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

Case No. ADJ7911474
Regular
Jan 22, 2019

KIA SPREWELL vs. STATE OF CALIFORNIA, RICHARD J. DONOVAN CORRECTIONAL FACILITY

This case involved Kia Sprewell's workers' compensation claim against the Richard J. Donovan Correctional Facility for injuries sustained as an office assistant. The defendant sought reconsideration of the initial award, primarily contesting the commutation method for attorney fees and the substantiality of the neurologist's medical opinions. The Workers' Compensation Appeals Board granted reconsideration in part, affirming the award of permanent disability but amending the attorney fees to be commuted from the side of the life pension award. The Board found the neurologist's opinions on apportionment and rating of various injuries, including headaches and spinal issues, to be substantial medical evidence.

Workers Compensation Appeals BoardKia SprewellRichard J. Donovan Correctional FacilityState Compensation Insurance FundPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentLife PensionAttorney Fees
References
0
Case No. ADJ8055062
Regular
May 28, 2013

JAIME CASTANEDA vs. KING DAHL EVENT DESIGN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation applicant seeking reconsideration of a prior award that found a $15\%$ permanent disability and no industrial injury to the psyche. The applicant argues the administrative law judge (WCJ) erred by not including a neurologist's impairment rating for a sleep disorder and by not relying on the primary treating physician's orthopedic assessment. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter for the WCJ to incorporate the neurologist's sleep disorder impairment rating, finding it uncontradicted. However, one commissioner dissented, arguing the sleep disorder was secondary to pain already included in the orthopedic rating and any psychiatric component was noncompensable.

WCABReconsiderationFindings and AwardIndustrial InjuryPermanent DisabilityOrthopedistNeurologistSleep DisorderAMA GuidesImpairment Rating
References
1
Case No. SAL 0103596
Regular
Jan 07, 2008

CHRISTIE GAYNES vs. GRANITE ROCK COMPANY, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration. The applicant sought to have a medical evaluation by an anesthesiologist or neurologist, arguing the chosen Agreed Medical Evaluator (AME), an orthopedist, lacked the necessary expertise for her specific nerve pain. The Board found the petition untimely and upheld the WCJ's recommendation for dismissal.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Compelling AttendanceMedical EvaluationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)WCJReport and RecommendationDismissed PetitionTimeliness
References
0
Case No. MON 0316510
Regular
Jul 18, 2008

MIGUEL LOPEZ vs. MV TRANSPORTATION, AMERICAN HOME ASSURANCE, BROADSPIRE CLAIM SERVICES

The Workers' Compensation Appeals Board granted reconsideration of an amended award finding applicant incurred industrial injury causing 78% permanent disability. The Board found the applicant's neurologist's report regarding post-traumatic head syndrome lacked substantial evidence due to contradictions with applicant's testimony. Consequently, the case is returned to the trial level to further address permanent disability and apportionment issues.

WCABMV TransportationAmerican Home AssuranceBroadsire Claim ServicesMIGUEL LOPEZBus DriverIndustrial InjuryNeck InjuryBack InjuryRight Shoulder Injury
References
14
Case No. LAO 0778165
Regular
Jul 29, 2008

ROBERTO REYES vs. DRAKE OFFICE OVERLOAD, RELIANCE NATIONAL INSURANCE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ADVO, INC, ST. PAUL TRAVELERS

This case involved a janitor injured while employed by both a general employer (Drake) and a special employer (Advo). The Workers' Compensation Appeals Board denied Advo's petition for reconsideration, upholding the finding of joint and several liability for the injury. The Board affirmed that Advo's agreement with Drake did not absolve Advo of liability, the statute of limitations did not bar the claim against Advo, and the neurologist's opinion constituted substantial medical evidence.

