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

Case No. ADJ900432 (SAC 0323091)
Regular
Dec 30, 2011

MARLENE COPUS vs. NORTH SACRAMENTO ELEMENTARY SCHOOL DISTRICT

This case involves a dispute over the necessity of spinal surgery for an applicant who sustained a cumulative trauma injury to her neck and back. While the applicant's treating physician recommended surgery, a second opinion physician disagreed, citing a lack of nerve root compression. The Appeals Board found that the medical evidence was insufficient to determine the necessity of surgery, particularly in light of ACOEM Practice Guidelines which generally recommend against surgery without nerve root compression. Therefore, the Board rescinded the prior award and remanded the case to appoint an independent physician to evaluate the applicant and determine the reasonableness and necessity of the proposed surgery.

Workers' Compensation Appeals BoardMarlene CopusNorth Sacramento Elementary School Districtcumulative traumaspinal surgerynerve root impingementcervical stenosisDr. OrisekDr. GregoriusACOEM Practice Guidelines
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. ADJ3744023
Regular
May 15, 2009

JOSEPH CRABTREE vs. MITCHELL BERMAN CABINET MAKER, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of an award finding an industrial injury to the applicant's abdomen/groin (hernia) and a resulting peripheral nerve injury causing 24% permanent disability. The defendant argued the peripheral nerve injury was not supported and the disability rating was incorrect due to misapplication of the AMA Guides. The Board denied reconsideration, adopting the judge's report and finding that the medical evidence supported the peripheral nerve injury and the AMA Guides were correctly applied. The Board found the agreed medical evaluator's conclusions were well-reasoned and supported by the evidence.

Workers Compensation Appeals BoardIndustrial InjuryHerniaPeripheral Nerve InjuryPermanent DisabilityAgreed Medical Evaluator (AME)AMA GuidesPetition for ReconsiderationMedical EvidenceWCJ
References
Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8814296
Regular
Feb 16, 2017

JANET WILDER vs. CAPRI GLOBAL MANAGEMENT, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the Findings and Award (F&A) concerning applicant Janet Wilder's work-related injuries. The WCAB affirmed the F&A's findings regarding the nature of the injuries and psychiatric disability but found the medical evidence supporting the cranial/trigeminal nerve impairment was not substantial. Consequently, the WCAB deferred the issues of permanent disability and attorney's fees, remanding the case to the WCJ for further proceedings to develop the record on those specific issues.

Workers Compensation Appeals BoardReconsiderationFindings and AwardAdministrative Law JudgePermanent DisabilityApportionmentQualified Medical EvaluatorCranial Nerve ImpairmentFacial DisorderPsychiatric Disability
References
Case No. RIV 0079075
Regular
Apr 14, 2008

JOSEPH VIGARI vs. ARNOLD PALMER'S RESTAURANT, EMPLOYER'S COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board overturned a prior finding, ruling that the applicant's nerve compression injury resulting from back surgery was a compensable consequence of the original admitted industrial injury, not a new and independent injury. Therefore, the applicant is not entitled to further temporary disability indemnity beyond the 104-week limit established by Labor Code section 4656(c)(1) for the original injury. The Board clarified that the "compensable consequences" doctrine applies, and certain cited cases regarding vocational rehabilitation do not alter this principle for temporary disability claims.

Compensable Consequences DoctrineLabor Code section 4656(c)(1)Temporary Disability IndemnityNew and Independent InjuryBack SurgeryNerve CompressionLateral Femoral Cutaneous NerveVocational RehabilitationStatute of LimitationsPetition for Reconsideration
References
Case No. SJO 0258872
Regular
Aug 12, 2008

JUANA MICHEL vs. JACK-IN-THE-BOX, AMERICAN CASUALTY COMPANY OF READING PENNSYLVANIA

The Appeals Board reconsidered a decision regarding Juana Michel's workers' compensation claim and amended the original award. The Board found that medical reports predating January 1, 2005, sufficiently indicated permanent disability, thereby making the 1997 Permanent Disability Rating Schedule applicable. Consequently, the applicant's permanent disability rating was increased from 31% to 53% based on the parties' stipulation and the application of the older rating schedule.

Workers' Compensation Appeals BoardPermanent DisabilityReconsiderationIndustrial InjuryLow Back InjuryPermanent Disability RatingSchedule for Rating Permanent DisabilitiesAmerican Medical Association GuidesAgreed Medical ExaminerTreating Physician
References
Case No. ADJ1498961
Regular
Sep 23, 2010

DALE ARNOLD vs. RALPH'S AKA KROGER

This case involves an applicant's claim for workers' compensation benefits for a right shoulder injury. While the initial award recognized industrial injury to the applicant's left shoulder, right elbow, and right forearm, the defendant sought reconsideration, arguing the right shoulder injury was not work-related. The Appeals Board granted reconsideration, finding the applicant failed to meet the burden of proof for the right shoulder injury. They disagreed with the primary treating physician's opinion and found the agreed medical evaluator's opinion more persuasive, ultimately reversing the finding for the right shoulder.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardCumulative TraumaIndustrial InjuryLeft ShoulderRight ElbowRight ForearmRight ShoulderPrimary Treating Physician
References
Case No. ADJ9895504
Regular
Jan 17, 2020

Elmer Umana vs. West Coast Arborists, Inc., Liberty Mutual Insurance Company

This case involves an employer's petition for reconsideration of a workers' compensation award. The employer argued the award was untimely, and that the Qualified Medical Examiner's (QME) reports were inadmissible as they lacked substantial evidence and proper causation analysis. The Appeals Board denied reconsideration, finding that any delay in issuing the award did not invalidate it. The Board also held that the QME's reports were admissible and constituted substantial evidence, as they detailed causation and reasoning for the impairment ratings.

Workers' Compensation Appeals BoardElmer UmanaWest Coast ArboristsInc.Liberty Mutual Insurance CompanyADJ9895504Opinion and Order Denying Petition for ReconsiderationFindings of Fact Award and OrdersAdministrative Law Judge (WCJ)Injury Arising Out of and Occurring in the Course of Employment (AOE/COE)
References
Case No. FRE 0219842
Regular
Mar 11, 2008

ELBEY LONERO vs. MERCED TRANSPORTATION, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) reversed an administrative law judge's decision regarding the applicant's temporary disability end date, finding it should be March 24, 2005, based on an agreed medical evaluator's opinion. The WCAB affirmed the use of the 1997 Permanent Disability Rating Schedule, finding that a treating physician's pre-2005 report indicated permanent disability. Finally, despite the adjusted temporary disability period, the defendant was denied credit for overpayments, as the applicant acted in good faith and the payments were continued after receiving the AME's report.

WORKERS' COMPENSATION APPEALS BOARDELBEY LONEROMERCED TRANSPORTATIONINC.STATE COMPENSATION INSURANCE FUNDCase No. FRE 0219842OPINION AND DECISION AFTER RECONSIDERATIONbus driverindustrial injurylow back
References
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