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

Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ1997686 (MON 0358806)
Regular
May 24, 2011

JAVIER GUTIERREZ vs. COOPER INDUSTRIES, INC., ACE AMERICAN INSURANCE COMPANY

The Appeals Board reversed the WCJ's award of 16% permanent disability for a neck injury. Dr. Brickman's report, which supported the award, was deemed unsubstantial as it relied on an incorrect medical history and erroneous legal theory regarding the cause of the applicant's sleep disturbance. The Board found that the applicant's sleep issues stemmed from a non-compensable psychological condition, not neck pain. Consequently, the Board adopted the opinion of PQME Dr. Portnoff, who concluded the applicant sustained a cervical strain with no resulting permanent disability.

Workers' Compensation Appeals BoardEAMS processing delayFindings and Awardindustrial injuryneck injuryassemblertemporary disabilitypermanent disabilityself-procured careAMA Guides
References
Case No. ADJ237483
Regular
Nov 13, 2012

RAYEK J. FAHOUM vs. KAISER FOUNDATION HOSPITAL

The Workers' Compensation Appeals Board denied Rayek J. Fahoum's petition for reconsideration, upholding the findings of the Workers' Compensation Judge. The Judge's report found Fahoum sustained industrial injury to his neck and low back with secondary chronic pain syndrome, awarding 41% permanent disability. This decision relied on the opinions of the Agreed Medical Examiner and Dr. Renee Rinaldi, who concluded Fahoum experienced symptom magnification and that his condition was chronic pain syndrome, not fibromyalgia as claimed by Dr. Allen Salick. The Board extended great weight to the Judge's credibility findings regarding the medical opinions.

Workers' Compensation Appeals BoardReconsideration DeniedAgreed Medical ExaminerSubstantial Medical EvidenceFibromyalgiaChronic Pain SyndromeSymptom MagnificationOrthopedic InjuryLumbosacral StrainCervical Strain
References
Case No. ADJ9823935, ADJ9088024
Regular
May 20, 2016

LE VAN vs. FEDEX OFFICE AND PRINT SERVICES, GALLAGHER BASSETT

The Workers' Compensation Appeals Board granted FedEx's petition for reconsideration but ultimately affirmed the original order finding treatment by Monrovia Memorial Hospital reasonable and necessary. The Board clarified that even if the cervical spine was not explicitly pled as an injured body part, FedEx authorized the treatment and failed to properly rescind that authorization. Therefore, the lien claimant is entitled to payment for the services rendered.

WCABPetition for ReconsiderationFindings and Orderlien claimantMonrovia Memorial Hospitalcervical spineDr. Wilkercervical surgeryobjection letterprimary treating physician
References
Case No. ADJ14808611
Regular
Sep 16, 2022

KATIE Y. LAM vs. COUNTY OF ORANGE, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns an applicant who sought reconsideration of a workers' compensation award denying her claim for neck injury. The Workers' Compensation Appeals Board granted reconsideration, amending the award to include injury to the cervical spine. This amendment was based on the substantial evidence from a Qualified Medical Examiner (QME) whose reports indicated C6 radiculopathy was causally related to the applicant's employment injury. The Board found the QME's opinion well-reasoned and not contradicted by other evidence.

Cervical radiculopathyQMEAOE/COEPetition for ReconsiderationFindings and AwardSubstantial evidenceCompensable consequenceApportionmentDeputy sheriff traineeAmbulatory imbalance
References
Case No. ADJ8103143
Regular
Dec 04, 2015

CHUONG VO vs. ZONARE MEDICAL SYSTEMS, INC., ONE BEACON INSURANCE COMPANY

This case involves a defendant seeking reconsideration of an order enforcing an Independent Medical Review (IMR) determination that authorized applicant's requested cervical surgery. The defendant argued a subsequent conflicting IMR determination, the WCJ's lack of jurisdiction, and an improper physician signature on the initial request voided the original IMR. The Appeals Board denied reconsideration, finding that a later IMR does not negate a prior one, the WCJ had jurisdiction to enforce the IMR, and the defendant waived the physician signature argument by proceeding with utilization review.

Independent Medical ReviewUtilization ReviewPetition for ReconsiderationLabor Code section 4610Labor Code section 4610.5anterior cervical decompression and fusionposterior cervical decompression and fusionmedical necessitywaived argumentsecondary treating physician
References
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
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
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
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