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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ6998138
Regular
Feb 13, 2012

WAI CHIU LI vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board denied the County of Los Angeles' Petition for Reconsideration. The Board upheld its prior decision to increase applicant Wai Chiu Li's permanent disability rating from 15% to 36% for a left forearm injury. This increase was based on the agreed medical examiner's use of clinical judgment to incorporate grip strength loss, consistent with the AMA Guides. The Board emphasized that physician judgment is crucial in accurately assessing impairment according to the Guides.

Workers' Compensation Appeals BoardDeputy SheriffIndustrial InjuryPermanent DisabilityReconsiderationAmerican Medical Association GuidesAMA GuidesAgreed Medical ExaminerAMEGrip Strength
References
Case No. ADJ9183350
Regular
Nov 02, 2016

MEGAN PRELL vs. CEDAR FAIR, L.P. dba as KNOTT'S BERRY FARM, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, finding that the original permanent disability rating of 2% was insufficient. The Board adopted the Panel Qualified Medical Evaluator's (PQME) finding of 15% Whole Person Impairment (WPI), applying the *Almaraz-Guzman* doctrine. This doctrine allows physicians to use clinical judgment, drawing upon the entire AMA Guides, to more accurately reflect an injured employee's impairment. The applicant's continued symptoms, post-surgery, and MRI findings supported the PQME's higher impairment rating.

WCABPERMANENT DISABILITYWHOLE PERSON IMPAIRMENTWPIAMA GUIDESALMARAZ-GUZMANPQMEORTHOPEDIC SURGERYLEFT SHOULDER INJURYINDUSTRIAL INJURY
References
Case No. ADJ2855195 (MF); ADJ965274
Regular
Jan 23, 2012

MARCELO RUEDA vs. ALL LABOR TIRES, STATE COMPENSATION INSURANCE FUND

The State Compensation Insurance Fund petitioned for reconsideration of awards made to Marcelo Rueda, arguing that Agreed Medical Examiner (AME) reports by Drs. Hyman and Sanders lacked substantial evidence. Specifically, the Fund disputed impairment ratings for hypertension, upper digestive tract issues, and sleep disorders, as well as the carpal tunnel syndrome diagnosis. The judge recommended denying the petition, finding that the AME reports provided reasoned medical opinions supported by the AMA Guides and clinical judgment. The Workers' Compensation Appeals Board granted reconsideration to further review the complex factual and legal issues involved.

Petition for ReconsiderationAgreed Medical ExaminerAMA GuidesPermanent DisabilityHypertensionUpper Digestive Tract ImpairmentSleep DisorderCarpal Tunnel SyndromeSubstantial EvidenceClinical Judgment
References
Case No. ADJ10121570
Regular
Aug 19, 2016

TRACY BAKER vs. FOOTHILL DEANZA COMMUNITY COLLEGE DISTRICT

In this Workers' Compensation Appeals Board case, the defendant sought reconsideration of an award finding the applicant sustained a work-related rib and chest injury. The defendant argued the QME's opinion on permanent disability and future medical treatment lacked substantial medical evidence, as it relied on analogy due to the absence of a specific rating in the AMA Guides. The Appeals Board affirmed the original award but deferred the issues of permanent disability and attorney's fees, finding the QME's analogical rating was conclusory and unsupported by sufficient reasoning. A dissenting commissioner argued the analogy was permissible under precedent allowing clinical judgment for poorly understood conditions manifesting solely as subjective symptoms.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityFuture Medical TreatmentQualified Medical EvaluatorWhole Person ImpairmentSubstantial Medical EvidenceAMA GuidesClinical Judgment
References
Case No. OAK 0293725
Regular
May 22, 2008

MARGARITA CHAVEZ vs. WESTERN NATIONAL PROPERTIES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded the initial denial of the lien claim by Bay Surgery Center (BSC). BSC's claim for facility fees was initially denied because it allegedly failed to prove it operated as an "outpatient setting" and thus was exempt from needing a fictitious business name permit. The Board found that BSC presented sufficient evidence of its "surgical clinic" license to meet its initial burden, thereby establishing it as an "outpatient setting" for purposes of the lien claim, and remanded the case for further proceedings on the reasonableness of the fees.

Workers' Compensation Appeals BoardLien claimantOutpatient settingFictitious Business Name permitSurgical clinic licenseDepartment of Health ServicesFacility feeMedical BoardLicensed physicianReasonable fee
References
Case No. ADJ6940334
Regular
Jan 28, 2011

AURELIO RAMOS LOPEZ vs. JESUS AGUILAR dba C&A FRAMING et al.

The Workers' Compensation Appeals Board granted reconsideration, rescinded a deficient arbitrator's judgment, and returned the matter for further proceedings. The original "Judgment" failed to comply with statutory requirements for a decision, lacking an opinion and a signature. Defendant Granite argued denial of due process due to insufficient time for discovery after being joined as a party. Defendant C&A contended substantial evidence supported coverage by AIG on the date of injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationJudgmentArbitrationCoverageDate of InjuryDue ProcessDiscoverySubstantial EvidenceWaiver
References
Case No. ADJ6722110
Regular
Oct 11, 2013

SERGIO RODRIGUEZ vs. AIR COASTAL FLEET SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed an administrative law judge's order dismissing a lien claim for failure to pay the required activation fee. The lien claimant, Advance Care Specialist Medical Clinic, and its representatives, Innovative Medical Management and Louis Heard, sought reconsideration, which was granted. However, the Board found no good cause to overturn the dismissal. Subsequently, the Board imposed a $1,000 sanction against Innovative Medical Management and Louis Heard for their failure to respond to a notice of intent to impose sanctions.

Lien activation feeSanctionLabor Code section 5813Appeals Board Rule 10561ReconsiderationWCJ Order Dismissing Lien ClaimNotice of Intention to Impose SanctionsWorkers' Compensation Appeals BoardHearing RepresentativeMedical Clinic
References
Case No. ADJ10187704, ADJ10924724
Regular
May 17, 2018

STEVEN CASE vs. GOLDEN GATE BRIDGE HIGHWAY AND TRANSPORTATION DISTRICT

The Workers' Compensation Appeals Board granted reconsideration to increase applicant's permanent disability rating for bilateral shoulder injury from 9% to 38%. The Board found the Agreed Medical Evaluator's (AME) alternative rating, based on strength loss, was substantial medical evidence and properly considered within the AMA Guides. The WCJ erred in applying an overly restrictive interpretation of "complex or extraordinary" cases for deviating from strict AMA Guides ratings. The AME's use of strength loss data from the AMA Guides, even for an age outside the specified range, was permissible under the *Almaraz-Guzman* line of cases when justified by clinical judgment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationAgreed Medical Evaluator (AME)permanent disability ratingbilateral shouldersorthopedic AMEAMA GuidesAlmaraz-Guzmanstrength loss index
References
Case No. RIV 0037205, RIV 0070473
Regular
Jul 24, 2007

LORRIE AVERETTE vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior ruling that Premier Outpatient Surgery Center was properly licensed and not required to have a fictitious name permit for services rendered. The defendant argued Premier lacked proper licensure and a fictitious name permit, but the Board found Premier met its burden of proof by submitting evidence of its licensure and accreditation. Premier was determined to be an "outpatient setting" rather than a "clinic," thus not requiring a fictitious name permit from the Medical Board.

Workers' Compensation Appeals BoardLien claimantFictitious name permitMedical Board of CaliforniaOutpatient surgery servicesLicensureAccreditationAmbulatory surgical centersZenith Ins. Co. v. Workers' Comp. Appeals Bd. (Capi)Stokes v. Patton State Hospital
References
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