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

Case No. ADJ1088522 (RIV 0015524)
Regular
Jan 03, 2013

SAMANTHA VAN DUINHOVEN vs. SPA HOTEL & CASINO, CALIFORNIA CASUALTY, Administered by GAB ROBINS NORTH AMERICA

This case involved an applicant who claimed industrial injury to her neck, back, left shoulder, psyche, and associated chronic pain syndrome, resulting in a finding of permanent total disability. The defendant sought reconsideration, arguing the medical evidence did not support injury to the low back or a diagnosis of chronic pain syndrome. The Appeals Board reversed the findings on the low back and chronic pain syndrome, finding no substantial evidence to support them. Consequently, the applicant's permanent disability award was amended to 70%, based on ratings for her neck, left shoulder, and psyche.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent Total DisabilityChronic Pain SyndromeAgreed Medical EvaluatorQualified Medical EvaluatorMedical Record ReviewIndustrial InjuryPermanent Disability Indemnity
References
0
Case No. ADJ605947 (MON 0274664)
Regular
Feb 02, 2009

LESLIE CELLUCCI vs. FLORENCE MACHINE PRODUCTS, STATE COMPENSATION INSURANCE FUND

This case concerns a workers' compensation claim for injuries to the applicant's hands, upper extremities, and neck, resulting in chronic pain syndrome and a sleep disorder. The defendant disputed the extent of permanent disability and the diagnoses of chronic pain syndrome and sleep disorder. The Appeals Board affirmed the finding of industrial injury and the 85% permanent disability rating, including the diagnoses of chronic pain syndrome and sleep disorder. The Board also granted reconsideration to amend the award to include a life pension for the applicant, as required by law for an 85% permanent disability finding.

Workers' Compensation Appeals BoardLeslie CellucciFlorence Machine ProductsState Compensation Insurance FundADJ605947Opinion and Order Granting ReconsiderationFindings and AwardPermanent DisabilityChronic Pain SyndromeSleep Disorder
References
0
Case No. ADJ2554534
Regular
Jan 03, 2023

WENDY COLLIE vs. STATE OF CALIFORNIA, EMPLOYMENT DEVELOPMENT DEPARTMENT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of a prior award. The initial award found the applicant sustained an injury AOE/COE to multiple body parts, resulting in permanent total disability without apportionment. The employer argued the finding of chronic pain syndrome was improper, and that the WCJ ignored credibility issues and apportionment opinions. The Appeals Board found substantial medical evidence supported the chronic pain syndrome diagnosis and that the employer failed to provide sufficient evidence for apportionment of permanent disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderAdministrative Law JudgeInjury AOE/COELumbar SpineCervical SpineLeft ShoulderRight HipRight Knee
References
20
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
4
Case No. ADJ6521264
Regular
Oct 11, 2013

ANGELA STUART-KNIGHTS vs. EMPLOYMENT DEVELOPMENT DEPARTMENT, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an award finding the applicant sustained 66% permanent disability due to a cumulative trauma injury. The applicant argued that the Agreed Medical Examiner's (AME) report rebutted the permanent disability rating, particularly regarding her chronic pain syndrome. However, the WCAB affirmed the original award, deferring to the judge's credibility determination regarding the applicant's demeanor and testimony, which contradicted the AME's assessment of severe pain. Furthermore, the AME himself deferred to another physician on the issue of chronic pain, undermining his report's evidentiary value on that point.

WCABReconsiderationFindings of FactAwardAdministrative Law JudgeWCJCumulative TraumaPermanent DisabilityAMA GuidesAlmaraz/Guzman
References
4
Case No. ADJ3931400 (MON 0218725) ADJ4561489 (MON 0257189)
Regular
Nov 07, 2008

ELLEAN SLAUGHTER vs. CENTINELA HOSPITAL MEDICAL CENTER/TENET HEALTHCARE CORPORATION

This case involves a petition to reopen a worker's compensation claim where the applicant's permanent disability increased from 77.5% to 100% due to chronic pain syndrome. The defendant argued for apportionment to non-industrial conditions like multiple sclerosis and chronic fatigue syndrome. The Appeals Board granted reconsideration, rescinded the original award, and remanded the case for a new permanent disability rating, specifically requiring apportionment of the increased disability to the applicant's non-industrial conditions as per *Vargas v. Atascadero State Hospital*.

ReconsiderationPermanent DisabilityApportionmentNew and Further DisabilityChronic Pain SyndromeMultiple SclerosisChronic Fatigue SyndromeAgreed Medical ExaminersSB 899Vargas v. Atascadero State Hospital
References
3
Case No. MISSING
Regular Panel Decision
Sep 04, 2013

Matter of Madigan v. ARR ELS

In 1994, the claimant sustained a low back injury during employment as a machinist, leading to workers' compensation benefits. Liability for the case was transferred to the Special Fund for Reopened Cases in 2003. Due to poor surgical outcomes, the claimant has been on pain medication, including oxycontin, since at least 2007, with doses escalating. A consultant for the Special Fund questioned the necessity of the increased medication, prompting a hearing. A Workers’ Compensation Law Judge ruled that the pain medications should continue, with the Special Fund covering the costs, until new Board guidelines or physician recommendations advised otherwise. The Workers’ Compensation Board affirmed this decision, citing that their Medical Treatment Guidelines for chronic pain were still in draft form at the time. The appellate court subsequently affirmed the Board's decision, noting that the guidelines were not yet in effect at the time of the Board's ruling and that the Board's interim guidance was rational.

Workers' CompensationPain ManagementOpioid PrescriptionsMedical Treatment GuidelinesSpecial FundReopened CasesLumbar InjuryOxycontinAppellate ReviewAdministrative Law
References
4
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. ADJ8376717
Regular
Apr 12, 2019

SOOHYUN KIM vs. VALENTINO, Permissibly Self-Insured, Administered By GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) affirmed the finding of industrial injury for Complex Regional Pain Syndrome (CRPS) but rescinded the finding of chronic pain. The WCAB also rescinded the finding of permanent and total disability, finding the medical evidence supported a scheduled disability rating between 64-81%. The vocational expert's opinion was deemed insufficient to rebut the scheduled rating or establish permanent total disability. The case was returned to the trial level for further proceedings and a new permanent disability finding based on the medical reports.

Complex Regional Pain SyndromeCRPSIndustrial InjuryPermanent and Total DisabilityReconsiderationVocational ExpertMedical EvidencePermanent Disability RatingAMA GuidesLabor Code
References
14
Case No. MISSING
Regular Panel Decision

Aldridge v. AC Rochester Products

The claimant, an employee of AC Rochester Products, experienced severe chest pain during employment in December 1987. After multiple medical examinations, her condition was diagnosed in January 1990 as chronic pain syndrome and costochondritis, related to the 1987 incident. She subsequently filed a workers' compensation claim in April 1990. The Workers' Compensation Board ruled the claim untimely, determining the injury was an accident and not an occupational disease. The appellate court affirmed the Board's decision, finding substantial evidence supported the conclusion that the injuries resulted from an accident, making the claim untimely under Workers’ Compensation Law § 28.

Workers' CompensationTimeliness of ClaimOccupational DiseaseAccidentChronic Pain SyndromeCostochondritisStatute of LimitationsMedical DiagnosisAppealEmployer Liability
References
7
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