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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. 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 The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record.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. 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
Case No. ADJ3600842 (SDO 0363689)
Regular
Jan 27, 2010

THEMAS POULIN vs. COUNTY OF SAN DIEGO

This case involves an applicant who sustained an industrial injury to his heart and hypertension. The initial award granted 65% permanent disability, which the defendant challenged, arguing the assigned Whole Person Impairment was disproportionately high and that Diminished Future Earning Capacity should be zero. The Appeals Board rescinded the original award and returned the matter for a new decision. This is because the trial judge had not yet considered the implications of the recent en banc decisions in *Almaraz II* and *Ogilvie II* regarding the rebuttability of scheduled permanent disability ratings and the evaluation of Diminished Future Earning Capacity. The Board noted concerns about the assigned impairment rating in light of the applicant's return to work and potential future earning capacity.

Workers' Compensation Appeals BoardDeputy SheriffIndustrial InjuryHeart ConditionHypertensionPermanent DisabilityWhole Person ImpairmentAgreed Medical EvaluatorReconsiderationAlmaraz
References
5
Case No. ADJ7906891, ADJ8200274
Regular
Nov 13, 2013

MARILYN LEVEQUE vs. CABRILLO CARE CENTER, CARE WEST PEGASUS

The Appeals Board reconsidered a Joint Findings and Award that found Applicant had a 62% disability due to two industrial injuries, rebutting the Permanent Disability Rating Schedule (PDRS). The Board found the vocational expert's attempt to rebut the PDRS by combining work restrictions from separate injuries was improper. Additionally, the Agreed Medical Examiner's apportionment opinion lacked sufficient reasoning to be considered substantial evidence. Consequently, the Board amended the award, rating each injury individually based on the AME's whole person impairment ratings and applying the PDRS accordingly.

Permanent Disability Rating ScheduleRebuttalApportionmentVocational ExpertAgreed Medical ExaminerCumulative TraumaSpecific InjuryWhole Person ImpairmentLabor Market AccessWork Restrictions
References
7
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. ADJ6760596
Regular
May 23, 2018

SAMUEL ESPINOZA vs. EXCEL STAFFING SERVICES, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend a prior decision regarding applicant Samuel Espinoza's work injury. The Board increased Espinoza's lumbar spine Whole Person Impairment (WPI) from 29% to 45%, based on the agreed medical examiner's alternative rating which was deemed more accurate. Consequently, Espinoza's permanent disability rating was increased from 43% to 57%. The Board also deferred the issue of mileage reimbursement.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardWhole Person Impairmentlumbar spineagreed medical examinerAMA Guidespermanent disabilitysexual dysfunctionurological issues
References
0
Case No. ADJ8558787
Regular
Apr 11, 2017

Mario Diaz vs. The Gainey Vineyard, Crump & Forster, United States Fire Insurance

This case involves Mario Diaz's workers' compensation claim for a lumbar spine injury. The Appeals Board granted reconsideration to amend the award, finding the agreed medical examiner's apportionment to pre-existing spondylolisthesis was not sufficiently justified. The Board also corrected the permanent disability rating calculation, utilizing the examiner's 34% whole person impairment instead of the initial 45% regional impairment, ultimately awarding 48% permanent disability without apportionment.

WCABapportionmentpermanent disabilityspondylolisthesisdegenerative disc diseaseAgreed Medical ExaminerAMEEscobedoAlmaraz-GuzmanWhole Person Impairment
References
7
Case No. ADJ4648769 (RIV0066289)
Regular
Mar 11, 2009

MARLON AGUIRRE vs. JACK IN THE BOX, CNA INSURANCE COMPANY

The Appeals Board granted reconsideration of a prior award finding 41% permanent disability for a left knee injury. The Board rescinded the award because the judge's permanent disability rating was not supported by the evidence, specifically the Agreed Medical Examiner's finding of only 17% whole person impairment. The case was returned to the trial level for further proceedings, including formal DEU rating instructions. Additionally, the Board noted the defendant's argument for a 15% reduction in benefits appears inapplicable to the 2004 injury date.

Workers' Compensation Appeals BoardADJ4648769Marlon AguirreJack in the BoxCNA Insurance CompanyReconsiderationFindings and AwardWorkers' Compensation Judge (WCJ)Industrial InjuryLeft Knee
References
0
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