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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. ADJ4028459 (SRO 0142511)
Regular
Mar 02, 2017

ANITA HOLSTEIN vs. SONOMA DEVELOPMENTAL CENTER, STATE COMPENSATION INSURANCE FUND

This case involved a defendant challenging a permanent total disability award for an applicant with cumulative trauma injuries and a seizure disorder. The defendant argued the vocational expert's opinion was unreliable and the disability rating was improperly calculated. The Board affirmed the award, agreeing that while the rating methodology was technically flawed, the applicant's seizure disorder rendered her unable to return to the labor market, making the calculation error moot. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardCumulative TraumaPermanent Total DisabilityVocational ExpertSeizure DisorderNon-Epileptic SeizuresRating MethodologyCombined Values ChartSubstantial EvidenceGainful Employment
References
Case No. AD10769216
Regular
Dec 13, 2019

Richard Hovannisian vs. UCLA, Permissibly Self-Insured, Administered By SEDGWICK CMS

The WCAB granted reconsideration and deferred issues of lumbar spine injury and permanent disability from a prior award. The WCJ's decision relied on a QME report that failed to establish industrial causation for the lumbar spine injury and lacked sufficient explanation for departing from AMA Guides methodology for permanent disability ratings. The Board found these deficiencies meant the decision was not based on substantial medical evidence. Further proceedings are required for the QME to adequately address causation, rating methodology, and lumbar spine classification.

WCABPetition for ReconsiderationFindings of Fact & Awardindustrial injurylumbar spinepermanent disabilitysubstantial medical evidencedue processDisability Evaluation Unitpanel qualified medical evaluator
References
Case No. ADJ4157066 (FRE 0207236)
Regular
Jul 01, 2009

PORFIRIO ABRAJAN vs. JOSE OCHOA FARM LABOR SERVICES, INC., VARIOUS EMPLOYERS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted SCIF's petition for reconsideration, rescinding the Arbitrator's prior order. The Board found the Arbitrator erred by incorrectly shifting the burden of proof to SCIF to disprove the reasonableness of the facility fees. Instead, the Board clarified that lien claimants, as the affirmative party, always bear the burden of proving their charges are reasonable. The case was returned to the Arbitrator to apply the correct legal standard and reassess the evidence.

Workers' Compensation Appeals BoardPorfirio AbrajanJose Ochoa Farm Labor ServicesState Compensation Insurance FundADJ4157066ReconsiderationFacility FeesOutpatient Surgical ProceduresIngenix methodologyLien Claimants
References
Case No. ADJ3447817 (SJO 0260464)
Regular
Dec 10, 2012

LIZABETH RUIZ vs. SUBSEQUENT INJURIES BENEFITS TRUST FUND (SIBTF)

This case concerns Lizabeth Ruiz's petition for reconsideration of the denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. Ruiz argued she had a pre-existing "labor disabling" psychiatric condition prior to her subsequent industrial injury. The Board affirmed its prior decision, holding that Ruiz failed to meet her burden of proof to establish that her pre-existing condition was labor-disabling and compensable at the time of the subsequent injury. The Board reiterated that retroactive medical evaluations are insufficient without contemporaneous evidence of such disability, and denied the petition to reopen the record.

Subsequent Injuries Benefits Trust FundSIBTFlabor disablingpermanent disabilitycumulative traumapsychiatric conditioncontemporaneous evidencerating methodologyadministrative law judgepetition for reconsideration
References
Case No. ADJ9499569
Regular
Sep 11, 2018

CHRIS HENDERSON vs. CDCR - CORCORAN STATE PRISON, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, increasing the applicant's permanent disability rating from 16% to 26%. This revision was based on incorporating the agreed medical evaluator's findings of a 14% upper extremity impairment due to decreased shoulder range of motion, which the original rating had omitted. The Board also noted the WCJ's rating instructions did not comply with established precedent regarding listing all impairments. The decision otherwise affirmed the WCJ's findings.

Workers' Compensation Appeals BoardCDCR - Corcoran State PrisonState Compensation Insurance FundPetition for ReconsiderationPermanent Disability RatingAgreed Medical EvaluatorOrthopedistEugene HarrisM.D.Temporary Disability Indemnity
References
Case No. ADJ1177048
Significant
Feb 03, 2009

Wanda Ogilvie, Applicant vs. City and County of San Francisco, Permissibly Self-Insured

The Appeals Board holds that the diminished future earning capacity (DFEC) portion of the 2005 Permanent Disability Rating Schedule is rebuttable and establishes a specific, formula-based method for doing so. The matter was remanded to the WCJ for further proceedings consistent with this new methodology.

Diminished Future Earning CapacityDFEC2005 ScheduleRebuttalRAND StudyLabor Code section 4660Vocational RehabilitationProportional Earnings LossWhole Person ImpairmentRating to Loss Ratio
References
Case No. SFO 0494473
Regular
Apr 15, 2008

ROBERT HARRISON vs. ACADEMY OF ART COLLEGE, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior award because the Agreed Medical Evaluator's apportionment opinions lacked sufficient explanation regarding causation and calculation methodology. The Board remanded the case for further development of the medical record. The trial judge must then issue a new decision on permanent disability and apportionment after reviewing further medical evidence.

Workers' Compensation Appeals BoardRobert HarrisonAcademy of Art CollegeLiberty Mutual Insurance CompanyOpinion and Order Granting ReconsiderationFindings and AwardIndustrial InjuryShuttle VanRear-endedNeck Injury
References
Case No. ADJ2786471 (AHM 0131183)
Regular
Feb 12, 2013

RENEGARCIA vs. CITY OF ANAHEIM, PRESSURE

The Appeals Board rescinded the prior award due to the physician's flawed methodology in determining permanent disability. The physician improperly used the *Almaraz/Guzman* analysis by considering both functional capacity and ability to compete in the labor market. Furthermore, the physician's supplemental report failed to correct this error and used speculative cumulative losses. The matter is returned for a new rating strictly applying the AMA Guides.

Workers' Compensation Appeals BoardCity of AnaheimRene GarciaReconsiderationJoint Findings and AwardPermanent DisabilityCumulative TraumaLeft KneeRight KneeBack Injury
References
Case No. ADJ1818278 (SFO 0495048) ADJ3997974 (SFO 0495050)
Regular
Oct 10, 2008

Dana Large vs. KLEIN PLASTERING, REDLANDS INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the original award because the judge's findings on permanent disability were not supported by substantial medical evidence. Specifically, the Agreed Medical Evaluator's impairment ratings for knee injury and unrelated left thigh atrophy lacked clear explanation and proper methodology according to the AMA Guides. The case is returned to the trial level for further development of the medical record and reconsideration of the permanent disability rating.

WCABReconsiderationFindings and AwardIndustrial InjuryRight KneePermanent DisabilityAMA GuidesAgreed Medical EvaluatorWhole Person ImpairmentLeft Thigh Atrophy
References
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