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

Case No. ADJ7352906
Regular
Jul 10, 2012

ANA PEREZ vs. PALOMINO JANITORIAL SERVICES, ENDURANCE INSURANCE COMPANY, FIRST COMP INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a "take nothing" finding, upholding the WCJ's decision that applicant Ana Perez failed to prove an industrial injury. The WCJ found applicant's testimony not credible due to inconsistent reporting of the injury date, mechanism, and prior medical history. The medical evidence, including a PQME report, concluded no reasonable evidence of an industrial injury existed, citing inconsistent history and denial of trauma in contemporaneous medical records. Therefore, applicant did not meet her burden of proof to establish an industrial injury.

ReconsiderationWCABWCJcredibility determinationamended claimmechanism of injuryinconsistent historyGarden Grove Hospitaldenies traumafibromyalgia
References
Case No. STK 0190139
Regular
Nov 07, 2007

ANTO'NIO ACOSTA vs. LUPTON EXCAVATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the Workers' Compensation Judge's finding that the applicant failed to prove his injury arose out of and in the course of employment. This decision was based on the judge's determination that the applicant was not a credible witness and presented inconsistent accounts of the incident. The Board gave great weight to the judge's credibility findings and the inconsistencies in the applicant's medical history and witness testimony.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeReport and RecommendationLabor Code § 3202.5Preponderance of the EvidenceInjury Arising Out of and In The Course of EmploymentCredibilityInconsistent HistoriesContemporaneous Medical Reports
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. ANA 0382448
Regular
Nov 07, 2007

Virginia Garcia vs. Merchants Building Maintenance, NOVPRO RISK SOLUTIONS

This case involves Virginia Garcia's workers' compensation claim for injuries sustained on February 27, 2004. The Workers' Compensation Appeals Board denied Garcia's petition for reconsideration, upholding the Administrative Law Judge's (WCALJ) findings. The WCALJ found Garcia lacked credibility due to inconsistent testimony and a conflicting medical history, concluding she failed to prove her injury arose out of and occurred in the course of employment.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ ReportCredibility FindingGarza v. Workmen's Comp. Appeals Bd.Applicant TestimonySpanish InterpreterInconsistent TestimonyPrior Injury HistoryLeft Shoulder Dislocation
References
Case No. ADJ252083 (NOR 0166266) ADJ3827633 (LAO 0784953) ADJ3395707 (LAO 0784956) ADJ629194 (LAO 0849490) ADJ2985386 (LAO 0784955) ADJ2625573 (LAO 0784951)
Regular
Apr 12, 2011

CLAUDIA DYER vs. BOEING/McDONNELL DOUGLAS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHARTIS INSURANCE

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the WCJ's findings of industrial injuries to the applicant's knees, neck, back, shoulders, hips, hands, and ankle across multiple dates. The Board found the WCJ's decision was supported by substantial evidence, specifically Dr. Nelson's well-reasoned medical opinions on causation and apportionment. CIGA's petition was also found deficient for failing to comply with procedural requirements for referencing the record. Finally, CIGA was estopped from asserting the statute of limitations defense due to the employer's knowledge of the injury and failure to provide notice of rights.

CIGAFremont InsuranceliquidationPetition for ReconsiderationJoint Findings and Awardindustrial injuryaircraft mechanickneesneckback
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
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. ADJ8185605
Regular
Oct 28, 2013

VERONICA RENDON vs. FULTON HOLDING CORP., SENTRY INSURANCE CO.

The Workers' Compensation Appeals Board denied Veronica Rendon's petition for reconsideration. The Board adopted and incorporated the administrative law judge's report, which found Rendon not to be a credible witness. This finding was based on numerous inconsistencies in her testimony regarding the alleged work injury and its reporting. Consequently, the Board upheld the judge's decision that Rendon failed to prove her injury arose out of and occurred in the course of employment.

AOE/COEPetition for ReconsiderationCredibilityInconsistenciesMedical HistoryWork InjuryEmployerWitness TestimonyCausationBurden of Proof
References
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. ADJ10443669
Regular
Oct 04, 2017

Donna Carter vs. Rose International Group, OneBeacon Insurance Group

The Appeals Board affirmed the Workers' Compensation Judge's finding that Donna Carter sustained an industrial injury to her right knee and left wrist on May 18, 2016. Despite inconsistencies in the applicant's testimony regarding a slip and fall incident, her account was corroborated by a witness who found her on the floor. Medical records from the day of the incident also supported the applicant's claim, establishing a clear mechanism of injury. The Board found that the common sense nature of a slip and fall does not require expert medical opinion to establish industrial causation for the incident itself.

ADJ10443669Rose International GroupOneBeacon Insurance GroupDonna CarterWorkers' Compensation Appeals BoardOpinion and Decision After Reconsiderationslip and fallindustrial injuryright kneeleft wrist
References
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