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

Case No. ADJ1700793 (SAC 0307437) ADJ3714832 (SAC 0307399)
Regular
Jun 13, 2011

JUANITA BRADLEY (Deceased) vs. COUNTY OF PLACER

This case involves a dispute over liability for a medical-legal report cost. The defendant seeks reconsideration of a prior award holding them responsible for Dr. Adelberg's $4,237.50 report. The defendant argues the judge ignored a prior order for an Agreed Medical Evaluation (AME) and that the applicant's attorney improperly proceeded with Dr. Adelberg's exam. The Board granted reconsideration, preliminarily finding it may be inequitable to place the full cost on the defendant, and intends to split the expense between the defendant and applicant's attorney. A dissenting opinion argues the defendant's own correspondence shows an ongoing dispute regarding the AME, supporting the original award of liability.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ReportAgreed Medical EvaluationQualified Medical EvaluatorJoint Findings and AwardLabor Code Section 4062(a)Stipulation and OrderEquitable PowersLien Claimant
References
1
Case No. ADJ10986659
Regular
Sep 30, 2025

ALFREDO SERRANO vs. BIG IDEA HOLDINGS, LLC; OLD REPUBLIC INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to further study the legal and factual issues raised by the Petition for Reconsideration. Applicant sought reconsideration of the January 27, 2022 Findings and Award, challenging the findings regarding a specific industrial injury to his right shoulder and a claimed cumulative injury. The Board concluded that the medical-legal opinions of the Qualified Medical Evaluator (QME), Dr. Bruce Huffer, were legally insufficient and analytically incomplete because he applied an incorrect legal standard for causation and apportionment, repeatedly requiring 'certainty' instead of 'reasonable medical probability'. Consequently, the Board rescinded the F&A and returned the matter to the trial level for further development of the medical-legal record, suggesting the selection of an Agreed Medical Evaluator.

QMEcumulative injuryapportionmentarthroplastysubstantial evidencemedical-legal opinionsrecord developmentLabor Code section 5701reasonable medical probabilitysuperimposed injury
References
24
Case No. ADJ9539091
Regular
Sep 23, 2016

MARY RAMSGARD vs. PACIFIC VINEYARD COMPANY, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board denied reconsideration, affirming the WCJ's finding that applicant's L3-4 back injury was not industrially caused, based on Dr. Sharma's opinion. Dr. Sharma's opinion was found to be substantial evidence, utilizing the correct legal standard of reasonable medical probability and supported by the applicant's pre-existing back issues. The Board also upheld the 20% apportionment of permanent disability to non-industrial causes, finding it supported by credible evidence, including prior medical reports and applicant's inconsistent testimony. Applicant's petition failed as her contentions regarding the medical opinion's legal theory and factual basis were not substantiated.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeApplicantDefendantPacific Vineyard CompanyInsurance Company of the WestPermanent DisabilityApportionment
References
10
Case No. ADJ2709955 (MON 0356320)
Regular
Jun 21, 2017

Mario Cocola vs. California Hospital Medical Center

The Workers' Compensation Appeals Board denied Mario Cocola's petition for reconsideration, upholding the finding that he sustained $69\%$ permanent disability from industrial injuries. Cocola argued the administrative judge erred by disregarding the Agreed Medical Examiner's opinion that he was totally disabled from the open labor market due to orthopedic injuries. The Board agreed with the judge's report that the physician's opinion lacked sufficient objective basis for the change in work restrictions. A dissenting opinion argued the medical and vocational evidence supported a $100\%$ permanent disability finding and requested clarification from the medical examiner.

