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

Case No. VNO 0365922
Regular
Mar 03, 2008

NANCY COULTER vs. SULPHUR SPRINGS UNION SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The applicant sought reconsideration of a WCJ's award, arguing injury to her psyche, neck, shoulders, and cardiovascular system, in addition to her teeth. The Appeals Board granted reconsideration to amend the finding of injury to specifically include "teeth (bruxism) resulting in myofascial pain to her jaw and muscle tenderness." Ultimately, the Board affirmed the original award, finding no industrial injury to the psyche, neck, shoulders, or cardiovascular system, relying on the credibility of a witness and substantial medical evidence.

Workers' Compensation Appeals BoardSulphur Springs Union School DistrictCalifornia Insurance Guarantee AssociationFindings and Awardpermanent disabilitypsychiatric injurygood faith personnel action defensePetition for Reconsiderationbruxismmyofascial pain
References
2
Case No. ADJ9402316
Regular
Aug 02, 2019

OSCAR SANDOVAL vs. THE STRIP JOINT, INC., STATE COMPENSATION INSURANCE FUND

This case involves applicant Oscar Sandoval seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that denied his claim for injury to his head, jaw/teeth, psyche, and sleep disorder. The WCAB denied reconsideration, affirming the WCJ's finding that the medical reports submitted by applicant's physicians lacked substantial evidence. Specifically, the WCAB found that Dr. Schames' report was based on an inadequate medical history, Dr. Reichwald's report was internally inconsistent and lacked review of sufficient medical records, and Dr. Saeid's report did not sufficiently explain his diagnosis of insomnia.

AOE/COEPetition for ReconsiderationFindings and AwardWCJmedical-legal reportssubstantial evidenceorthopedicpsychologicalinternal medicinecervical spine
References
9
Case No. ADJ3882013
Regular
Mar 22, 2023

TERESA LARA vs. DAUGHTERS OF MARY AND JOSEPH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Dental Trauma Center's petition for reconsideration, upholding the finding that the lien claimant failed to prove applicant sustained industrial injury to the psyche, headaches, or TMJ/mouth/jaw/teeth. The Board adopted the WCJ's reasoning that Dental Trauma Center did not meet its burden of proof as it failed to present substantial medical evidence supporting these claims. Consequently, the burden never shifted to the defendant to provide rebuttal evidence. The Board also addressed and rejected the petitioner's arguments regarding proper referral, lack of incorporation, and the binding nature of the Compromise and Release.

Petition for ReconsiderationWorkers' Compensation Appeals BoardLien ClaimantStatute of LimitationsBurden of ProofSubstantial Medical EvidencePrima Facie CaseRebuttal EvidenceProper ReferralCompromise and Release
References
5
Case No. MISSING
Regular Panel Decision

Claim of De Beauharnais-Romanovsky v. Sheraton Corporation

Claimant, a hotel worker, sustained a facial injury in 1982, leading to a workers' compensation claim for a nose injury that was initially granted. Subsequently, he alleged additional injuries, including back, neck, jaw, dental conditions, and hearing loss. After multiple hearings, a Workers' Compensation Law Judge (WCLJ) found the jaw and dental conditions causally related. However, the Workers’ Compensation Board overturned this finding, ruling there was no credible evidence to support the causal relationship of his back, neck, jaw, or dental conditions to the 1982 accident, thereby denying his claim. The Appellate Division affirmed the Board's decision, emphasizing that resolving conflicting medical testimony falls within the Board's authority and noting that certain issues were not preserved for review.

Workers' CompensationCausal RelationshipMedical Testimony ConflictBoard JurisdictionAppellate ReviewDental ConditionsJaw ConditionsBack ConditionsNeck ConditionsHearing Loss
References
2
Case No. ADJ7242853
Regular
Dec 04, 2012

DANNY SABAG vs. MITRANI USA CORP c/o CPEHR, CASTLEPOINTE NATIONAL INSURANCE CO by TOWER GROUP

This case concerns applicant Danny Sabag's claim for workers' compensation benefits for cumulative trauma injury to his back, neck, right shoulder, psyche, jaw, and digestive system. The defendant contested the finding of industrial injury, particularly regarding the aggravation of pre-existing Crohn's disease by work stress. The Appeals Board found the current medical record insufficient to support injury to the psyche, jaw, and digestive system. Therefore, the matter is returned to the trial level for further medical development on these specific body parts, while upholding the finding of orthopedic injury.

