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

Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. VNO 452114, VNO 452108
Regular
Aug 17, 2007

AURELIA SANCHEZ vs. PARACELSUS HEALTH CORP.

The Appeals Board granted reconsideration of the WCJ's decision, finding that the Agreed Medical Examiner's (AME) opinion regarding the applicant's neck injury was not substantial evidence. This was due to the AME's failure to review relevant medical records and consider the applicant's subsequent neck surgery. The case is returned to the trial level for further development of the record, including potentially obtaining a supplemental opinion from the AME or appointing a new medical examiner.

Workers Compensation Appeals BoardAurelia SanchezParacelsus Health Corp.industrial injurybilateral handswristsneck injuryorthopedic agreed medical examinerAMEDr. Jeffrey A. Berman
References
Case No. ADJ370366 (VNO 0526012)
Regular
Jun 24, 2009

JUAN ZAMANO vs. DIVERSE STAFFING, F. A. RICHARDS AND ASSOCIATES

This case involved a dispute over an applicant's entitlement to temporary disability benefits and recommended neck surgery following an admitted industrial injury. The employer sought reconsideration, arguing the medical evidence supporting the WCJ's award was insufficient and that a different statutory scheme for medical treatment disputes should apply. The Appeals Board found the employer's arguments regarding statutory interpretation unpersuasive and, critically, that the employer's utilization of the correct dispute resolution process for spinal surgery, specifically whether Utilization Review (UR) was properly conducted under Labor Code section 4610, was unclear. Consequently, the Board rescinded the WCJ's decision and remanded the case to the trial level to determine if the employer engaged in UR, instructing the WCJ to issue a new decision based on that determination and relevant case law.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuryTemporary DisabilityNeck SurgerySpinal SurgeryQualified Medical EvaluatorLabor Code Section 4062Labor Code Section 4610Utilization Review
References
Case No. ADJ6939425
Regular
Oct 01, 2016

Rene Garcia vs. American Tire Distributors, Broadspire

This case concerns a worker, Rene Garcia, seeking reconsideration of a Workers' Compensation Appeals Board decision. The applicant argued that a stipulation for an Agreed Medical Examiner (AME) should bind the defendant to their recommended bi-level neck surgery. The Board denied reconsideration, affirming the judge's finding that the AME stipulation did not override the statutory requirement to resolve medical treatment disputes through the Utilization Review/Independent Medical Review process. The Board also upheld the denial of attorney fees, as no benefits were awarded under the specific 2011 stipulation.

Workers' Compensation Appeals BoardRene GarciaAmerican Tire DistributorsBroadspirePetition for ReconsiderationFindings and OrderAdministrative Law Judgeunreasonable delaypayment of compensationtemporary disability
References
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
Case No. ADJ8022679, ADJ7722045
Regular
Apr 22, 2013

CARRIE PARKER vs. ENTERTAINMENT PARTNERS, CHARTIS CLAIMS, INC.

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior Findings and Award, and returned the matter for further proceedings and a new decision. Defendant argued the award should have been for cumulative trauma, sought credit for EDD reimbursements against the temporary disability cap, and contended the PQME reports and awarded neck surgery were not substantial evidence. The Board agreed that the prior award needed to be rescinded for further clarification on the PQME's findings regarding the necessity of surgery and specific diagnostics. They encouraged further medical evaluation, potentially through an Agreed Medical Evaluator, to clarify treatment recommendations for the applicant's cervical spine injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardTemporary Disability IndemnityPanel Qualified Medical EvaluatorNeck SurgeryDiagnosticsCumulative Trauma InjurySpecific InjuryApportionment
References
Case No. SAC 286368
Regular
Jan 25, 2008

DALE OLIVER vs. BRIAN WILLIAMS CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

This case involves an applicant seeking approval for disc replacement surgery for a work-related back injury. The defendant argued the surgery is experimental per ACOEM guidelines, thus not covered. The Board denied reconsideration, finding the applicant's physician rebutted the presumption of experimental status. The Board determined the surgery is no longer experimental, citing FDA approval, and is reasonably required for the applicant's specific condition, supported by expert medical opinion.

Workers' Compensation Appeals BoardBrian Williams ConstructionState Compensation Insurance Fundindustrial injuryright anklefootelbowshoulderskneesleft lower extremity
References
Case No. MON 281887
Regular
Jul 11, 2007

ROBERT CAIN vs. VONS, INC.

The Workers' Compensation Appeals Board rescinded a prior decision denying a lien claim and returned the case for further proceedings. The Appeals Board found that the administrative law judge erred by not applying the factors established in the en banc decision *Kunz v. Patterson Floor Coverings, Inc.* to determine the reasonableness of the outpatient surgery facility fee. The defendant failed to present sufficient rebuttal evidence under *Kunz*, and the case must now be re-evaluated based on that precedent.

Kunz v. Patterson Floor CoveringsOutpatient surgery facility feesReasonableness of feeMedicare reimbursementOfficial Medical Fee ScheduleLien claimantCompromise and releasePetition for reconsiderationFindings and OrderWorkers' Compensation Appeals Board
References
Case No. ADJ3027246
Regular
Nov 26, 2012

KATHRYN MILOSTAN-EGUS vs. SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT

The Workers' Compensation Appeals Board denied reconsideration of the decision. The Board adopted the Administrative Law Judge's (WCJ) report, finding that the Agreed Medical Examiner's (AME) opinion constituted substantial medical evidence. The WCJ's credibility findings, which the Board gave great weight, supported the conclusion that the applicant's neck and right upper extremity injuries were causally related to positioning during ankle surgery. Therefore, the defendant's petition to dispute this finding was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeAgreed Medical ExaminerSubstantial Medical EvidenceAnkle SurgeryNeck InjuryRight Shoulder InjuryBrachial Plexus Traction InjuryCervical Spine
References
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