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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ10788598
Regular
Jul 19, 2019

Shanai King vs. Food 4 Less

This case involves a claimant alleging a psychiatric injury due to workplace stress. The administrative law judge (WCJ) denied the claim, finding the applicant's testimony not credible and the medical evaluations insufficient. The Appeals Board granted reconsideration, rescinded the WCJ's findings, and returned the case for further proceedings. This decision stems from deficiencies in the medical evaluator's analysis of causation, conflating injury causation with permanent disability causation, and the need to develop the medical record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and OrderPsyche InjuryQualified Medical EvaluatorIndustrial CausationPredominant CauseGood Faith Personnel ActionSubstantial EvidenceMedical Opinion
References
Case No. ADJ4251836 (LAO 0830604) ADJ2226654 (LAO 0830603)
Regular
Dec 15, 2015

CALEB CHUA vs. DELIVERY SOLUTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to further develop the medical record regarding permanent disability apportionment for Caleb Chua. The original award found 30% permanent disability, apportioned by the WCJ based on Dr. Burstein's opinion. Applicant contended this apportionment was improperly based on pre-existing factors without substantial medical evidence, while his treating physician, Dr. Miller, supported a higher industrial causation. The Board found neither physician's apportionment opinion met the required legal standards for substantial evidence, necessitating further development of the record on this issue.

ApportionmentPermanent DisabilitySubstantial Medical EvidenceIndustrial InjuryCumulative TraumaStrokeHypertensionMedical CausationLabor Code Section 4662(a)(3)Findings and Award
References
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. VNO 0439261, VNO 0439262
Regular
May 08, 2008

CAROL SIERRAS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration, reversing the trial judge's decision to deny the applicant's fibromyalgia claim. The Board found the trial judge erred by disregarding the Agreed Medical Examiner's (AME) opinion on causation without sufficient justification, emphasizing that medical causation is a question for expert opinion. The case was remanded for further proceedings, including potential apportionment of disability.

Workers Compensation Appeals BoardCarol SierrasLos Angeles Unified School DistrictSedgwick Claims ManagementAmended Findings and Awardscumulative trauma injurypsychelumbar spinebilateral kneespermanent disability
References
Case No. ADJ9132951
Regular
Jul 25, 2016

MICHAEL APPIS vs. SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration. The Board affirmed the finding that the applicant sustained a psychiatric injury arising out of and in the course of employment. The Board clarified that causation of injury is distinct from apportionment of permanent disability, and that the Agreed Medical Evaluator's opinion on causation of injury was persuasive. Finally, the Board found no merit in the employer's argument that the applicant's stress was limited to events within 12 months prior to the injury date.

AOE/COEpsychelawful non-discriminatory good-faith personnel actionsapportionmentagreed medical evaluatorAMEcausation of injurycausation of disabilitycumulative injurylabor code section 5500.5
References
Case No. ADJ9616391
Regular
Aug 28, 2015

ROBERTO LOZANO vs. SANGER BOATS, INC., ZENITH INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior decision. The Board found that applicant's claim was not barred by Labor Code section 3600(a)(10) because medical records existed prior to his termination evidencing his neck injury. The issue of whether applicant sustained industrial injury and causation was deferred for further development, as the applicant bears the burden of proof on this matter.

Labor Code section 3600(a)(10)post-termination claimmedical records exceptionindustrial injurycausationWorkers' Compensation Appeals Boardpetition for reconsiderationfindings of factdeferred issueburden of proof
References
Case No. ADJ8276769
Regular
Jun 25, 2015

JAMES ROBINSON vs. REBAS, INC dba TOYOTA LIFT, ACE USA, administered by SEDGWICK CMS

The Workers' Compensation Appeals Board granted reconsideration to allow further development of the medical record regarding applicant's psychiatric injury. While affirming the finding of no neck or back injury, the Board deferred the issue of psychiatric injury causation. This decision stems from the Qualified Medical Evaluator's need for additional records and applicant's testimony to provide a definitive opinion on whether employment events predominantly caused the alleged psychiatric harm. The case is returned to the trial level for further proceedings on this specific issue.

Workers' Compensation Appeals BoardPSYCHIATRIC INJURYLABOR CODE SECTION 3208.3ACTUAL EVENTS OF EMPLOYMENTPREDOMINANT CAUSATIONMEDICAL RECORD DEVELOPMENTQUALIFIED MEDICAL EVALUATOROPINIONCAUSATIONRECONSIDERATION
References
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