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

Case No. ADJ8939504
Regular
Oct 13, 2016

RAMON RAMIREZ vs. INTEX AUTO PARTS, SENTRY INSURANCE COMPANY

This case involves Ramon Ramirez claiming workers' compensation for an injury. The Workers' Compensation Appeals Board (WCAB) denied the employer's petition for reconsideration. The WCAB found that the defendant failed to meet their burden of proof regarding apportionment. This failure was based on a physician's report being too brief and conclusory without adequate reasoning or factual support, as required by established law.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedWorkers' Compensation Administrative Law JudgeWCJ ReportPhysician's ReportReasonable Medical ProbabilitySpeculativeApportionmentBurden of Proof
References
4
Case No. LAO 0876361 LAO 0876364
Regular
Apr 14, 2008

REYNA ROJO vs. EDGEWATER CONVALESCENT HOSPITAL, ACE INSURANCE COMPANY

The Appeals Board dismissed the defendant's petition for reconsideration as it was an interim order not subject to reconsideration. The Board also denied the defendant's petition for removal, agreeing with the Administrative Law Judge that further medical development was necessary due to conflicting and conclusory reports from the existing physician. The case was remanded for examination by a new physician to clarify injury AOE/COE, permanent disability, and apportionment.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrdersOff CalendarMedical TreatmentInjury AOE/COEPermanent DisabilityApportionmentQualified Medical Evaluator
References
21
Case No. SJO 182505 SJO 182506
Regular
Mar 10, 2008

DEBRA TULLBANE vs. HOME EXPRESS, CALIFORNIA GUARANTEE INSURANCE ASSOCIATION

The Workers' Compensation Appeals Board granted reconsideration to further develop the medical record regarding the apportionment of applicant Debra Tullbane's permanent disability. The Board found the Agreed Medical Evaluator's apportionment opinion to be conclusory and lacking the detailed explanation required by statute and case law for substantial evidence. Therefore, the case was returned to the Workers' Compensation Judge for further proceedings and a new decision on apportionment.

Wilkinson ruleBenson v. The Permanente Medical Groupapportionmentsubstantial medical evidencecausationdegenerative diseaseAMEWCJLabor Code § 4663industrial injury
References
11
Case No. ADJ7888241, ADJ9249140
Regular
Mar 02, 2016

Bruce White vs. Montecito Country Club (MCC BB Property, LLC), Liberty Mutual Insurance Company

The applicant, Bruce White, sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded him 52% permanent disability for a back injury. White argued he was 100% disabled, relying on a PQME's opinion, but the WCAB found this opinion conclusory and lacking substantial evidence. The WCAB affirmed the 52% rating, stating it was presumptively correct and supported by the evidence. Therefore, the Petition for Reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderCumulative InjuryPermanent DisabilityPanel Qualified Medical EvaluatorAMA GuidesRange of Motion MethodLumbar SpineRadiculopathy
References
0
Case No. ADJ10863930
Regular
Aug 05, 2019

BERNARDINO HERNANDEZ vs. HAMMERHEAD AVIATION, PREFERRED EMPLOYERS

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The WCAB affirmed the finding that the applicant sustained injuries to his neck, elbows, and bilateral extremities, based on substantial evidence from treating physicians. The Board found the defendant's argument that the medical opinions were conclusory unpersuasive, and the PQME's opinions on causation lacked sufficient reasoning. The applicant's proof of injury arising out of and occurring during employment was found to be reasonably probable.

WCABPetition for ReconsiderationFindings of Fact and OrderInjuryNeckElbowsBilateral ExtremitiesPost-termination defenseLabor Code Section 5412Substantial Evidence
References
0
Case No. ADJ8914346
Regular
Aug 05, 2019

GERALD FREENY vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION/STATE OF CALIFORNIA

The Workers' Compensation Appeals Board affirmed a prior award finding the applicant sustained injury to his bilateral knees, hearing loss, and hypertension during his employment. The Board rejected the defendant's arguments regarding due process and substantial evidence, finding the defendant waived its right to contest the injury period by stipulating to it. Furthermore, the Board found the defendant failed to meet its burden of proof for apportionment of permanent disability due to conclusory medical opinions.

WCABFindings and Awardpermanent disabilitybilateral kneeshearing losshypertensionparole officerqualified medical evaluatororthopedicsapportionment
References
1
Case No. ADJ10452586
Regular
Sep 24, 2018

CONSTANTINO MARTINEZ vs. BLUEWATER GRILL, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION, AMERICAN CLAIMS MANAGEMENT, INC.

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board denied reconsideration of a decision finding injury AOE/COE. The Board affirmed the Administrative Law Judge's reliance on the Agreed Medical Evaluator's (AME) opinion, finding no persuasive reason to deviate. Defendants' arguments that the AME's opinion was based on an inadequate history or was conclusory were rejected. The Board also refused to consider a neurologic report procured after trial, as discovery had closed.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorWCJ reportsubstantial medical evidencePetition for RemovalPetition for Change VenueApplication for Adjudication of ClaimFindings and AwardInjury AOE/COE
References
4
Case No. ADJ4311260
Regular
Feb 16, 2010

ROBERT LEWIS vs. TOPA INSURANCE CO. INC., STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address whether applicant's sleep apnea is industrially related. The initial WCJ found it was not, based on stipulations and medical reports, but the applicant contested this, relying on Dr. Fu's report. The Board found Dr. Fu's report lacked substantial evidence due to insufficient reasoning and a conclusory approach. Therefore, the case is returned to the trial level for further development of the record regarding the industrial causation of the applicant's sleep apnea.

Workers' Compensation Appeals BoardIndustrial InjuryCervical SpineRight ShoulderPermanent DisabilitySleep ApneaIndustrial CausationMedical TreatmentReconsiderationAgreed Medical Examiner (AME)
References
0
Case No. ADJ3332763 (OAK 0340542)
Regular
Mar 27, 2009

AUGUSTINE SCOTT vs. UNIVERSITY OF CALIFORNIA, OFFICE OF THE PRESIDENT, Legally Uninsured, Adjusted By SEDGWICK CMS/UNIVERSITY OF CALIFORNIA OFFICE

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding 51% permanent disability without apportionment. The Board found the primary treating physician's apportionment reports insufficient as substantial evidence because they were conclusory and lacked adequate reasoning regarding causation. Consequently, the Board rescinded the award and returned the case to the trial level for further development of the medical record, particularly concerning apportionment. This may involve obtaining supplemental opinions or appointing an Agreed Medical Evaluator.

Workers' Compensation Appeals BoardAugustine ScottUniversity of CaliforniaOffice of the PresidentLegally UninsuredSedgwick CMSSenior Data ProcessorProduction CoordinatorIndustrial InjuryHands
References
1
Case No. ADJ6924000
Regular
Mar 07, 2011

DULCE GONZALEZ vs. RAFAEL RODRIGUEZ dba LA LLAMARADA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior findings, and returned the case for further development of the record. The Board found that while the applicant's medical evidence was admissible due to the defendant's failure to comply with MPN notification requirements, there was no substantial medical evidence to support industrial causation. The primary treating physician's opinion was deemed conclusory, lacking a sufficient link between the described work activities and the claimed injuries. Therefore, further proceedings are required to develop the record on industrial causation.

Workers Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Industrial InjurySubstantial Medical EvidenceIndustrial CausationAdmissibilityLabor CodePetition for ReconsiderationReport and Recommendation
References
17
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