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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ2211265 (AHM 0083473) ADJ4072860 (AHM 0083472)
Regular
May 06, 2011

Darlyn Piper vs. DANKA OFFICE IMAGING, ZURICH NORTH AMERICA, LIBERTY MUTUAL INSURANCE CO.

This case concerns applicant Darlyn Piper's appeal of a permanent disability award for injuries sustained while employed by Danka Office Imaging. Applicant argues for total permanent disability, challenging the WCJ's reliance on Dr. Marinow's apportionment and deposition testimony. The Appeals Board granted reconsideration because the WCJ failed to address the admissibility of Dr. Marinow's deposition testimony. The case is therefore remanded for the WCJ to determine the deposition's admissibility and weight before issuing a new decision.

Darlyn PiperDanka Office ImagingZurich North AmericaLiberty Mutual Insurance Co.permanent disabilitytotal permanent disabilityvocational rehabilitationDr. Marinowapportionmentnon-industrial factors
References
Case No. STK 183882
Regular
Feb 24, 2009

ROBERTO REYES vs. NEW IMAGE FOAM PRODUCTS INC., EVEREST NATIONAL INSURANCE COMPANY

This case concerns whether the 1997 or 2005 Permanent Disability Rating Schedule should apply to an applicant's back injury. The majority affirmed the administrative law judge's use of the 2005 schedule, finding no basis to deviate. However, a dissenting commissioner argued the 1997 schedule should have been used, citing the employer's May 2004 admission that the treating physician indicated permanent disability. This admission, the dissent argued, falls under an exception to the 2005 schedule's applicability, as interpreted by relevant case law.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability Rating Schedule1997 PDRS2005 PDRSLabor Code section 4660(d)Treating Physician ReportPermanent and Stationary StatusVocational RehabilitationAdmission
References
Case No. ADJ1292068 (STK 0203177)
Regular
Apr 26, 2010

Kenneth Bryant vs. STAFF MARK INVESTMENT LLC, AMERICAN HOME ASSURANCE COMPANY, CHARTIS

The defendant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision awarding permanent disability and asserting estoppel regarding earnings. The WCAB granted reconsideration, finding the judge erred by treating an initial answer's earnings admission as a final stipulation. The Appeals Board determined that the issue of earnings was actively disputed and evidence was presented, thus the prior admission was withdrawn. Consequently, the WCAB rescinded the decision and returned the matter for further proceedings to determine average weekly wages and other related issues.

WCABReconsiderationOpinion and OrderFindings Award and OrderPermanent DisabilityTemporary DisabilityEarningsOverpaymentCreditAdmission
References
Case No. ADJ2375135 (MON 0350920) ADJ3115402 (MON 0350919)
Regular
Nov 09, 2011

ISAIAS H. AYALA vs. D & D MOVE IT TREES COMPANY, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the WCJ's award of home care to the applicant, ordering the case returned for further proceedings and a new decision. This action stems from disputed stipulations regarding the admissibility of a PQME report and the reliability of a secondary treating physician's recommendations. Key issues to be clarified include the exact stipulations made, the admissibility of medical reports, and the reasonableness and necessity of the proposed 24/7 home care, along with its specific parameters. The WCJ must address these foundational issues before making a new determination on home care.

Workers' Compensation Appeals BoardReconsiderationHome CarePrimary Treating PhysicianSecondary Treating PhysicianPanel Qualified Medical Evaluator (PQME)AdmissibilityStipulationMedical TreatmentPsychiatric Injury
References
Case No. ADJ6820997
Regular
Feb 08, 2012

RODOLFO VILLALOVOS vs. ACE BEVERAGE COMPANY, TOPA INSURANCE COMPANY

This case involves a dispute over the admissibility of medical reports from a physician outside the defendant's Medical Provider Network (MPN) and the subsequent award of temporary and permanent disability benefits. The Appeals Board rescinded the original decision due to unresolved issues regarding the proper establishment and notice of the MPN. The case is returned to the trial level for further proceedings to determine the validity of the MPN and the admissibility of the medical evidence. The WCJ must also clarify whether certain QME reports were admitted into evidence, as reliance on unadmitted evidence is improper.

