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

Case No. ADJ1411734 (MON 0361062) MF ADJ130407 (MON 0361061) ADJ4416246 (MON 0361065) ADJ1320492 (MON 0361064) ADJ3297635 (MON 0361063) ADJ7166968 ADJ8574761 ADJ9019769 ADJ9045920
Regular
Jul 28, 2017

MARTHA IBRAHIM vs. THE STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION, legally uninsured; STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to review the defendant's contention that the Agreed Medical Examiner (AME) did not properly address causation and apportionment of the applicant's permanent disability. The Board found that the AME reports lacked substantial evidence regarding causation and apportionment across the applicant's multiple claimed injuries. Consequently, the Board rescinded the previous award and returned the matter for further proceedings to develop the record in compliance with relevant Labor Code sections and case law. The goal is to ensure proper determination of disability causation and apportionment among the various industrial injuries.

Workers' Compensation Appeals BoardReconsiderationJoint Findings of Fact and AwardAgreed Medical ExaminerApportionmentCausationPermanent DisabilityLabor Code section 4663Benson v. The Permanente Medical GroupInextricably Intertwined
References
7
Case No. ADJ9571986
Regular
Feb 22, 2019

ANNE CHOU vs. COUNTY OF RIVERSIDE

The Appeals Board granted reconsideration to address the apportionment of psychiatric permanent disability. The Board clarified that Labor Code section 3208.3(h) pertains to the causation of the injury itself, not the apportionment of permanent disability. Therefore, lawful nondiscriminatory personnel actions, which did not meet the 35% causation threshold for non-compensability, cannot be used to apportion permanent disability under Labor Code section 4663. Accordingly, the applicant's permanent disability was increased from 19% to 22%.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeIndustrial InjuryGastrointestinal SystemPsycheHypertensionTemporary DisabilityPermanent Disability
References
0
Case No. ADJ824062 (VNO 0395359) ADJ1729914 (VNO 0452072) ADJ385264 (VNO 0548716) ADJ4506449 (VNO 0548713)
Regular
May 11, 2016

SHARON SPRAGUE vs. BEVERLY FABRICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE, SUPERIOR NATIONAL INSURANCE COMPANY, MIKASA, SOMPO JAPAN INSURANCE COMPANY OF AMERICA

This case involves multiple injury claims for Sharon Sprague against Beverly Fabrics and Mikasa, primarily concerning back, hip, and fibromyalgia injuries. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over permanent disability ratings and apportionment of injuries. The WCAB rescinded prior findings, finding insufficient evidence for permanent total disability and the exact causation of fibromyalgia. The matter is remanded for further proceedings to develop the record on fibromyalgia causation, permanent disability, and apportionment.

CIGASompo JapanReconsiderationJoint Findings Award OrdersPermanent DisabilityApportionmentFibromyalgiaScapula/Rhomboid StrainBilateral KneesAgreed Medical Evaluator
References
0
Case No. ADJ6675568
Regular
May 01, 2015

GERALD KEYES vs. B&L MECHANICAL, LINCOLN GENERAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the finding of industrial injury to the applicant's teeth. This injury was found to be a consequence of medications prescribed for a prior industrial back injury, which caused dry mouth and accelerated tooth decay. While the apportionment of industrial versus non-industrial causation was debated, the Board found substantial medical evidence supporting that the industrial medications contributed to the dental condition. The decision focused on causation of injury, not permanent disability apportionment.

Workers' Compensation Appeals BoardGerald KeyesB&L MechanicalLincoln General Insurance CompanyADJ6675568dental injuryhyposalivationPQMEDr. Gregory StephensDr. Dennis Shamlian
References
1
Case No. FRE 0197989, FRE 0200410
Regular
Feb 04, 2008

SANDRA LaPLANTE vs. WAL-MART, AMERICAN HOME ASSURANCE, AIG, FRANK GATES SERVICE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, finding that the WCJ erred by not applying the *Benson* doctrine on apportionment of permanent disability based on causation. The Board remanded the case for further proceedings to determine the percentage of permanent disability attributable to each industrial injury and pre-existing conditions, as required by Labor Code sections 4663 and 4664. The *Benson* doctrine dictates that the prior *Wilkinson* doctrine, allowing combined awards in successive injury cases, is no longer generally applicable due to the legislative intent for causation-based apportionment.