Petition for ReconsiderationFindings of Fact and Awardpermanent disabilitycumulative traumalumbar spinecervical spinepsychecervicogenic headachesEmergency Unit CoordinatorAgreed Medical Examiner
References
1
Case No. ADJ1885105
Regular
Dec 16, 2010

SCOTT SIMONS vs. SUPERHEAT SERVICES, INC., SPECIALTY RISK PLEASANTON

The Appeals Board denied the applicant's petition for reconsideration regarding penalties and attorney fees, finding no evidence of unreasonable delay by the defendant. The Board granted the defendant's petition in part, reversing the order for a medical-legal examination by Dr. Sadoff for left knee surgery due to an underdeveloped record. However, the Board affirmed the WCJ's award of significant medical treatments, including home care, a motorized wheelchair, and neurological treatment for dementia, finding the treating physician's opinions more persuasive than utilization review denials. Finally, the Board clarified that transportation expenses are only for medical and medical-legal appointments, not legal ones.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFurther Medical TreatmentDr. DeSallesDr. SadoffHome CareMotorized WheelchairTilt-Table TestENG Study
References
12
Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
Case No. SAC 339641, SAC 352335
Regular
Dec 21, 2007

Richard D. Smith vs. STATE OF CALIFORNIA, DEPARTMENT OF TRANSPORTATION; Legally Uninsured, c/o STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision due to questions about the Agreed Medical Examiner's (AME) apportionment of permanent disability. The applicant argued the AME's opinion was based on an incorrect legal theory and lacked substantial evidence, as it mischaracterized prior treatment and failed to adequately account for the cumulative trauma injury. The Board remanded the case for further development of the record, specifically requesting a follow-up opinion from the AME regarding the 25% apportionment.

WCABReconsiderationApportionmentAgreed Medical ExaminerCumulative TraumaSpecific InjuryPermanent DisabilityIndustrial InjuryLegally UninsuredState Compensation Insurance Fund
References
4
Case No. ADJ6743543
Regular
Mar 10, 2011

TERESA RODEZNO vs. CORONA REGIONAL MEDICAL CENTER, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration for both applicant and defendant, rescinded the prior Findings and Award, and returned the case for further proceedings. The Board found that the medical expert's opinion on permanent disability was not substantial evidence because it relied on an outdated "ability to compete in the open labor market" standard instead of diminished future earning capacity. Permanent disability, apportionment, and attorney fees were deferred, with the trial judge to obtain a new medical report consistent with current legal standards. The Board otherwise affirmed the judge's decision, noting that applicant's contentions would be addressed on remand.

Workers' Compensation Appeals BoardPermanent DisabilityApportionmentReconsiderationFindings and AwardDiminished Future Earning CapacityOgilvie AnalysisAMA GuidesSubstantial EvidenceQualified Medical Examiner
References
0
Case No. ADJ7454504
Regular
Aug 01, 2019

JANE ELLIS vs. CALIFORNIA DEPARTMENT OF SOCIAL SERVICES legally uninsured, administered by YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior Findings and Award. The Board found that the agreed medical examiner's opinion on permanent disability was not substantial evidence because it was based on an outdated medical examination and an inaccurate assumption about the applicant's current medications. Additionally, the Board noted that vocational expert reports failed to address the impact of apportionment. The case is returned to the WCJ for further proceedings to obtain updated medical opinions and address vocational expert reporting deficiencies.

Petition for ReconsiderationFindings and AwardAgreed Medical ExaminerQualified Medical ExaminerPermanent DisabilityApportionmentSubstantial EvidenceInadequate Medical HistoryVocational ExpertLabor Code Section 5903
References
10
Case No. MISSING
Regular Panel Decision

In re Westchester County Medical Center

The dissenting opinion by Justice Brown argues against the majority's presumed decision to discontinue artificial feeding for Mary O’Connor. He contends that there is insufficient "clear and convincing" evidence that O'Connor, while competent, clearly desired to refuse intravenous and nasogastric feeding under her current circumstances. Brown points to the ambiguity in her past statements to a friend and daughters, along with the daughters' initial failure to object to intravenous feeding, as indicators that O'Connor's wishes were not unequivocally expressed regarding these specific life support measures. Citing legal precedents, Justice Brown emphasizes the high evidentiary standard required for such decisions. Consequently, he would reverse the judgment, grant the Medical Center's petition to insert a nasogastric feeding tube, and deny the application to discontinue intravenous feeding.

Right to refuse medical treatmentLife support systemsArtificial hydration and nourishmentClear and convincing evidencePatient autonomyIncompetent patientDissenting opinionMedical ethicsEnd-of-life careNasogastric feeding tube
References
7
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