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

Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
4
Case No. ADJ12705097
Regular
Sep 21, 2022

FRED BROYLES vs. ATLAS VAN LINES, ARCH INSURANCE, GALLAGHER BASSETT SERVICES

In Broyles v. Atlas Van Lines, the WCAB denied the defendant's petition for reconsideration, affirming the finding of 29% permanent disability. The Administrative Law Judge and the Board found that the Qualified Medical Evaluator (QME) properly utilized the Almaraz/Guzman principles to deviate from a strict AMA Guides rating. The QME's analogy to a hernia condition was deemed substantial evidence for assessing the applicant's impairment due to limitations on lifting and its impact on daily living activities. The Board concluded the QME adequately explained the departure from the standard rating and provided sufficient reasoning for the alternative assessment.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 4660.1(d)scheduled ratingprima facie evidencerebuttableMilpitas Unified School Dist. v. Workers' Comp. Appeals Bd.Almaraz-Guzman IIIwhole person impairment (WPI)AMA Guides
References
3
Case No. ADJ10222181 (MF) ADJ10222198
Regular
Jan 30, 2019

SAM ALBOUDOOR vs. AMJES, INC. dba K&B FREIGHT SYSTEMS

This case concerns claims for hernias and spine injuries sustained by a truck driver. The Workers' Compensation Appeals Board granted reconsideration to review the finding that hernias were work-related, noting the medical evaluator's conflicting opinions on causation. The Board determined further medical development is required on the hernia issue due to contradictory expert testimony. Additionally, the issue of reimbursement for self-procured medical treatment was deferred pending the resolution of the hernia claims.

Workers' Compensation Appeals BoardAMJES INCK&B Freight SystemsSam Alboudoorherniahiatal herniainguinal hernialumbar spinethoracic spinePQME
References
0
Case No. ADJ300802 (AHM 0109743) ADJ2310921 (AHM 0115931)
Regular
Nov 21, 2008

CHRISTOPHER SHIELDS vs. LAIDLAW TRANSIT; BROADSPIRE

The Appeals Board granted reconsideration, amending the original award to establish a permanent and stationary date of January 3, 2005, for applicant's abdominal hernia injuries. The Board deferred the issues of permanent disability and attorneys' fees, returning the case to the trial level for re-rating based on hernia/abdominal injuries rather than spinal injuries. The Board affirmed the finding of an industrial inguinal hernia injury, while also noting that the defendant did not provide evidence of unreasonable refusal of medical treatment for the hernias.

HerniaUmbilical herniaInguinal herniaLow back painPermanent and stationary dateTemporary total disabilityMedical treatmentAttorney's feesReconsiderationWorkers' Compensation Appeals Board
References
0
Case No. SDO 0322942
Regular
Jan 31, 2008

ROBERT WEIS vs. VULCAN MATERIALS COMPANY, ZURICH NORTH AMERICA

The applicant claims an admitted industrial spinal injury caused his umbilical hernia, but the WCJ denied benefits for the hernia, finding it nonindustrial. The applicant argues the Qualified Medical Evaluator's opinion supports industrial causation for the hernia, contradicting the defense. The Appeals Board granted reconsideration to obtain a report from the WCJ regarding this contested issue.

Workers' Compensation Appeals BoardVulcan Materials CompanyZurich North AmericaRobert Weisindustrial injuryspineherniaumbilical herniatruck driverqualified medical evaluator
References
0
Case No. ADJ8109410
Regular
Apr 03, 2015

KRISTINA BROOKS vs. COUNTY OF TULARE

The Workers' Compensation Appeals Board reversed the Administrative Law Judge's decision, finding that the applicant's hiatal hernia and GERD were not industrial injuries. The Board determined that the Labor Code section 3212 presumption for hernias in law enforcement officers was rebutted by medical evidence. Specifically, the Board found that the applicant's hiatal hernia was primarily caused by complications from a prior non-industrial bariatric surgery, not her employment. Therefore, the Board rescinded the award for medical treatment and temporary/permanent disability.

