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

Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ2073428 (VNO 0465400) ADJ1610465 (VNO 0540972) ADJ3247765 (VNO 00384869)
Regular
Apr 04, 2011

JAY ZAVERI vs. STATE COMPENSATION INSURANCE FUND; Legally Uninsured

The applicant sought reconsideration of a workers' compensation award, arguing for a 100% permanent disability rating and challenging the permanent disability start date used for attorney fee commutation. The Appeals Board denied the petition, finding insufficient evidence to establish total permanent disability, as the applicant was currently employed and medical opinions did not definitively support such a rating. The Board also ruled that the applicant waived arguments regarding the rating of specific injuries by failing to properly object, and that even if considered, separate ratings for back, knee, and plantar fasciitis conditions would not result in a higher award due to fibromyalgia being the primary cause and rating higher. Finally, the Board clarified that the July 2, 2000 date was only relevant to the attorney fee commutation calculation and not to the determination of permanent disability indemnity payments.

WCABPetition for ReconsiderationJoint Findings and AwardWorkers' Compensation Judge (WCJ)Industrial InjuryBack InjuryHip InjuryBilateral Knee InjuryBilateral Foot InjuryBilateral Plantar Fasciitis
References
Case No. ADJ4145263 (VEN 0120366) ADJ2903274 (OXN 0124883)
Regular
Jul 16, 2012

SHARON ANGELL vs. MARYMOUNT ACADEMY, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) by its servicing agent SEDGWICK CMS, for FREMONT INDEMNITY in liquidation

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original decision, remanding the case for further proceedings. The primary issue is whether applicant's fibromyalgia should be rated separately from her orthopedic injuries. The Board found no clear evidence in the record supporting the WCJ's conclusion that fibromyalgia was solely a consequence of the orthopedic conditions. On remand, the WCJ must determine the causation of the fibromyalgia and whether it warrants separate rating. The Board deferred ruling on other issues raised by the parties.

Workers' Compensation Appeals BoardCIGAFremont Indemnityliquidationreconsiderationfibromyalgiaorthopedic injuryapportionmentvocational evidencetemporary disability
References
Case No. ADJ824062 (VNO 0395359) ADJ1729914 (VNO 0452072) ADJ385264 (VNO 0548716) ADJ4506449 (VNO 0548713)
Regular
May 11, 2016

SHARON SPRAGUE vs. BEVERLY FABRICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE, SUPERIOR NATIONAL INSURANCE COMPANY, MIKASA, SOMPO JAPAN INSURANCE COMPANY OF AMERICA

This case involves multiple injury claims for Sharon Sprague against Beverly Fabrics and Mikasa, primarily concerning back, hip, and fibromyalgia injuries. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to address disputes over permanent disability ratings and apportionment of injuries. The WCAB rescinded prior findings, finding insufficient evidence for permanent total disability and the exact causation of fibromyalgia. The matter is remanded for further proceedings to develop the record on fibromyalgia causation, permanent disability, and apportionment.

CIGASompo JapanReconsiderationJoint Findings Award OrdersPermanent DisabilityApportionmentFibromyalgiaScapula/Rhomboid StrainBilateral KneesAgreed Medical Evaluator
References
Case No. ADJ3316075 (VNO 0426272)
Regular
May 20, 2011

CHRISTINE COLFER AUCHTERLONIE vs. RALPHS GROCERY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address an applicant's 100% permanent disability award for cumulative trauma, including fibromyalgia. The defendant, Ralphs Grocery Company, argued for apportionment to a prior 44% permanent disability award, citing Dr. Silverman's conflicting medical reports on apportionment for fibromyalgia. The Board found Dr. Silverman's reasoning on apportionment unclear and contradictory between his 2000 and 2010 reports. Therefore, the case was returned to the trial level for further clarification on Dr. Silverman's apportionment opinions regarding the fibromyalgia disability.

