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

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. ADJ8738819
Regular
Jun 10, 2015

Stephanie MOTEN vs. CITY OF LOS ANGELES

This case involves a dispute over Stephanie Moten's permanent disability rating following a work injury. Both the applicant and defendant sought reconsideration of an award of 19% permanent disability. The Appeals Board found the Agreed Medical Evaluator's (AME) permanent disability ratings were not substantial evidence due to improper application of the AMA Guides and failure to properly analyze nerve impairment. Consequently, the Board deferred the issues of permanent disability and attorney's fees, returning the case to the trial level for further proceedings.

Workers' Compensation Appeals BoardStephanie MotenCity of Los AngelesTristar Risk ManagementOpinion and Decision After ReconsiderationPermanent DisabilityAmerican Medical Association GuidesAMA GuidesAgreed Medical EvaluatorAME
References
Case No. ADJ823138 (OXN 0142604)
Regular
Oct 25, 2010

CHERYL PEET vs. COUNTY OF VENTURA, Permissibly SelfInsured, Administered By CORVEL CORPORATION

The Workers' Compensation Appeals Board is reconsidering a prior decision that found a deputy probation officer sustained industrial injuries resulting in 78% permanent disability. The defendant sought reconsideration, arguing the Qualified Medical Examiner's (QME) opinion, which formed the basis of the award, was ambiguous and unsubstantiated. The Board agrees that the QME's assessment of 60% whole person impairment is not adequately supported by the record, particularly in light of the applicant's own testimony regarding her daily activities. Therefore, the case is returned to the trial level for further evidence development and a new decision, with consideration for cost of living adjustments if a life pension is awarded.

Workers Compensation Appeals BoardCheryl PeetCounty of VenturaCORVEL CORPORATIONADJ823138OXN 0142604Opinion and Decision After Reconsiderationdeputy probation officerindustrial injuryright upper extremity
References
Case No. ADJ7162019
Regular
Aug 13, 2010

Abraham Avila vs. Victory Outreach San Bernardino, Guide One Ins. Co.

This case involves a petition for reconsideration filed by the defendant, Victory Outreach San Bernardino, and its insurer, Guide One Ins. Co. The Workers' Compensation Appeals Board has granted this petition. The Board determined that reconsideration is necessary to allow for further study of the factual and legal issues to ensure a just and reasoned decision. Further proceedings may be held pending the issuance of a Decision After Reconsideration.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationVICTORY OUTREACH SAN BERNARDINOGUIDE ONE INS. CO.ABRAHAM AVILAOPINION AND ORDERGRANTING PETITIONSTATUTORY TIME CONSTRAINTSFACTUAL AND LEGAL ISSUESJUST AND REASONED DECISION
References
Case No. ADJ3849676 (AHM 0147658) ADJ1948081 (AHM 0147721)
Regular
Feb 14, 2011

ROBERT LEON vs. RF DEVELOPMENT & BUSCH CORPORATION, LINCOLN GENERAL INSURANCE

In this workers' compensation case, the defendant sought reconsideration of a $37\%$ permanent disability award, arguing the physician's impairment rating improperly deviated from the AMA Guides. The Appeals Board granted reconsideration, finding the physician's justification for not strictly applying the Guides was insufficient and not based on substantial medical evidence. Specifically, the physician's reliance on subjective complaints and analogies to amputation were not adequately supported. The Board rescinded the award and remanded the case for a new rating strictly following the AMA Guides.

Workers' Compensation Appeals BoardRF Development & Busch CorporationLincoln General InsuranceAmerican Claims ManagementRobert LeonADJ3849676ADJ1948081ReconsiderationFindings and AwardIndustrial Injuries
References
Case No. ADJ9890148
Regular
Feb 02, 2017

Timothy Bedford vs. CITY OF LOS ANGELES

This Workers' Compensation Appeals Board case denies reconsideration of a permanent disability rating. The Board affirmed the use of Figure 15-19 of the AMA Guides, finding it permissible to use any chapter or method within the Guides that most accurately reflects impairment. The Agreed Medical Evaluator's opinion was deemed substantial, as he explained how Figure 15-19 was used to derive a more accurate rating based on the applicant's specific spinal condition. The decision also distinguished the current case from prior panel decisions regarding the application of the AMA Guides and work limitations.

AMA Guidespermanent disability ratingrebuttable presumptionwhole person impairmentAlmaraz/Guzman IIclinical judgmentagreed medical evaluator (AME)Figure 15-19functional losssurgical-grade disc herniations
References
Case No. ADJ6788177
Regular
May 13, 2015

GREGORY GREENE vs. CENTRAL PARKING SYSTEMS, SEDGWICK CMS

In this workers' compensation case, the Appeals Board denied the defendant's petition for reconsideration. The defendant challenged a $75\%$ permanent disability award, arguing the primary treating physician's rating improperly combined various lower extremity impairments, violating the AMA Guides. The Board found the WCJ's reliance on the physician's opinion was supported by substantial evidence, emphasizing the need for accurate, not mechanical, application of the Guides. A dissenting opinion argued the rating was not substantial evidence as it failed to follow proper *Almaraz-Guzman* procedures for deviating from strict AMA Guides application and advocated for remand.

Workers' Compensation Appeals BoardAmended Findings and AwardPetition for Reconsiderationindustrial injurypermanent disabilitylife pensionLabor Code section 4658 (d) increasesubstantial medical evidenceLabor Code section 4660 (b)(1)AMA Guides
References
Case No. ADJ285115 (STK 0203659)
Regular
May 17, 2010

ARTEMIO GONZALEZ vs. RANGEL DRYWALL, INC., STATE COMPENSATION INSURANCE FUND

The applicant sustained an admitted industrial injury to his left lower extremity, specifically a fractured ankle requiring surgery. The defendant sought reconsideration of the WCJ's award of 30% permanent disability, arguing the panel QME's reports lacked specific measurements and explanations required by the AMA Guides. The Appeals Board affirmed the WCJ's decision, finding the QME's deposition testimony, which provided detailed explanations and measurements, constituted substantial evidence. The Board clarified that while AMA Guides sections must be followed, physicians can use their clinical judgment and specific tables within the Guides as long as the basis is explained.

Workers' Compensation Appeals BoardArtemio GonzalezRangel DrywallState Compensation Insurance FundPermanent DisabilityMedical TreatmentConstruction WorkerQualified Medical ExaminerAMA GuidesPermanent Impairment
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. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
Significant
Feb 03, 2009

Mario Almaraz, Joyce Guzman vs. Environmental Recovery Services (a.k.a. ENVIROSERVE), State Compensation Insurance Fund, Milpitas Unified School District, Permissibly Self-Insured, Keenan & Associates, Adjusting Agent

The Appeals Board held that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable by showing that an impairment rating based on the AMA Guides would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability.

AMA Guidesrebuttable presumptionpermanent disability rating2005 Scheduleimpairment determinationmedical opinionevidentiary standardequitable awardvocational specialistsactivities of daily living
References
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