Workers' Compensation Appeals BoardReconsiderationCumulative Trauma InjuryCrohn's DiseaseAggravationMedical EvidenceQualified Medical Evaluator (QME)Agreed Medical Examiner (AME)Psychiatric InjuryLabor Code Section 3208.3
References
0
Case No. ADJ1776695 (STK 0194100)
Regular
Dec 28, 2015

LINDA PACKARD vs. SAN JOAQUIN COUNTY MENTAL HEALTH

This case concerns applicant Linda Packard's request for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying specific dental treatment, extraction of tooth 18 and a cantilever bridge. The WCAB denied reconsideration, upholding the administrative law judge's finding that the requested treatment was not medically necessary due to the industrial injury. The dissenting commissioner argued that the jaw condition was encompassed within the initial finding of "head" injury and that the WCAB retained jurisdiction to enforce the prior award of further medical treatment. The dissent proposed granting reconsideration to find liability for jaw treatment and allow for utilization review of the specific procedure.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderWCJindustrial injurytooth extractioncantilever bridgetemporomandibular jointLabor Code section 4610utilization review
References
10
Case No. MISSING
Regular Panel Decision

Claim of Catapano v. Jaw, Inc.

A claimant suffered work-related injuries in 1996, leading to an established workers' compensation claim. The employer's workers' compensation carrier sought reimbursement from the Special Disability Fund, which was found liable in 2000. Subsequently, the claimant settled a third-party personal injury action, and the carrier consented to the settlement and waived its lien without obtaining the Fund's consent. The Special Disability Fund refused reimbursement, leading the Workers' Compensation Board to rule that the Fund's consent was not required. The appellate court reversed the Board's decision, citing its failure to provide reasons for deviating from prior precedent requiring the Fund's consent in such situations. The matter was remitted to the Workers' Compensation Board for further proceedings.

Special Disability FundThird-party settlementWorkers' Compensation LawCarrier reimbursementBoard precedentArbitrary and capricious decisionConsent requirementWaiver of reimbursementAppellate reviewRemittal
References
5
Case No. ADJ8033034
Regular
Jan 10, 2017

NAMES EDWARDS vs. HURST JAWS OF LIFE, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the defendant's Petition for Removal in this case. Removal is an extraordinary remedy granted only when substantial prejudice or irreparable harm will result and reconsideration will be inadequate. The WCAB found that the defendant failed to demonstrate these conditions, especially since the parties voluntarily participated in a Commissioner's Conference. Therefore, the WCAB adopted the WCJ's report and denied the petition.

Petition for RemovalWorkers' Compensation Appeals BoardSubstantial PrejudiceIrreparable HarmReconsiderationWCJ ReportCommissioner's ConferenceExtraordinary RemedyUnreasonable Delay
References
2
Case No. ADJ6991789
Regular
Oct 19, 2010

BONNIE MCCLINTIC vs. STATE OF CALIFORNIA, DEPARTMENT OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration regarding a finding that the applicant did not sustain an industrial injury. The applicant's own petition for reconsideration, arguing the evidence supported her claim of injury to her psyche, low back, neck, and jaw, was denied. The Board granted the applicant's request to file supplemental petitions in response to the proceedings. The defendant's initial petition was dismissed because they withdrew it.

Workers' Compensation Appeals BoardDepartment of Motor VehiclesState Compensation Insurance FundFindings of FactPetition for ReconsiderationSupplemental PetitionWCJ ReportApplicantDefendantIndustrial Injury
References
1
Case No. ADJ1401919
Regular
Oct 19, 2011

LUIS TORRES vs. LEW WEBB'S TOYOTA OF BUENA PARK, SEDGWICK CLAIMS MANAGEMENT, CALIFORNIA COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the finding of a mechanic's industrial injury to his right shoulder, wrist, teeth, and gastrointestinal system, resulting in 100% permanent disability. The Board adopted the WCJ's reliance on Dr. Markovitz's opinion that the gastrointestinal condition, leading to total disability, was entirely industrial. However, the issue of psychiatric injury was deferred for further consideration as the WCJ had not addressed statutory requirements. The decision also corrected a clerical error regarding the temporary disability end date.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary DisabilityPermanent DisabilityApportionmentCausationGastro paresisPsychiatric InjuryMedical Evidence
References
4
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