ApportionmentCumulative TraumaFibromyalgiaPermanent DisabilityReconsiderationAgreed Medical ExaminerWCJLabor Code section 4664Labor Code section 4663Findings and Award
References
Case No. ADJ4579042
Regular
Aug 02, 2010

MARY LOPEZ vs. GRANADA HILLS COMMUNITY HOSPITAL, SAFETY NATIONAL CASUALTY COMPANY

Here's a summary of the case in four sentences for a lawyer: The Workers' Compensation Appeals Board granted reconsideration to further study the medical evidence regarding applicant Mary Lopez's claims of psyche injury and fibromyalgia stemming from an admitted neck and back injury. Defendants contended the WCJ relied on insufficient medical evidence, specifically Dr. Levine's fibromyalgia diagnosis due to an inadequate medical history and a psychiatric report where the applicant withheld suicidal ideation from the evaluating physician. The Board found the existing medical record inadequate to establish fibromyalgia or psychiatric injury and rescinded the prior findings. The matter was returned to the trial level for further development of the medical record, potentially through Agreed Medical Examiners or an Independent Medical Examiner.

Workers Compensation Appeals BoardReconsiderationFibromyalgiaPsyche InjuryQualified Medical EvaluatorSubstantial Medical EvidenceMedical HistoryDue ProcessIndustrial InjuryNeck Injury
References
Case No. ADJ660645 (LAO 0798224)
Regular
May 11, 2009

Norma Flores vs. FIRST DATA ORLANDI VALUTA, ST. PAUL TRAVELERS INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The defendant appealed, arguing the administrative law judge erred by relying on a speculative medical opinion, finding 100% permanent disability, and failing to address the applicant's fibromyalgia claim. The Board affirmed the award, but amended the findings to include fibromyalgia as an industrially injured condition, aligning with the judge's recommendation.

Workers' Compensation Appeals BoardAgreed Medical Examiner (AME)Industrial InjuryNeck InjuryBack InjuryPsyche InjuryTemporary DisabilityPermanent DisabilityFibromyalgiaPetition for Reconsideration
References
Case No. ADJ10268942, ADJ10268936, ADJ10268937, ADJ12179713
Regular
Aug 06, 2019

SANDRA VELASQUEZ vs. CITY OF HOPE NATIONAL MEDICAL , CENTER

The Workers' Compensation Appeals Board granted reconsideration to address applicant's claims of injury to her right knee and fibromyalgia. The Board found that the Agreed Medical Examiner's opinions on fibromyalgia were not substantial evidence as the physician deferred to a specialist, and further development of the record was needed for the right knee claim. The Board rescinded the original award and returned the matter to the judge for further proceedings on these deferred issues, affirming all other aspects of the original decision.

WCABAOE/COEPetition for ReconsiderationJoint Findings and AwardWCJAgreed Medical Examiner (AME)Substantial EvidenceFibromyalgiaRheumatologistRight Knee Arthroscopy
References
Case No. ADJ3096300 (VNO 0326012) ADJ4162370 (VNO 0346321) ADJ2446314 (VNO 0276125)
Regular
Jul 03, 2012

SUSAN BRITT vs. OFFICE OF THE COUNTY COUNSEL, Permissibly Self-Insured c/o TRISTAR RISK MANAGEMENT

This case concerns the Workers' Compensation Appeals Board's decision after a petition for removal by lien claimant David Silver, M.D. After granting the removal, the Board issued notice that it would find the applicant did not sustain an industrial injury to fibromyalgia, absent objection. As no objection was received, the Board affirmed this finding of no injury AOE/COE to fibromyalgia. The matter is returned to the trial level for final disposition of the lien, allowing for further relevant evidence presentation.

WORKERS' COMPENSATION APPEALS BOARDPetition for Removallien claimantDavid Silver M.D.injury arising out of and occurring in the course of employmentAOE/COEfibromyalgiatrial levelfinal dispositionadministrative law judge
References
Case No. LAO 0833762
Regular
Sep 07, 2007

IRMA MARTINEZ, IRMA A. NAVAREZ-MARTINEZ vs. CORONA CLIPPER, STATE COMPENSATION INSURANCE FUND, LIBERTY MUTUAL INSURANCE COMPANY, AMERICAN HOME ASSURANCE COMPANY

The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the case for further proceedings. This action defers the issue of injury to the psyche while affirming findings of industrial injury to the back, neck, shoulders, elbows, wrists, and fibromyalgia, based on a cumulative trauma period ending August 23, 1999. Fibromyalgia was properly considered as an issue, and substantial evidence supports the established cumulative trauma period and related injuries, despite the defendant's contentions.

FibromyalgiaCumulative traumaDate of injuryMandatory settlement conferenceIndustrial injuryAgreed medical examinationRheumatologistOccupational diseaseSubstantial evidenceStipulation
References
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