Wilkinson doctrineBenson v. The Permanente Groupapportionmentcausationsuccessive industrial injuriescumulative traumaspecific injurypermanent disability ratingmedical examiner reportcompensable consequence
References
9
Case No. ADJ3449073 (LBO 0392250) ADJ3573639 (LBO 0393361)
Regular
Sep 17, 2012

STEPHEN KEMBLE vs. BAY VIEW PUMBING AND HEATING, ENDURANCE INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration of prior decisions that apportioned the applicant's 100% permanent disability between two industrial injuries and non-industrial factors. The Board found the psychiatric Agreed Medical Examiner's opinion unsubstantial due to a lack of review of pre-injury records and a misunderstanding of apportionment duties. Consequently, the matter was returned to the trial level for further proceedings, including appointing a new medical examiner to address causation and apportionment issues more thoroughly. The Board emphasized the need for a fully developed record on complex medical causation concerning the psyche injury.

ReconsiderationFindings and AwardsIndustrial InjuryRight KneeLow BackBoth FeetPsychePlumberPermanent DisabilityApportionment
References
7
Case No. ADJ3817836 (SJO 0250881)
Regular
May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability
References
3
Case No. MISSING
Regular Panel Decision

Claim of Huss v. Tops Markets, Inc.

In 1985, claimant sustained a right shoulder injury while employed by Dunlop Tire, resulting in a permanent partial disability. In 1998, he re-injured the same shoulder while working for Tops Markets, Inc., leading to a new workers' compensation claim. An impartial specialist attributed 85% of the disability to the 1985 injury and 15% to the 1998 injury. Although a Workers' Compensation Law Judge initially rejected apportionment, the Board reversed and applied the 85/15 apportionment. Claimant appealed, contending apportionment was unwarranted due to his disclosure of the prior injury and lack of prior disability symptoms. The Appellate Division affirmed the Board's decision, finding substantial medical evidence to support the apportionment.

Workers' CompensationPermanent Partial DisabilityApportionmentPrior InjuryShoulder InjuryCausal RelationshipMedical Expert TestimonyBoard DecisionAppellate ReviewExacerbation
References
3
Case No. ADJ1817589 (POM 0209340)
Regular
Feb 22, 2011

MARIAM HASAN vs. GUADALUPE HOMES, SEDGWICK CIGA GLENDALE

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding 100% permanent disability due to industrial injuries sustained in 1991. The defendant sought apportionment based on pre-existing degenerative spinal conditions. While the Agreed Medical Evaluator opined some apportionment was warranted, their report lacked sufficient detail to meet legal standards for causation and apportionment. Consequently, the case is returned to the trial level for further development of the medical record regarding permanent disability and apportionment.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderPermanent DisabilityApportionmentAgreed Medical EvaluatorWCJLabor Code Section 4663EscobedoGatten
References
4
Case No. ADJ2628303
Regular
Apr 01, 2014

GLORIA CAIRES vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE

The Appeals Board rescinded the original award and returned the case for further proceedings due to insufficient medical evidence on apportionment. Specifically, the Board found that the opinions of the orthopedic and psychiatric medical evaluators regarding the apportionment of permanent disability lacked substantial medical evidence. The orthopedic evaluator's apportionment methodology, referencing an AMA Guides example, was deemed improper under current Labor Code sections 4663 and 4664. The psychiatric evaluator's apportionment was also found insufficient as it did not adequately explain how psychiatric permanent disability should be apportioned separately from injury causation.

Workers' Compensation Appeals BoardPermanent Disability ApportionmentQualified Medical Evaluator (PQME)Agreed Medical Evaluator (AME)American Medical Association Guides to the Evaluation of Permanent ImpairmentRange of Motion MethodDiagnosis-Related Estimate (DRE) MethodCompensable ConsequenceCausation of Permanent DisabilitySubstantial Medical Evidence
References
12
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