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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. 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. ADJ7816317, ADJ8290118
Regular
Apr 08, 2013

CANDY AMAYA vs. ATASCADERO STATE HOSPITAL

In two consolidated workers' compensation cases, both the applicant and defendant sought reconsideration of findings of permanent disability. The Administrative Law Judge (WCJ) admitted error in awarding 21% permanent disability for each of two left wrist injuries, conceding that the correct impairment should have been 6% Whole Person Impairment (WPI), translating to a 10% overall permanent disability award. The Workers' Compensation Appeals Board granted reconsideration, rescinded the original awards, and returned the matters to the trial level for redetermination of permanent disability. The Board took no position on issues of vocational expert rebuttals or cost recovery, allowing them to be raised in further proceedings.

Workers' Compensation Appeals BoardIndustrial InjuryPermanent DisabilityVocational ExpertScheduled DisabilityReconsiderationFindings and AwardsWPIAMA GuidesApportionment
References
0
Case No. ADJ6820873
Regular
Oct 29, 2010

Thomas Wong vs. CITY OF LOS ANGELES/LAPD, TRISTAR 29106 GLENDALE

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board denied the City of Los Angeles' petition for reconsideration of an award for an injured police officer. The defendant contended the WCJ erred in adopting the PQME's whole person impairment (WPI) ratings for hypertension and cardiomyopathy, and in finding the defendant failed to rebut the diminished future earning capacity (DFEC) component. The Board affirmed the WCJ's reliance on Dr. Carlish's WPI ratings, finding them supported by the AMA Guides and substantial evidence. Furthermore, the Board found the defendant failed to meet its burden of proof to rebut the scheduled DFEC rating, as their arguments lacked sufficient evidentiary support.

Workers' Compensation Appeals BoardIndustrial InjuryHypertensionHypertensive Heart DiseaseCardiomyopathyWhole Person Impairment (WPI)AMA GuidesDisability Evaluation SpecialistDiminished Future Earning Capacity (DFEC)Ogilvie v. City and County of San Francisco
References
6
Case No. ADJ1078163, ADJ3341185
Significant
Sep 03, 2009

Applicant vs. Workers' Compensation Appeals Board

The court holds that a permanent disability rating under the 2005 Schedule is rebuttable, but any rebuttal evidence concerning Whole Person Impairment (WPI) must be founded within the four corners of the AMA Guides.

AMA GuidesPermanent Disability RatingRebuttablePrima Facie EvidenceWhole Person ImpairmentScheduleLabor Code Section 4660SB 899En Banc DecisionWorkers' Compensation Appeals Board
References
73
Case No. ADJ1078163, ADJ3341185
En Banc
Sep 03, 2009

MARIO ALMARAZ, JOYCE GUZMAN vs. ENVIRONMENTAL RECOVERY SERVICES, STATE COMPENSATION INSURANCE FUND, MILPITAS UNIFIED SCHOOL DISTRICT, KEENAN & ASSOCIATES

This en banc decision clarifies that a permanent disability rating established by the Schedule is rebuttable, but any evidence to rebut the Whole Person Impairment (WPI) component must be based within the four corners of the AMA Guides.

AlmarazGuzmanWorkers' Compensation Appeals Boarden bancprecedentAMA Guides2005 Schedulepermanent disabilityrebuttableprima facie evidence
References
49
Case No. ADJ1735018
En Banc
Jun 03, 2010

CYNTHIA BLACKLEDGE vs. BANK OF AMERICA, ACE AMERICAN INSURANCE COMPANY

An en banc decision clarifying the respective roles of the evaluating physician, the workers’ compensation administrative law judge (WCJ), and the disability rater in determining whole person impairment (WPI). The Appeals Board amended the WCJ's decision and remanded the matter for further proceedings.

AMA GuidesWhole Person ImpairmentPhysician's RoleWCJ's RoleRater's RoleFormal Rating InstructionsSubstantial Medical EvidenceDisability Evaluation UnitNon-Formal RatingsEx Parte Communication
References
32
Case No. ADJ1735018
Significant
Jun 03, 2010

CYNTHIA BLACKLEDGE vs. BANK OF AMERICA, ACE AMERICAN INSURANCE COMPANY

This en banc decision clarifies the distinct roles of the evaluating physician, the workers’ compensation administrative law judge (WCJ), and the disability rater in determining whole person impairment (WPI) under the AMA Guides, and remands the specific case for reassessment of the permanent disability.

AMA GuidesWhole Person ImpairmentPhysician's RoleWCJ's RoleRater's RoleFormal RatingPermanent DisabilitySubstantial EvidenceDRE Lumbar Category IIPatellofemoral Pain Syndrome
References
33
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
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