Workers Compensation Appeals BoardSpecial EmployeeGeneral EmployerJoint and Several LiabilityCIGAInsurance Code section 1063.1Labor Code section 5405Statute of LimitationsLachesSubstantial Medical Evidence
References
19
Case No. ADJ11025609
Regular
Apr 30, 2018

DONNA IVES vs. DR MYERS DISTRIBUTING COMPANY, PREFERRED EMPLOYERS INSURANCE COMPANY

In this workers' compensation case, the Appeals Board rescinded the WCJ's decision and returned the matter for further proceedings. The Board found that the defendant improperly modified the applicant's Request for Authorization (RFA) for treatment by a chiropractic neurologist. Instead of referring the request for medical utilization review, the claims administrator authorized treatment with a general chiropractor. The Board emphasized that claims adjusters cannot modify RFAs and that medical necessity decisions must be made by physicians.

WCABPetition for ReconsiderationFindings of FactWCJindustrial injurychiropractic neurologistMedical Provider Network (MPN)Request for Authorization (RFA)Utilization Review (UR)Medical Treatment Utilization Schedule (MTUS)
References
3
Case No. ADJ10737420, ADJ11230735
Regular
May 28, 2019

METHVEN BROWN (Deceased), JANINE BROWN (Widow) vs. COUNTY OF SACRAMENTO, Permissibly Self-Insured, SACRAMENTO COUNTY PROBATION DEPARTMENT

The Workers' Compensation Appeals Board denied reconsideration of a decision finding no industrial injury to the decedent's heart or cerebrovascular system. The widow argued the administrative law judge erred by disallowing further discovery from a cardiologist. However, the Board adopted the judge's report, which noted a neurologist already testified that heart trouble and industrial stress were not medically probable causes of the decedent's stroke and death. The applicants failed to demonstrate why a cardiologist would be more competent to offer such opinions.

Methven BrownJanine BrownCounty of SacramentoSacramento County Probation DepartmentADJ10737420ADJ11230735Petition for ReconsiderationJoint Findings and Orderindustrial injuryheart injury
References
0
Case No. ADJ4518619
Regular
Aug 17, 2011

XIOMARA LEMUS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The Workers' Compensation Appeals Board denied the defendant's (Los Angeles Unified School District) Petition for Removal. The defendant sought to rescind an order continuing the case for trial, arguing it was deprived of due process by not obtaining a Qualified Medical Evaluation (QME) to rebut the applicant's treating neurologist. The Board found that removal is an extraordinary remedy, and the defendant failed to demonstrate substantial prejudice or irreparable harm, nor that reconsideration would be inadequate. The case was returned to the trial level for rescheduling.

Petition for RemovalQualified Medical EvaluationRebuttalTreating NeurologistDue ProcessExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationAdequacy of Remedy
References
2
Case No. ADJ7838570
Regular
Dec 10, 2012

MARCO MILLAN vs. WESTOWER COMMUNICATIONS, HARTFORD

The Workers' Compensation Appeals Board dismissed applicant's first petition for reconsideration and denied his second. The applicant sought reconsideration of a finding that his stroke and related injuries were not work-related, arguing a physiatrist's opinion constituted substantial medical evidence. The WCJ and Board found Dr. Schilling lacked the neurological expertise to establish industrial causation, and the consulting neurologist did not confirm it. The Board affirmed the WCJ's decision, finding the applicant failed to meet his burden of proof with substantial evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalIndustrial CausationStrokeCirculatory SystemNegligenceBurden of ProofMedical EvidencePhysiatrist
References
3
Case No. ADJ6916901
Regular
Dec 10, 2013

BERNARD DeROCK vs. HERITAGE OAKS HOSPITAL, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding their petition was not filed from a final order. The WCAB also denied the defendant's petition for removal, stating there was no evidence of significant prejudice or irreparable harm in allowing further development of the medical record. The Board reaffirmed its prior decision to defer issues of industrial causation and permanent disability to allow for reconsideration of a neurologist's opinion improperly rejected by the judge. This decision allows the applicant to present all relevant medical evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndustrial CausationThoracic Outlet SyndromePermanent DisabilityMedical Record DevelopmentSubstantial Medical EvidenceWCJ ErrorReopening Record
References
8
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