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

Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. LAO 0857845
Regular
Oct 12, 2007

NATIVIDAD URIAS vs. VISHAY TRANSDUCERS, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a workers' compensation applicant seeking further medical treatment for admitted industrial injuries to her right shoulder and bilateral upper extremities. The Workers' Compensation Appeals Board granted reconsideration to clarify the scope of awarded medical treatment. The Board affirmed the need for a right carpal tunnel release surgery as recommended by the applicant's physician but reversed the award of arthroscopic shoulder surgery, finding it premature without a specific recommendation or request for authorization.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardExpedited HearingFurther Medical TreatmentArthroscopic Shoulder SurgeryCarpal Tunnel ReleasePrimary Treating PhysicianQualified Medical EvaluatorUtilization Review
References
Case No. ADJ9582137
Regular
Sep 20, 2016

SHERYL FEVOLD MILTON vs. COUNTY OF TULARE

This case involves a worker injured in an industrial accident, sustaining shoulder injuries and bilateral carpal tunnel syndrome. The defendant employer sought to delay mandated home modifications until post-surgery recovery, arguing they weren't medically necessary. However, the court found that the modifications were primarily necessitated by the shoulder injuries, not the carpal tunnel syndrome. Medical experts and an occupational therapist confirmed the need for these modifications to enable the applicant's return to independent living and work. Therefore, the defendant's petition for reconsideration was denied, upholding the order for home modifications.

home modificationspermanent and stationarycarpal tunnel release surgerybilateral shouldersrotator cuff tearT-12 paraplegicoccupational therapistcertified aging-in-place specialistskilled nursing facilityindependent living
References
Case No. ADJ602790 (STK 0179563)
Regular
Jul 17, 2012

TRACEE MAWYER vs. GALLO GLASS COMPANY

This case involves Tracee Mawyer's workers' compensation claim against Gallo Glass Company for cumulative trauma injuries. The Appeals Board granted reconsideration, reversing the trial judge's denial of injury to applicant's bilateral upper extremities, specifically carpal tunnel syndrome. The Board found Dr. Clayman's reports sufficiently supported an industrial injury to the upper extremities and awarded additional temporary disability for the period following carpal tunnel surgery. The case was returned for a new permanent disability rating for the upper extremity injuries.

Cumulative traumabilateral upper extremitiescarpal tunnel release surgerytemporary disabilitypermanent disability ratingreconsiderationDr. Claymanneck injuryshoulder injuryspine injury
References
Case No. ADJ620371 (VNO 0542153)
Regular
May 01, 2009

ELIZABETH VENTOCILLA vs. KAISER PERMANENTE, Permissibly Self-Insured

This case involves a dispute over the need for carpal tunnel release surgery. The applicant's physician recommended surgery, but the employer denied authorization and sought a Qualified Medical Examiner (QME) without initiating utilization review as required by Labor Code section 4610. The Workers' Compensation Appeals Board (WCAB) granted removal, rescinded the order to take the case off calendar, and remanded it for an expedited hearing. The WCAB found the applicant was entitled to a hearing on whether a QME was permissible without prior utilization review and on the entitlement to the recommended surgery.

RemovalUtilization ReviewPQMELabor Code Section 4610Labor Code Section 4062Labor Code Section 4616Primary Treating PhysicianMedical Provider NetworkCarpal Tunnel ReleaseExpedited Hearing
References
Case No. ADJ9625407
Regular
Sep 12, 2018

KEITH FIELD vs. CITY OF PINOLE

This case involves a firefighter who sustained bilateral carpal tunnel syndrome after retirement. The Appeals Board reversed the trial judge, holding that Labor Code section 4458.5 applies, entitling the applicant to permanent disability benefits calculated at the maximum indemnity rate. This applies regardless of the applicant's actual earnings or the fact that carpal tunnel syndrome is not a specifically enumerated presumptive injury. The case is remanded for determination of the precise date of injury to calculate the benefit rate.

Workers' Compensation Appeals BoardKeith FieldCity of PinolePermissibly Self-InsuredMunicipal Pooling AuthorityADJ9625407Opinion and Decision After Reconsiderationindustrial injuryfirefighterbilateral upper extremities
References
Case No. ADJ2283259
Regular
Sep 19, 2000

SHAWN COOPER vs. UNITED PARCEL SERVICE, LIBERTY MUTUAL INSURANCE COMPANY

Reconsideration denied for lien claim for carpal tunnel release surgeries. The WCJ's decision, which is adopted and incorporated, found the lien claimant's billing unreasonable and grossly disproportionate to amounts accepted by other facilities.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeLien ClaimantFacility FeeCarpal Tunnel ReleaseCPT CodeOfficial Medical Fee ScheduleGeographic ComparablesReasonableness of Billing
References
Case No. ADJ8484771
Regular
Nov 14, 2014

MIKE REIS vs. SILVAS OIL COMPANY, EMPLOYERS INSURANCE OF WAUSAU

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, reversing a prior decision that had found carpal tunnel surgery authorized. The Board determined that a letter from defendant's attorney did not authorize the surgery, and the subsequent utilization review (UR) was timely and not procedurally defective. As the UR was timely, any challenges to its validity must go through Independent Medical Review (IMR), which had previously determined the surgery was not medically supported. Therefore, the prior award granting the surgery was rescinded.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended OpinionSilvas Oil CompanyEmployers Insurance of WausauUtilization ReviewAgreed Medical EvaluatorCarpal Tunnel SurgeryRequest for AuthorizationIndependent Medical Review
References
Case No. LAO 838220
Regular
May 14, 2007

MARIA SERAFIN vs. LANSCO DIE CASTING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and remanded the case to determine permanent disability using the 1997 Schedule. This decision stems from the Board's finding that the applicant's treating physician's December 20, 2004, report indicated the existence of permanent disability, triggering an exception under Labor Code section 4660(d). Consequently, the outdated 1997 Schedule, not the 2005 Schedule, must be applied to calculate the applicant's permanent disability benefits.

Workers' Compensation Appeals BoardMaria SerafinLansco Die CastingState Compensation Insurance FundLAO 838220ReconsiderationFindings and AwardWCJIndustrial InjuryRight Shoulder
References
Case No. OAK 0315547
Regular
Jan 24, 2008

CECILE DJAFAR vs. UCSF MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to address the lien claimant's (Bay Area Surgery Center) claim for unpaid medical services. The Board rescinded the previous order disallowing the lien and remanded the case to the trial level. This action was taken because the lien claimant's crucial evidence of accreditation, which was believed to have been submitted and admitted, was missing from the official file, and further review is necessary to ensure substantial justice.

Workers' Compensation Appeals BoardUCSF Medical CenterSedgwick Claims Management ServicesBay Area Surgery CenterLien claimantCarpal tunnel releaseCompromise and release agreementAccreditation Association for Ambulatory Health CareOutpatient settingDue process
References
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