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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Nov 14, 1978

Claim of Spasiano v. Empire City Iron Works

The claimant, a mechanic hired in 1974, suffered a low back injury at work in November 1974. He had a pre-existing medical condition, having undergone subtotal gastrectomy in 1965. The employer's insurance carrier filed a C-250 seeking reimbursement from the Special Fund, alleging a pre-existing permanent physical impairment. To claim reimbursement, it needed to be established that the employer hired or continued the claimant with knowledge of the impairment and a good faith belief in its permanency, and that the impairment materially and substantially increased the disability. Conflicting medical opinions were presented regarding whether the claimant's prior stomach condition materially and substantially increased his disability. The Workers' Compensation Board found, based on medical evidence including Dr. Lehv's report, that the prior stomach condition did not materially and substantially increase the disability. This finding, supported by substantial evidence, led to the affirmation of the Board's decision, discharging the Special Fund from liability.

Workers' Compensation BoardSpecial Fund LiabilityPre-existing ConditionSubtotal GastrectomyLow Back InjuryMaterially and Substantially Greater DisabilityMedical EvidenceReimbursementEmployabilityPermanency
References
2
Case No. ADJ8815528
Regular
Aug 22, 2016

RICARDO SALINAS vs. SOUTHEAST PERSONNEL LEASING, INC.; STATE NATIONAL INSURANCE COMPANY

The applicant sought reconsideration of a decision finding his psychiatric injury, stemming from a fall, was not compensable at an increased impairment rating. The applicant argued the injury was a "violent act" or "catastrophic" under Labor Code § 4660.1, thereby exempting it from limitations on psychiatric impairment increases. The Workers' Compensation Judge recommended denying reconsideration, finding the applicant's fall lacked the element of a violent act and that the resulting orthopedic injury and restrictions did not qualify as catastrophic. The judge concluded that the mere fact of hospitalization did not elevate the injury to catastrophic status.

Petition for ReconsiderationWorkers' Compensation Appeals Boardpsychiatric injuryLabor Code § 3208.3Labor Code § 4660.1catastrophic injuryviolent actpredominant causesix months employmentorthopedic injury
References
1
Case No. ADJ8181938; ADJ8702275
Regular
Apr 10, 2023

KAREN MILLER vs. STATE OF CALIFORNIA, VENTURA YOUTH CORRECTIONAL FACILITY, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued against the statutory 15% increase, the method of evaluating spine impairment, and the inclusion of a sleep disorder. The Board adopted the WCJ's report, finding no error in the application of the 15% increase or the evaluation of the spine impairment using the ROM method as deemed appropriate by the agreed medical examiner. Furthermore, the Board upheld the finding of an industrially caused sleep disorder, noting that formal sleep studies are not always required for diagnosis and that the physician's rating falls within the AMA Guides.

WCABPetition for ReconsiderationDeniedVentura Youth Correctional FacilityAdjudication NumbersOccupational Group 214Cervical SpineLumbar SpineBilateral ShouldersGastrointestinal System
References
1
Case No. ADJ7483972, ADJ7483952
Regular
Nov 08, 2012

ROY HAAS vs. CITY OF SANTA ROSA, REDWOOD EMPIRE MUNICIPAL INSURANCE FUND

This case involves a workers' compensation applicant, Roy Haas, who sustained injuries to his left elbow and bilateral shoulders. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to increase Haas's permanent disability ratings. The WCAB adopted the WCJ's recommendation to rate impairments based on the highest applicable factor, citing that Dr. Suchard's report did not adequately explain combining strength and range of motion impairments for the elbow, and that strength deficits should not be rated where objective anatomic findings like loss of motion are present and prioritized by the AMA Guides. Consequently, Haas's permanent disability for the left elbow was increased to 25%, and for his shoulders to 31%.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardsPermanent Disability RatingAgreed Medical ExaminerAMA GuidesRange of MotionLoss of StrengthOccupational CodeLabor Code Sections
References
2
Case No. ADJ11197293
Regular
Dec 18, 2020

KEVIN TORRES vs. ARCTIC MECHANICAL, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns an applicant's entitlement to an increased impairment rating for sleep dysfunction. The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The Board affirmed the Administrative Law Judge's finding that Labor Code Section 4660.1(c)(1) does not preclude an increased impairment rating for sleep dysfunction if it is directly caused by the industrial injury, rather than a consequence of it. Medical evidence from Dr. Jonathan Wang established a direct causal link between the applicant's sleep dysfunction and the industrial injury. The Board found Dr. Wang's report and deposition testimony constituted substantial medical evidence supporting this conclusion and rejected the defendant's arguments.

