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

Case No. ADJ7924562
Regular
Sep 19, 2014

RAUL HERNANDEZ vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The applicant sought reconsideration of a WCJ decision that found an industrial injury to the low back but not the cervical spine or left ankle, with no permanent disability or further medical treatment. The applicant argued the QME's reports were insubstantial and that prior permanent disability was not considered. The Appeals Board granted reconsideration to amend the original award to include injury to the cervical spine, affirming the remainder of the decision. Therefore, the applicant sustained injury to his low back and cervical spine.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjuryCervical Spine InjuryPermanent DisabilityFurther Medical TreatmentPanel Qualified Medical EvaluatorLabor Code Section 4664(b)
References
0
Case No. ADJ1337074 (GRO 0034564) ADJ1286218 (GRO 0034565)
Regular
Jun 24, 2009

Dave Gerletti vs. SANTA MARIA AIRPORT DISTRICT, GREGORY BRAGG STOCKTON

The Workers' Compensation Appeals Board denied Dave Gerletti's petition for reconsideration of an award for a cumulative trauma injury to his cervical spine and lungs. The original award found 35% permanent disability, apportioning 50% of the cervical spine disability to non-industrial factors based on a Qualified Medical Evaluator's opinion of degenerative changes. The majority affirmed the WCJ's reliance on this opinion, finding it adequately explained. A dissenting opinion argued the QME's apportionment was speculative and improperly based on age and genetics, recommending an unapportioned award for the cervical spine injury.

Workers' Compensation Appeals Boardcumulative traumacervical spinelungspermanent disabilityapportionmentQualified Medical EvaluatorAgreed Medical Examinerarthritic degenerationnon-industrial factors
References
1
Case No. 2024 NY Slip Op 00599 [224 AD3d 428]
Regular Panel Decision
Feb 06, 2024

Matter of New Millennium Pain & Spine Medicine, P.C. v. Garrison Prop. & Cas. Ins. Co.

This case involves two appeals by New Millennium Pain & Spine Medicine, P.C. against Garrison Property & Casualty Insurance Company and GEICO Casualty Company. New Millennium sought to vacate master arbitration awards that denied its claims for no-fault benefits for medical services. The Supreme Court denied these applications. The Appellate Division, First Department, affirmed the Supreme Court's decisions, stating that an arbitrator's award will not be set aside unless it is irrational. The court also addressed the argument regarding a 20% wage offset in no-fault benefits, finding it unavailing under Insurance Law § 5102 (b). Ultimately, New Millennium was not entitled to attorneys' fees as it was not the prevailing party.

No-fault benefitsarbitration awardvacaturinsurance lawwage offsetappellate reviewmedical servicesno-fault policy exhaustionattorneys' feesCPLR Article 75
References
8
Case No. ADJ7288330
Regular
Oct 03, 2016

GLORIA BENITEZ vs. NEWPORT SUBACUTE HEALTH CARE CENTER, ALASKA NATIONAL INSURANCE COMPANY

The applicant, Gloria Benitez, sought to reopen her workers' compensation claim to include injury to additional body parts beyond her cervical spine and psyche. The original award found injury only to the cervical spine and psyche, with a 19% permanent disability rating for the cervical spine. While the WCJ's initial decision denied injury to additional body parts, the Board granted reconsideration. The Board amended the original findings to defer the issue of injury to the alleged additional body parts, while affirming other aspects of the WCJ's order, including the appointment of a regular physician to evaluate new and further disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderNew and Further DisabilityAgreed Medical ExaminerRegular PhysicianLabor Code Section 5410Petition to ReopenIndustrial InjuryCervical Spine
References
4
Case No. 526688
Regular Panel Decision
Dec 27, 2018

Matter of Bufearon v. City of Rochester Bur. of Empl. Relations

Claimant Kamren Bufearon sustained work-related injuries in a motor vehicle collision on March 4, 2016, for which his workers' compensation claim was established for injuries to his left shoulder, left hip, and lower back. Subsequently, he sought to amend his claim to include a causally-related cervical spine injury, which was initially approved by a Workers' Compensation Law Judge. However, the Workers' Compensation Board reversed this decision, finding that the claimant failed to sufficiently demonstrate a causal relationship between his cervical spine condition and the March 4, 2016 incident. The Appellate Division affirmed the Board's decision, noting that the medical testimony from two physicians contained conflicting findings and equivocal narratives regarding causation. The court concluded that the Board was entitled to reject the physicians' opinions as speculative, particularly since neither physician had reviewed the claimant's prior medical records for a pre-existing cervical spine fusion surgery.

