered Whole Foods to authorize Ms. Brown to return to Dr. Henriksen or provide a panel of psychologists/psychiatrists for assessment of her need for ongoing care and/or referral.

Mental injuryWorkers' CompensationPsychological evaluationChronic painDepressionAnxietyCausationImpairment ratingPsychiatric referralAuthorized treatment
References
4
Case No. M2009-02442-COA-R3-CV
Regular Panel Decision
Oct 28, 2010

Estate of David Holt Ralston, by John A. Ralston, Personal Representative v. Fred R. Hobbs

The personal representative of David Holt Ralston's estate filed an action to rescind twelve deeds executed by Fred R. Hobbs, the decedent's attorney-in-fact, without the decedent's knowledge and for no consideration. The properties were conveyed to Hobbs, his mother, and his daughter. The personal representative alleged breach of fiduciary duty. The trial court rescinded the conveyances for properties still owned by Hobbs and awarded monetary damages for properties transferred to innocent third parties. On appeal, Hobbs challenged the personal representative's standing, statute of limitations, the finding of fiduciary duty breach, and damage calculation. The Court of Appeals affirmed the trial court's decision on all grounds, finding the personal representative had standing, the action was timely filed, and Hobbs breached his fiduciary duty by making unauthorized gifts not in line with the principal's gifting history.

Fiduciary DutyPower of AttorneyReal Property ConversionStatute of LimitationsDeed RescissionMonetary DamagesAppellate ReviewEstate LawUndue InfluenceAttorney-in-Fact Breach
References
32
Case No. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
1
Case No. 08-04-00018-CV
Regular Panel Decision
Jun 30, 2005

Financial Insurance Co. v. William Ragsdale

This appeal concerns a jury verdict in a workers’ compensation case regarding William Ragsdale's impairment rating. William Ragsdale, an employee of MR Drilling or MR Oil, suffered a fall in 2001 and filed a workers' compensation claim. While his treating physician assigned a 0% impairment rating, the designated doctor, Dr. Steven Ellsworth, initially indicated 10% on a form but stated a 'whole person impairment' of 67% in his report. The Texas Workers’ Compensation Commission Appeals Panel subsequently determined the impairment rating to be 67%. Financial Insurance Company, the employer’s carrier, appealed the trial court's judgment affirming this 67% rating and the award of attorney's fees. The Court of Appeals affirmed the judgment of the trial court.

Workers' CompensationImpairment RatingAppellate ReviewJury VerdictMedical EvidenceDesignated DoctorTreating PhysicianAttorney's FeesTexas Labor CodeJudicial Review
References
18
Case No. 2022 NY Slip Op 00289
Regular Panel Decision
Jan 18, 2022

Matter of Personal-Touch Home Care of N.Y., Inc. v. City of N.Y. Human Resources Admin.

The Appellate Division affirmed the Supreme Court's judgment, which denied a petition to overturn a decision by the Office of Administrative Trials and Hearings Contract Dispute Resolution Board (CDRB). The CDRB had found that Personal-Touch Home Care's claim to use unspent Medicaid funds for fiscal year 2007 to offset workers' compensation assessment expenses from 2009-2010 was foreclosed. The court agreed that the State Department of Health (DOH) rationally interpreted its regulations, concluding that these retroactive assessments, levied due to financial mismanagement of a self-insurance trust, were not

Workers' CompensationMedicaid FundsSelf-Insurance TrustFiscal YearRetroactive AssessmentAdministrative LawAgency DeferenceContract DisputeHealth Care AgenciesFinancial Mismanagement
References
4
Case No. 2019-06-1190
Regular Panel Decision
Jan 19, 2021

Williams, Stefanie v. Lifepoint Hospitals, Inc.