Labor Code 4660.1(c)(1)sleep dysfunctiondirect causationincreased impairment ratingcompensable consequencepsychiatric disordersubstantial medical evidenceQME reportdeposition testimonyAMA Guides
References
2
Case No. ADJ10544189
Regular
Nov 09, 2018

MARTIN GARCIA vs. HARVEST CHURCH, GUIDEONE MUTUAL

This case involves an applicant seeking an increased permanent impairment rating for a psychiatric injury stemming from a physical injury to his left foot. The applicant's injury occurred when a gate fell on his foot, and he claims this constitutes a "violent act" under Labor Code section 4660.1(c)(2)(A), which allows for exceptions to a general rule against increased impairment ratings for psychiatric issues arising from physical injuries. The Appeals Board denied reconsideration, affirming the WCJ's finding that the gate falling was an accidental injury, not a violent act, based on definitions involving strong physical force or extreme threats. The Board found the applicant's experience lacked the intensity seen in prior cases of violent acts, such as being struck by a car or being crushed in a vehicle.

AOE/COEViolent ActLabor Code Section 4660.1Psychiatric InjuryPermanent Impairment RatingPetition for ReconsiderationFindings of FactWorkers' Compensation Judge (WCJ)Industrial InjuryPreponderance of the Evidence
References
6
Case No. ADJ8693536
Regular
Dec 28, 2017

MARQUITA DONES vs. WEST CONTRA COSTA UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board denied Marquita Dones' petition for reconsideration regarding an increase in permanent disability benefits. The Board adopted the Workers' Compensation Judge's report, which found no objective medical evidence supported an increase in disability beyond the original 7% award. While applicant testified to increased pain, neither the Qualified Medical Evaluator nor the treating physician could establish an increase in impairment, as required by the AMA Guides. The Board also admonished applicant's attorney for filing a non-compliant document.

WCABPetition for ReconsiderationDeniedPermanent DisabilityCumulative InjuryLeft ElbowLeft WristAwardPetition to ReopenNew and Further Disability
References
1
Case No. ADJ4397000
Regular
Jun 10, 2011

MARIA MERCEDES FELIX vs. SEA DWELLING CREATURES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that applicant Maria Mercedes Felix has 0% whole person impairment for her back injury and requires no further medical treatment. This decision was based on the opinion of a qualified medical evaluator (PQME) whose findings were consistent with a prior medical report. The PQME's report concluded that various diagnostic tests were normal and revealed no significant clinical findings, structural alterations, or neurological impairment. Crucially, the Appeals Board clarified that a 3% pain add-on for whole person impairment is legally permissible only to increase an already established impairment rating, which was not the case here as the initial rating was zero.

Workers' Compensation Appeals BoardReconsideration deniedExpert medical evidencePanel Qualified Medical Evaluator (PQME)American Medical Association Guides (AMA Guides)Permanent ImpairmentWhole Person Impairment (WPI)DRE Lumbar Category IMedical treatmentPain add-on
References
2
Case No. ADJ8550681
Regular
May 14, 2015

NANCY TOM vs. PARAMOUNT PICTURES

Applicant Nancy Tom sought reconsideration of a workers' compensation award, arguing her 9% permanent disability rating was too low. She contended for further medical evaluation regarding worsening symptoms and a claimed 40% grip loss in her right hand, plus additional impairment ratings for her thumb and knee. The Board denied reconsideration, adopting the WCJ's reasoning that Dr. Angerman's conclusory deposition testimony regarding increased impairment lacked substantial medical evidence and conflicted with AMA Guides to the Evaluation of Permanent Impairment. The Board found that Applicant failed to meet her burden of proof for a higher disability rating.

Workers' Compensation Appeals BoardParamount PicturesPermissibly Self-InsuredPetition for ReconsiderationFindings of Fact and AwardExecutive AssistantIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorOrthopedist
References
4
Case No. ADJ361974
Regular
Feb 11, 2013

ANA VELASQUEZ vs. AMERICAN BUILDING MAINTENANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a $1,000 sanction against applicant's attorney, Peter T. Brown, and his firm. The original sanction was for violating rules regarding supervision of non-attorney employees and requiring specific written authorization for settlement documents. The WCAB found Brown's conduct, including alleged misrepresentations and failure to adequately supervise his employee's submission of a compromise and release without full disclosure, warranted an increased sanction. The WCAB is now considering imposing a sanction of up to $2,500 and has given Brown an opportunity to show cause why this increase is not warranted.

Workers' Compensation Appeals BoardSanctionsPetition for ReconsiderationFindings and OrderAdministrative Law JudgeCompromise and ReleaseSupervisionWritten AuthorizationCumulative TraumaGood Faith Negotiation
References
0
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