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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ2616452
Regular
Feb 19, 2009

Alicia Montgomery vs. Tip Top Meats European Deli, Commercial Casualty Insurance Company

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award. The Board found the medical record insufficient to support the finding of permanent total disability, specifically lacking evidence on how applicant's medications affected her cognitive function. The case was returned to the trial level for further development of the medical record to address this deficiency. The Board also noted that pre-existing non-industrial factors cannot be solely relied upon for vocational rehabilitation non-feasibility.

Permanent Total DisabilityVocational RehabilitationMedical Record DevelopmentMedication EffectsCognitive FunctioningIntellectual AbilitiesPain BehaviorsFunctional Capacity EvaluationApportionmentLeBoeuf
References
Case No. ADJ10278736
Regular
Nov 15, 2019

UFRACINA CERVANTES vs. STRATEGIC RESTAURANT COMPANY II, LLC, NEW HAMPSHIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a finding of $75\%$ permanent disability. The applicant argued for $100\%$ permanent disability based on vocational and medical expert opinions. The Board found the applicant failed to meet her burden of proof for total disability due to insufficient substantial medical evidence. A dissenting commissioner believed the record was undeveloped, particularly regarding a requested functional capacity evaluation and a psychiatric evaluation, and that further development was necessary for substantial justice.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityVocational ExpertFunctional Capacity EvaluationQualified Medical EvaluatorResidual Functional CapacityPain Management SpecialistPsychologist
References
Case No. ADJ8393129
Regular
Feb 24, 2020

THOMAS HASSON vs. ANN TAYLOR, TRAVELERS INSURANCE

Here's a concise summary for a lawyer: This case involves a defendant's petition for reconsideration of a finding of permanent total disability due to cumulative trauma. The defendant argued the treating physician's report was unsubstantial regarding causation and functional capacity, and that apportionment to a pre-existing condition was wrongly disregarded. The Board denied reconsideration, affirming the administrative law judge's decision, finding substantial evidence supported the permanent total disability finding based on the applicant's inability to benefit from vocational rehabilitation. The Board adopted the judge's reasoning that the applicant's medical restrictions precluded him from returning to full-time employment in the open labor market.

cumulative traumapermanent total disabilitymedical evidencevocational evidencefunctional capacity evaluationresidual functional capacityapportionmentpre-existing conditionsubstantial medical evidencelabor market
References
Case No. ADJ2450523 (MON 0361699), ADJ3686785 (MON 0361700), ADJ6526089, ADJ6527240, ADJ6527336
Regular
Nov 07, 2013

NINA IGLESIAS vs. ORIENT TALLY COMPANY, NATIONAL INTERSTATE INSURANCE COMPANY

In *Iglesias v. Orient Tally Company*, the Workers' Compensation Appeals Board (WCAB) issued an order dismissing a petition for removal. The petitioner filed the petition for removal and subsequently withdrew it. Due to this withdrawal, the WCAB deemed the petition dismissed and will take no further action.

WORKERS' COMPENSATION APPEALS BOARDPetition for RemovalDismissedWithdrawnNina IglesiasOrient Tally CompanyNational Interstate Insurance CompanyADJ2450523Long Beach District OfficeMarina del Rey District Office
References
Case No. ADJ7087449
Regular
Nov 02, 2012

ELVIRA VASQUEZ vs. DEL MONTE FOODS, ZURICH INSURANCE

This case involves a workers' compensation claim by Elvira Vasquez against Del Monte Foods. The defendant sought reconsideration of a prior Appeals Board decision that found applicant sustained an industrial injury and that the defendant failed to prove intoxication was the proximate cause. The defendant argued the applicant's amphetamine use was established and impaired her function, making it a substantial factor in the injury. The Appeals Board denied reconsideration, holding that a positive drug test alone is insufficient to prove intoxication or causation, citing precedent that requires further evidence of impaired function or substantial evidence of causation.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryLabor Code Section 3600(a)(4)Proximate CauseIntoxicationBurden of ProofAmphetaminesDrug TestImpaired Function
References
Case No. ADJ9358356
Regular
Sep 12, 2018

BLADIMIR RAMIREZ vs. J&J APARTMENT RENTALS, NORGARD INSURANCE COMPANY

This case concerns a lien claim for acupuncture services rendered to applicant Bladimir Ramirez. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award, finding the lien claimant failed to demonstrate functional improvement required for more than six acupuncture treatments. While acknowledging some improvement in physical examinations, the WCAB determined this alone did not satisfy the regulatory definition of functional improvement. Ultimately, the WCAB modified the award to allow the lien claimant $\$647.92$ for services rendered between June 17, 2014, and July 24, 2014, based on a submitted bill review.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardLien ClaimantOfficial Medical Fee ScheduleFunctional ImprovementActivities of Daily LivingWork RestrictionsPrimary Treating PhysicianCompromise and Release
References
Case No. ADJ9585461
Regular
Feb 02, 2017

TONY DE LA GARZA vs. ROLL GLOBAL/DEL REY JUICE PLANT dba POM WONDERFUL, Permissibly Self-Insured, Administered by BROADSPIRE

The WCAB dismissed the defendant's Petition for Removal, treating it as a Petition for Reconsideration, and denied it. The Board affirmed the WCJ's order requiring the defendant to authorize surgical treatment. The defendant's initial challenge was based on a prior IMR denial, but the Board found a material change in facts occurred when the treating physician clarified the surgery's non-cosmetic, functional purpose. The Board concluded the subsequent UR certification was valid and the defendant must authorize the treatment.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderUtilization ReviewIndependent Medical ReviewMedical TreatmentSurgical ProcedureScar DeformityPainful Scar
References
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