Stefanie Williams, a registered nurse, suffered a work-related back injury while employed by LifePoint Hospitals, Inc. The core dispute revolved around determining the extent of permanent impairment from this injury, complicated by a prior non-work-related back surgery and conflicting interpretations of Dr. George Lien's medical reports and testimony. Dr. Lien, the authorized physician, initially reported a twelve-percent total impairment but later differentiated, attributing five-percent impairment to the work injury if previous radicular symptoms had resolved, or none otherwise. The Court, finding Ms. Williams's testimony credible that her prior symptoms had resolved, ruled she sustained a five-percent whole-person impairment from the work injury. As a result, LifePoint was ordered to pay additional permanent partial disability benefits of $7,872.41 and provide future medical treatment with Dr. Lien.

Workers' CompensationPermanent Partial DisabilityMedical ImpairmentPre-existing ConditionRadicular SymptomsCredibilityBack InjuryNurseCompensation RateTennessee Bureau of Workers’ Compensation
References
3
Case No. NO. 03-06-00631-CV
Regular Panel Decision
Mar 26, 2009

Samuel Campos v. Texas Property & Casualty Insurance Guaranty Association for Reliance National Indemnity Company, an Impaired Carrier

Samuel Campos, an employee, was injured on the job, leading to disputes over his impairment rating and reimbursement for travel expenses. The Texas Workers’ Compensation Commission affirmed a designated doctor's 6% impairment rating and denied travel expenses, which Campos challenged in court. The case involved the Texas Property & Casualty Insurance Guaranty Association (TPCIGA) because Campos's employer's insurer became impaired. Initially filed in Winkler County, the case was transferred to Travis County, where TPCIGA was granted summary judgment. The Third District Court of Appeals reversed the summary judgment, ruling that the Workers' Compensation Act's specific mandatory venue provision, which places venue in the county of the employee's residence at the time of injury (Winkler County), overrides the Guaranty Act's general venue provision, which would place it in Travis County. The court remanded the case with instructions to transfer it to Winkler County.

Workers' CompensationVenue DisputeMandatory VenueStatutory ConstructionTexas Labor CodeTexas Insurance CodeImpairment RatingTravel Expenses ReimbursementJudicial ReviewAppellate Procedure
References
12
Case No. ADJ9183350
Regular
Nov 02, 2016

MEGAN PRELL vs. CEDAR FAIR, L.P. dba as KNOTT'S BERRY FARM, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, finding that the original permanent disability rating of 2% was insufficient. The Board adopted the Panel Qualified Medical Evaluator's (PQME) finding of 15% Whole Person Impairment (WPI), applying the *Almaraz-Guzman* doctrine. This doctrine allows physicians to use clinical judgment, drawing upon the entire AMA Guides, to more accurately reflect an injured employee's impairment. The applicant's continued symptoms, post-surgery, and MRI findings supported the PQME's higher impairment rating.

WCABPERMANENT DISABILITYWHOLE PERSON IMPAIRMENTWPIAMA GUIDESALMARAZ-GUZMANPQMEORTHOPEDIC SURGERYLEFT SHOULDER INJURYINDUSTRIAL INJURY
References
3
Case No. ADJ7238353
Regular
Dec 10, 2012

Arthur Cannon vs. CITY OF SACRAMENTO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the denial of permanent disability for Arthur Cannon, a police officer injured in 2008. An Agreed Medical Examiner (AME) opined that while objective findings were minimal, the applicant's heel pain justified a 7% Whole Person Impairment rating by analogy to gait derangement. The WCAB found the AME's analogy was permissible under *Almaraz/Guzman* to address impairments not specifically covered by the AMA Guides, thus rescinding the original award. The dissenting opinion argued there was no objective evidence of impairment in earning capacity, normal member use, or competitive handicap, and therefore no basis for the rating.

Workers' Compensation Appeals BoardArthur CannonCity of SacramentoReconsiderationPermanent Disability Rating ScheduleAgreed Medical ExaminerAMA GuidesWhole Person ImpairmentPlantar FasciitisGait Derangement
References
5
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