MPNValdezPrimary Treating PhysicianReconsiderationMedical Provider NetworkInadmissible ReportsStipulationTemporary DisabilityPermanent DisabilityMedical Treatment
References
Case No. ADJ2275744
Regular
Mar 28, 2011

LARRY COLE vs. LOS ANGELES COUNTY METROPOLITAN TRANSPORTATION AUTHORITY, TRAVELERS INSURANCE COMPANY

In *Cole v. Los Angeles County Metropolitan Transportation Authority*, the Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of a favorable award for the applicant. The Board affirmed the finding of industrial injury to the applicant's low back and psyche, resulting in a 78% permanent disability rating. The defendant's objections regarding the admissibility of psychiatric reports and apportionment of disability were rejected, with the Board finding the defendant waived the admissibility issue by failing to object at trial. The Board also held the defendant failed to meet its burden of proof for apportionment regarding both psyche and low back disability.

ADJ2275744MON 0298527Larry ColeLos Angeles County Metropolitan Transportation AuthorityTravelers Insurance CompanyreconsiderationFindings of Fact & Awardindustrial injurylow back injurypsyche injury
References
Case No. ADJ3289260
Regular
Dec 15, 2008

MIGUEL MOGUEL vs. KITTRICH CORPORATION, ACE PROPERTY AND CASUALTY COMPANY c/o ESIS

The Appeals Board granted the defendant's petition for reconsideration and rescinded the WCJ's prior award due to procedural errors. Specifically, the defendant argued that the WCJ improperly admitted medical reports and held an expedited hearing before the panel QME process was complete, especially concerning disputed injuries to the left shoulder and neck. The case is returned to the trial level for further proceedings to properly develop the record.

Petition for ReconsiderationExpedited HearingTemporary Disability IndemnityLeft Shoulder SurgeryQualified Medical Evaluator (QME)Labor Code Section 4062Medical Reports AdmissibilityTreating PhysicianReport of Panel QMERescinded Findings and Award
References
Case No. ADJ2522892 (ANA 0394094)
Regular
Mar 03, 2009

DONNA SMITH vs. MASTER FINANCIAL, INC., MIDCENTURY INSURANCE COMPANY

This case involves an admitted industrial injury to the applicant's upper extremities, with the Workers' Compensation Appeals Board (WCAB) granting reconsideration of a previous award. The WCAB rescinded the original award due to the trial judge's failure to rule on the defendant's objection to the admissibility of a key medical report. The admissibility of this report, which reviewed an inadmissible prior opinion, is central to determining permanent disability and related benefits like a supplemental job displacement voucher. The case is returned to the trial level for an express ruling on the report's admissibility and further proceedings on the remaining issues.

Workers' Compensation Appeals BoardReconsiderationFindings of Fact and AwardIndustrial InjuryUpper ExtremitiesBankruptcy ManagerMaster FinancialMid-Century Insurance CompanyPermanent DisabilitySupplemental Job Displacement Voucher
References
Case No. TI11710087
Regular
Nov 20, 2018

Theodore Davis vs. CITY OF MODESTO, YORK INSURANCE SERVICES, GROUP, INC.

This case involves applicant Theodore Davis's prostate cancer claim against the City of Modesto. The core dispute centers on the admissibility and review of a medical report by Dr. Besses. The Appeals Board initially denied review of Dr. Besses' report but, following a court of appeal remittitur, is now granting removal. The matter is returned to the trial level for the WCJ to re-evaluate the admissibility of Dr. Besses' report under Labor Code section 4605 and related rules, and whether it can be provided to the QME. This decision clarifies that while QME evaluations are required for compensability disputes, privately obtained medical reports may still be admissible.

RemittiturPetition for RemovalPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4060Labor Code Section 4605Admissibility of Medical ReportsEx Parte CommunicationCumulative TraumaSpecific Injury
References
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