Labor Code section 3212presumptionrebuttalhiatal herniaGERDQualified Medical EvaluatorIra FishmanM.D.deposition testimonybariatric surgery
References
1
Case No. ADJ10121570
Regular
Aug 19, 2016

TRACY BAKER vs. FOOTHILL DEANZA COMMUNITY COLLEGE DISTRICT

In this Workers' Compensation Appeals Board case, the defendant sought reconsideration of an award finding the applicant sustained a work-related rib and chest injury. The defendant argued the QME's opinion on permanent disability and future medical treatment lacked substantial medical evidence, as it relied on analogy due to the absence of a specific rating in the AMA Guides. The Appeals Board affirmed the original award but deferred the issues of permanent disability and attorney's fees, finding the QME's analogical rating was conclusory and unsupported by sufficient reasoning. A dissenting commissioner argued the analogy was permissible under precedent allowing clinical judgment for poorly understood conditions manifesting solely as subjective symptoms.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityFuture Medical TreatmentQualified Medical EvaluatorWhole Person ImpairmentSubstantial Medical EvidenceAMA GuidesClinical Judgment
References
7
Case No. MISSING
Regular Panel Decision
Jul 27, 1978

Claim of Lopez v. New York City Housing Authority

This case involves an appeal from a decision of the Workers’ Compensation Board, which found that the claimant sustained an occupational hernia. The claimant initially filed a claim in 1976 for an injury on July 12, 1973, which was dismissed by a referee due to the two-year limitation under section 28 of the Workers’ Compensation Law. Subsequently, the claimant filed a new claim, and a referee found an occupational disease and causal relationship for an incisional hernia, setting the disablement date as January 19, 1976. The employer and carrier appealed, arguing that the first dismissal was res judicata. The board affirmed the referee's decision, citing its broad powers of continuing jurisdiction under section 123 of the Workers’ Compensation Law. The court affirmed the board's determination, finding substantial medical evidence supporting the conclusion that heavy lifting and bending led to the occupational hernia.

Occupational HerniaWorkers' Compensation LawRes JudicataContinuing JurisdictionTimeliness of ClaimMedical EvidenceBoard DecisionAppealCausal RelationshipIncisional Hernia
References
5
Case No. ADJ9811478
Regular
Aug 14, 2017

MARCOS RAMIREZ vs. HALL MANAGEMENT CORPORATION, NATIONAL UNION FIRE INSURANCE COMPANY/AIG

The applicant sought reconsideration of an order approving a compromise and release (C&R) settlement, claiming there was no agreement to include his hernia claim. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration. The WCAB found that the applicant's claim regarding the hernia was a dispute over the C&R, not a final decision on the merits. The matter was remanded to the WCJ for a hearing to create a record on the applicant's allegations before further appeal.

Compromise and ReleasePetition for ReconsiderationWorkers' Compensation Appeals Boardmeeting of the mindshernia claimdefective servicecontinuing jurisdictiongood causemutual mistake of factduress
References
0
Case No. ADJ6475661
Regular
May 11, 2015

ALAN COLGROVE vs. SANTA ROSA PRESS DEMOCRAT, TRAVELERS PROPERTY & CASUALTY COMPANY OF AMERICA

The Appeals Board rescinded the WCJ's decision finding a hernia to be a compensable consequence of a back injury, citing insufficient medical evidence. Dr. Klein’s opinion on causation was found to be inconsistent and not substantial evidence. The Board concluded the medical record requires further development to determine if the hernia is causally related to the industrial injury. Therefore, the case is returned to the trial level for further proceedings and a new decision by the WCJ.

COMPENSABLE CONSEQUENCEPETITION TO REOPENMEDICAL RECORD DEVELOPMENTQUALIFIED MEDICAL EVALUATOR (PQME)OPINIONCAUSAL RELATIONSHIPHERNIABACK INJURYSTIPULATIONSSUBSTANTIAL EVIDENCE
References
3
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