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

Case No. ADJ3288464 (LAO 0772800)
Regular
Mar 27, 2009

NACHUM SAGI vs. OLYMPIC HOLDING CORP., CIGA by its servicing facility BROADSPIRE CLAIMS SERVICES, SUPERIOR NATIONAL INSURANCE COMPANY in liquidation

The Workers' Compensation Appeals Board denied reconsideration of the applicant's petition. The denial was based on the WCJ's report, which found the applicant's testimony and reported medical history inconsistent and not credible. Specifically, the Board found that the Agreed Medical Evaluator's (AME) opinion did not constitute substantial evidence due to the flawed history provided by the applicant. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorSubstantial EvidenceVargas v. Atascadero State HospitalLabor Code section 5313CredibilityConflicting HistoriesMedical FileStipulated Award
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ11225008
Regular
Mar 06, 2019

JOE DAVIS vs. COUNTY OF RIVERSIDE IHSS, YORK INSURANCE SERVICES

This case involves Joe Davis, a homecare provider, who claimed injury to his left leg and ankle on September 23, 2017. The applicant's petition for reconsideration was denied by the Workers' Compensation Appeals Board. The Board adopted the findings of the administrative law judge (WCJ), who found the applicant's testimony regarding the work-related incident to be not credible due to significant inconsistencies with contemporaneous medical records. These inconsistencies, along with the applicant's prior guilty plea for defrauding his employer, undermined his credibility in establishing an industrial injury.

Petition for ReconsiderationCredibility DeterminationsIndustrial InjuryCourse of EmploymentHomecare ProviderWorkers' Compensation Administrative Law JudgeMedical RecordsConflicting HistoriesFraudulent ReportingWitness Testimony
References
Case No. ADJ8410459
Regular
Oct 22, 2019

DIETRA WALKER vs. YMCA METROPOLITAN LOS ANGELES

The Workers' Compensation Appeals Board (WCAB) granted the applicant's Petition for Reconsideration, overturning the trial judge's decision to strike a Qualified Medical Evaluator's (QME) report. The WCAB found no disqualifying conflict of interest for Dr. Gabriel, despite co-authored articles and past professional association with another dentist, Dr. Schames. Furthermore, the Board deemed the defendant's motion to strike Dr. Gabriel untimely due to a nearly three-year delay after his deposition. The case is affirmed with an amendment finding Dr. Gabriel free of conflict, and the defendant's motion is denied.

QMEconflict of interestdisqualifying conflict of interestlachesestoppelpetition for reconsiderationremovalmotion to strikeAOE/COEdeposition
References
Case No. ADJ3190249 (SFO 0500553)
Regular
Mar 24, 2010

Quintella Eutsey vs. CITY & COUNTY OF SAN FRANCISCO, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted removal, dismissing the defendant's petition for reconsideration. The Board found the prior administrative law judge's order improperly limited discovery into the applicant's psychiatric injury claim. The Board rescinded the previous order, allowing further deposition to explore the applicant's full medical history relevant to her psyche claim, as this is discoverable when a psychological injury is at issue. Both parties were admonished to conduct themselves professionally during future discovery.

removalpetition for reconsiderationdiscovery disputepsyche injurydeposition testimonyright lower extremityindustrial injurypersonal lifefamily lifepast history
References
Case No. ADJ9805248
Regular
Aug 30, 2017

FRANCISCO PEREZ vs. MASSIVE PRINTS, HARTFORD/ SENTINEL INSURANCE COMPANY

The Appeals Board granted reconsideration of the WCJ's award due to questions regarding the substantiality of the Qualified Medical Evaluator's (QME) opinion. The Board found the QME's report and deposition testimony unreliable due to an incorrect work history, inadequate examination, and potentially flawed application of disability rating guidelines. Consequently, the Board affirmed the original award but deferred issues of permanent disability, apportionment, and attorney fees, returning the case to the WCJ for further proceedings and potentially a new medical evaluation.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentAttorney FeesQualified Medical EvaluatorAgreed Medical ExaminerSubstantial EvidenceMedical Opinion
References
Case No. ADJ1082547 (LBO 0311990), ADJ3651061 (LBO 0321320)
Regular
Nov 17, 2017

KARLA NEAL vs. J. PAUL GETTY TRUST; ESIS CENTRAL WC CLAIMS

The Workers' Compensation Appeals Board denied Karla Neal's Petition for Reconsideration, upholding the Workers' Compensation Judge's (WCJ) decision. The Board gave great weight to the WCJ's credibility determination based on observing the applicant's demeanor during testimony. The applicant's claims of worsening industrial injuries and newly developed psychiatric injury were not supported by substantial evidence or raised appropriately at trial. The WCJ found the applicant lacked credibility, presenting inconsistent histories and making disparaging accusations against medical examiners.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationAgreed Medical Examiner (AME)orthopedic injuriespsychiatric injurycumulative traumapro persubstantial evidenceindustrial injury
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. ADJ10968178
Regular
May 24, 2019

MIRNA GUERRA vs. KENNERLEY SPRATLING, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award finding applicant sustained bilateral wrist and hand injury AOE/COE. The WCAB found that neither the applicant's treating physician, Dr. Mirza, nor the defense qualified medical examiner, Dr. Roth, provided substantial medical evidence. Dr. Roth's report failed to address aggravation of any pre-existing condition by the applicant's work duties. Dr. Mirza's reports suffered from inconsistencies, inadequate medical history, and lack of reasoning. Therefore, the WCAB rescinded the award and returned the case to the WCJ for further record development.

AOE/COEPetition for ReconsiderationFindings of FactAward and OrderWCJbilateral wristsbilateral handscumulative traumaprimary treating physicianqualified medical examiner
References
Case No. ADJ8741844
Regular
Jan 14, 2014

CARLOS MIRANDA vs. PACIFIC EXCHANGE, HANOVER INSURANCE GROUP

The Appeals Board rescinded the prior finding of injury to the applicant's back, concluding it was not supported by substantial evidence. The Board found the medical report relied upon by the trial judge was based on an inaccurate and incomplete history provided by the applicant, inconsistent with other statements and undisputed trial evidence. Therefore, the applicant did not sustain an industrial injury to his back, and the case was returned for further proceedings on other alleged body parts.

WCABReconsiderationFindings of FactLabor CodeStatute of LimitationsIndustrial InjuryAOE/COESubstantial EvidenceInaccurate Medical HistoryIncomplete Medical History
References
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