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

Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ10815810
Regular
May 06, 2019

Derrell Meek vs. Corcoran State Prison, State Compensation Insurance Fund

The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's decision, overturning the finding of 86% permanent disability. The Board found that the physician's initial assessment of 75% whole person impairment for hypertensive cardiovascular disease, as per the AMA Guides, was appropriate. This 75% impairment was then adjusted to permanent total disability, recognizing that the scheduled rating adequately addressed the applicant's condition. The decision ultimately awarded permanent total disability indemnity and ongoing medical treatment.

Workers' Compensation Appeals BoardCorcoran State PrisonState Compensation Insurance FundDerrell Meekcorrectional officercirculatory systempermanent disabilityMilpitas Unified School District v. Workers' Comp. Appeals Bd. (Guzman)alternative impairment analysisAMA Guides
References
Case No. ADJ6662275
Regular
Jun 13, 2011

DARRIN BEAN vs. CITY OF CHULA VISTA

This case involves an applicant seeking workers' compensation for a skin cancer injury. The applicant contests the testimony of an independent medical expert, Dr. Brigham, who offered an opinion on his impairment rating that differed from the agreed medical evaluator's (AME). The Appeals Board granted the applicant's Petition for Removal, ruling that Dr. Brigham's testimony was inadmissible as he was neither an AME nor a treating physician and his testimony was not in rebuttal to formal rating instructions. Consequently, Dr. Brigham's testimony was stricken, the prior order was rescinded, and the case was returned to the trial level for further proceedings based solely on admissible medical evidence.

Petition for RemovalAgreed Medical EvaluatorAMA GuidesWhole Person ImpairmentPermanent Disability RatingClass 1 ImpairmentClass 2 ImpairmentClass 3 ImpairmentMedical Evidence AdmissibilityRebuttal Testimony
References
Case No. ADJ7927652
Regular
Oct 25, 2016

Bozenna Kasperowicz vs. Metropolitan State Hospital, State Compensation Insurance Fund

This case involves an industrial injury to the applicant, a psychiatric technician, sustained on June 14, 2011, from a patient strike to the head. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over psychiatric impairment and a sleep disorder rating. The WCAB affirmed the original award but reduced the permanent disability rating from 76% to 70% by excluding the sleep dysfunction impairment. The WCAB found Dr. O'Brien's opinion on psychiatric impairment more persuasive than conflicting medical evaluations and determined Dr. Matos's opinion on sleep impairment lacked substantial medical evidence due to staleness.

WCABReconsiderationPsychiatric ImpairmentWhole Person ImpairmentGAF ScoreSleep DisorderSubstantial Medical EvidencePermanent DisabilityQualified Medical EvaluatorInsomnia
References
Case No. ADJ7713711
Regular
Mar 11, 2016

JULIANA MASTERS vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES

The Appeals Board denied reconsideration of the WCJ's decision, upholding the finding that applicant's sleep impairment, though present, was subsumed by the physical upper extremity impairments and thus not separately ratable. The Board found the Agreed Medical Examiner's opinion on sleep disorder impairment was not substantial evidence as it was predicated on pain already accounted for in the physical injury ratings per the AMA Guides. Therefore, the applicant's permanent disability rating remained at 69%. A dissenting opinion argued the Agreed Medical Examiner's opinion should be followed, as it addressed distinct impairments beyond pain and was supported by relevant case law.

Workers' Compensation Appeals BoardAmended Findings of Fact and AwardsIndustrial InjuryUpper ExtremitiesPsycheBook BinderSleep ImpairmentAMA GuidesPermanent DisabilityAgreed Medical Examiner
References
Case No. ADJ10243412
Regular
Jun 10, 2019

DEBRA LUX vs. COUNTY OF SANTA BARBARA

This case involves an injured firefighter seeking workers' compensation for a right knee injury. The defendant sought reconsideration of a finding of 17% permanent disability, arguing the administrative law judge erred by combining range of motion and diagnosis-based impairments, and by not apportioning the diagnosis-based impairment. The Appeals Board denied reconsideration, finding the medical evaluator adequately explained the departure from standard AMA Guides methodology for rating the combined impairments. The Board also affirmed no apportionment of the diagnosis-based impairment as no substantial evidence showed non-industrial factors contributed to the need for surgery.

Workers' Compensation Appeals BoardApplicantDefendantPermissibly Self-InsuredAdministered by CORVELFirefighterIndustrial InjuryRight KneePermanent DisabilityWhole Person Impairment
References
Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
Case No. ADJ10307426
Regular
Dec 10, 2018

CHRISTOPHER DEVEREUX vs. STATE COMPENSATION INSURANCE FUND

This case involves applicant Christopher Devereux seeking reconsideration of a 90% permanent disability award for cumulative trauma, primarily hypertension and cognitive impairment, as an attorney. The defendant contested the award, arguing the permanent disability rating should have been calculated using the Combined Value Chart (CVC) instead of simple addition. The Board granted applicant's reconsideration to amend the award for future medical treatment and to include annual increases based on the state average weekly wage. Ultimately, the Board affirmed the 90% permanent disability rating, finding the additive method was appropriate based on medical expert opinions, and denied the defendant's petition.

WCABPermanent Disability RatingCumulative TraumaHypertensionDiabetesHeart ImpairmentCirculatory ImpairmentCognitive ImpairmentApportionmentAddition Method
References
Case No. ADJ7181658
Regular
May 13, 2014

Sheriee Borela vs. State of California, Department of Motor Vehicles, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration and rescinded a previous award. The employer challenged the administrative law judge's (ALJ) method of combining orthopedic and psychiatric permanent disability ratings, arguing it should have used the Combined Values Chart (CVC) instead of simple addition. The Board found the ALJ abused her discretion by not applying the CVC without sufficient medical evidence to justify an alternative method. The case was returned for a new permanent disability rating utilizing the CVC.

Workers' Compensation Appeals BoardPermanent Disability RatingCombined Values ChartOrthopedic ImpairmentsPsychiatric ImpairmentsAdditive FashionSchedule for Rating Permanent DisabilitiesAgreed Medical ExaminersWhole Person ImpairmentApportionment
References
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