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

Case No. ADJ79 96674
Regular
Mar 24, 2016

ARLZENIA HASLEY vs. EL CENTRO REGIONAL MEDICAL CENTER

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Removal, which sought to invalidate the medical evidence of the Agreed Medical Examiner (AME), Dr. Luros. The WCAB found that removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. The defendant's arguments regarding flawed medical opinions and the AME's unavailability can be addressed through standard appeal procedures. Furthermore, the defendant filed a supplemental pleading without prior permission, which was disregarded by the Board.

Petition for RemovalArlzenia HasleyEl Centro Regional Medical CenterTriStar Risk ManagementWCABWCJsubstantial prejudiceirreparable harmreconsiderationsupplemental pleading
References
2
Case No. ADJ3568698 (MON 0246436)
Regular
Nov 15, 2016

ROGER SCHENDEL vs. B&B SALES, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought renewed prescriptions for Norco and Omeprazole. Defendant contested the award of these medications, arguing the Workers' Compensation Appeals Board lacked jurisdiction due to a timely Utilization Review (UR) denial upheld by Independent Medical Review (IMR). The Board denied reconsideration, affirming the WCJ's award based on a stipulation agreement that waived the UR/IMR process in favor of an Agreed Medical Examiner (AME). The majority found defendant bound by the stipulation to abide by the AME's report, which deemed the prescriptions medically appropriate. A dissenting opinion argued the AME's report was insufficient for an award as it was not based on a current examination or complete review of the applicant's medical records.

WCABPetition for ReconsiderationFindings Award and OrdersStipulations with Requests for AwardsNorcoOmeprazoleSynvisc injectionsRequest for Authorization (RFA)Utilization Review (UR) denialIndependent Medical Review (IMR)
References
2
Case No. VNO 452114, VNO 452108
Regular
Aug 17, 2007

AURELIA SANCHEZ vs. PARACELSUS HEALTH CORP.

The Appeals Board granted reconsideration of the WCJ's decision, finding that the Agreed Medical Examiner's (AME) opinion regarding the applicant's neck injury was not substantial evidence. This was due to the AME's failure to review relevant medical records and consider the applicant's subsequent neck surgery. The case is returned to the trial level for further development of the record, including potentially obtaining a supplemental opinion from the AME or appointing a new medical examiner.

Workers Compensation Appeals BoardAurelia SanchezParacelsus Health Corp.industrial injurybilateral handswristsneck injuryorthopedic agreed medical examinerAMEDr. Jeffrey A. Berman
References
9
Case No. ADJ4406096 (LAO 0784412)
Regular

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER

Defendant sought removal from a WCJ's order stipulating to two Agreed Medical Evaluators (AMEs), alleging the WCJ "forced" the agreement. Applicant's attorney and the WCJ countered that defense counsel had agreed to and proposed the AMEs, with the WCJ merely documenting the stipulation. The Appeals Board denied removal as defendant showed no prejudice, but initiated its own removal to address the attorney's alleged false statements and vexatious tactics. Consequently, the Board intends to impose sanctions of up to $2,500 on the defendant and its attorneys for filing a frivolous petition containing misrepresentations.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical EvaluatorsWCJSanctionsBad Faith TacticsFrivolousUnnecessary DelayStipulationMisrepresentation of Facts
References
1
Case No. ADJ7498085 ADJ7264010
Regular
Dec 03, 2012

SANDRA CATLIN vs. JC PENNEY, INC., AMERICAN HOME ASSURANCE COMPANY

The Appeals Board granted reconsideration, rescinded the WCJ's award, and returned the matter to the trial level. While not finding the Agreed Medical Examiner's (AME) report inadmissible due to a procedural violation, the Board determined it lacked substantial medical evidence. The AME's report was deemed cursory and not based on adequate examination or reasoning to support the award of housekeeping services. Further proceedings are required to develop the record, potentially including a re-evaluation by the AME and cross-examination.

Workers Compensation Appeals BoardJoint Findings and AwardAgreed Medical Examiner (AME)Supplemental ReportLabor Code Section 4062.3Treating Physician ReportHousekeeping ServicesSubstantial Medical EvidenceReconsiderationRescind Decision
References
10
Case No. ADJ3388749 (VNO 0561016)
Regular
Nov 26, 2018

ROBERTA MOORE vs. CITY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration to address conflicting medical opinions from the Agreed Medical Examiner (AME) regarding the apportionment of applicant Roberta Moore's fibromyalgia disability. The AME's report initially apportioned 70% of the disability to the industrial injury, but later changed to 100% to the industrial component, citing remission of her non-industrial condition. The Board found this sudden change unexplained and is remanding the case for further clarification from the AME or a new medical examination. Additionally, the Board will allow parties to address permanent total disability findings in light of the *Fitzpatrick* decision.