Cervical spine injuryCausal relationshipMedical evidenceSubstantial evidence reviewAppellate DivisionWorkers' Compensation BoardPre-existing conditionCredibility of physiciansBurden of proofMotor vehicle accident
References
13
Case No. ADJ7969168; ADJ9330687
Regular
Mar 23, 2016

Mario Alcantar vs. Alfredo Melchor, Zenith Insurance Company

This case involves applicant Mario Alcantar's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB previously rescinded a joint finding and substituted a new one finding applicant sustained a lumbar spine injury but not a cervical spine injury during specified employment periods. Alcantar sought reconsideration to include a cervical spine injury during a different, unspecified period. The WCAB denied the petition, affirming its prior decision and incorporating it by reference.

Petition for ReconsiderationDecision After ReconsiderationJoint Findings of Factcumulative periodlumbar spinecervical spineindustrial injuryarising out of and occurring in the course of employmentWorkers' Compensation Appeals BoardZenith Insurance Company
References
0
Case No. SBA 0083738, SBA 0084753
Regular
Dec 04, 2007

MAGDALENA PINEDA vs. INAMED CORPORATION aka MCGHAN MEDICAL, CIGA by CAMBRIDGE INTEGRATED SERVICES, SAFECO

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a previous award. The applicant had sought reconsideration of findings that she sustained industrial injury to her bilateral upper extremities, neck musculature, shoulders, and upper back, but not to her psyche or cervical spine. The Board adopted the WCJ's report and recommendations, denying the petition and noting a potential clerical error in the award regarding medical treatment for the cervical spine and psyche.

Workers' Compensation Appeals BoardMagdalena PinedaInamed CorporationMcGhan MedicalCIGACambridge Integrated ServicesSafecobilateral upper extremitiesneck musculatureshoulders
References
0
Case No. ADJ4283233
Regular
Aug 03, 2009

GARY JOHNSTON vs. BAY PACIFIC PIPELINES, STATE COMPENSATION INSURANCE FUND

This case concerns Gary Johnston's claim for workers' compensation benefits for a cumulative injury to his cervical spine. Initially, the workers' compensation judge denied the claim, finding no industrial injury and citing the statute of limitations. The Appeals Board granted reconsideration, reversed the initial decision, and found that Johnston sustained a cumulative injury that was not time-barred. The Board has now denied the defendant's petition for reconsideration, affirming its prior decision that the applicant's cervical spine injury is compensable.

Workers' Compensation Appeals BoardIndustrial InjuryCervical SpinePipe LayerStatute of LimitationsReconsideration DeniedFindings and OrderOpinion and Order Granting ReconsiderationDecision After ReconsiderationCompensability
References
2
Case No. ADJ7177206
Regular
Sep 28, 2017

Richard Jee vs. Metropolitan Transit Authority San Francisco Municipal Railway, Intercare Insurance Services

The Workers' Compensation Appeals Board granted reconsideration and modified a prior decision regarding Richard Jee's claim. The Board affirmed that Jee sustained an injury to his cervical spine on February 17, 2010, while employed as a bus driver. He is awarded temporary and permanent disability indemnity, further medical care for his cervical spine, and reimbursement for self-procured medical treatment, with his attorney entitled to a 15% fee. The Board also addressed the Employment Development Department's lien for benefits paid.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrdersBus DriverCervical SpineLeft Eye InjurySelf-Insured EmployerTemporary Disability IndemnityPermanent Partial DisabilityInitial Aggressor Defense
References
0
Case No. ADJ8429146 ADJ8429148
Regular
Dec 11, 2018

STEPHANIE L. TRUEX vs. ALLEGENT GROUP CERTIFIED ACCOUNTANTS, STATE FARM CALIFORNIA, WC CLAIMS

The Appeals Board affirmed a decision that the applicant did not sustain an injury arising out of and occurring in the course of employment on January 15, 2010. In a separate case, the Board affirmed findings regarding cumulative injury to the applicant's wrists but amended the decision to defer the issue of injury to the cervical spine and shoulders pending further proceedings. This amendment is due to the finding that the basis for injury to the cervical spine and shoulders was not substantial evidence. The matter is returned to the WCJ for further development of the record, including an examination by a court-appointed physician.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersInjury AOE/COESubstantial EvidenceQualified Medical ExaminerRegular PhysicianCervical SpineShouldersWrists
References
7
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