Agreed Medical ExaminerFibromyalgiaCumulative TraumaApportionmentUndifferentiated Connective Tissue DiseasePermanent Total DisabilityVocational FeasibilityLabor MarketAgreed Medical Examiner (AME)Medical-Legal Expense
References
0
Case No. ADJ7361379
Regular
Oct 05, 2016

Hugh Lubkin vs. State of California, Board of Chiropractic Examiners, State Compensation Insurance Fund

The Appeals Board denied applicant's Petition for Removal, finding no irreparable harm or prejudice to warrant this extraordinary remedy. The Board held that a WCJ can order documents, including prior settlement and disability rating documents, be provided to an Agreed Medical Examiner (AME) when parties cannot agree. This aligns with WCAB Rule 53, which allows a WCJ to resolve discovery disputes regarding AME submissions. The Board also admonished applicant's counsel for violating procedural rules regarding inflammatory language and redundant filings.

Workers Compensation Appeals BoardPetition for RemovalAgreed Medical ExaminerCompromise and ReleaseDisability Evaluation UnitLabor Code 4062.3(c)WCAB Rule 10842Discovery DisputeSubstantial PrejudiceIrreparable Harm
References
2
Case No. MISSING
Regular Panel Decision

Equal Employment Opportunity Commission v. Grief Bros.

This employment discrimination case, filed July 1, 2002, involves Michael Sabo (Plaintiff) who alleges constructive discharge based on sexual harassment and claims severe emotional pain and suffering. The Defendant moved for a mental examination of Sabo under Fed.R.Civ.P. 35 and to compel the production of his medical records. Sabo alleged severe humiliation, anxiety, depression, loss of self-esteem, sleeplessness, and weight gain, and admitted to a history of depression, past suicide attempts, and current psychiatric treatment with prescribed medications. The court granted the Defendant's motions, finding that Sabo had placed his mental condition in controversy due to the nature and severity of his claims and his medical history, justifying both the examination and the production of relevant medical records. The court also granted Defendant's request for costs associated with compelling the medical records, but denied the request for costs related to the Rule 35 motion itself, and denied Plaintiff's request for counsel or recording during the examination.

Employment DiscriminationSexual HarassmentConstructive DischargeEmotional DistressMental ExaminationRule 35Medical RecordsDepressionSuicide AttemptsCompensatory Damages
References
11
Case No. ADJ2709955 (MON 0356320)
Regular
Jun 21, 2017

Mario Cocola vs. California Hospital Medical Center

The Workers' Compensation Appeals Board denied Mario Cocola's petition for reconsideration, upholding the finding that he sustained $69\%$ permanent disability from industrial injuries. Cocola argued the administrative judge erred by disregarding the Agreed Medical Examiner's opinion that he was totally disabled from the open labor market due to orthopedic injuries. The Board agreed with the judge's report that the physician's opinion lacked sufficient objective basis for the change in work restrictions. A dissenting opinion argued the medical and vocational evidence supported a $100\%$ permanent disability finding and requested clarification from the medical examiner.

Petition for ReconsiderationFindings of Fact and Awardpermanent disabilitycumulative traumalumbar spinecervical spinepsychecervicogenic headachesEmergency Unit CoordinatorAgreed Medical Examiner
References
1
Case No. ADJ8106886
Regular
Sep 12, 2013

HECTOR VAZQUEZ vs. DEUEL VOCATIONAL INSTITUTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of an administrative law judge's decision that applicant Hector Vazquez's heart disease was not industrially caused. The majority adopted the judge's report, noting a clerical error in identifying the medical examiner as an Agreed Medical Examiner (AME) instead of a Panel Qualified Medical Examiner, but found this did not affect the judge's analysis. Commissioner Brass dissented, arguing the record was undeveloped regarding job stress's contribution to the heart disease, and that the medical examiner's opinion was not substantial evidence to rebut the statutory presumption of industrial causation for correctional officers.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical ExaminerAgreed Medical Examinerheart diseasejob stresscorrectional officerpresumptionrebuttalsubstantial evidence
References
3
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