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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ1904323 (GRO 0034275) ADJ3208896 (GRO 0034276) ADJ649343 (GRO 0034277)
Regular
Nov 01, 2010

SARAH SHIPP vs. GOTTSCHALKS, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration, rescinding the prior award due to the Workers' Compensation Judge's (WCJ) improper reliance on an Agreed Medical Evaluator's (AME) hernia analogy to rate upper extremity impairment. This analogy violated *Almaraz II* by not adhering to the AMA Guides and potentially incorporating pre-2005 rating schedules. The rater also used an incorrect impairment number and occupational adjustment. The case is remanded for further proceedings and a new decision by the WCJ, ensuring the rating is not based on the flawed hernia analogy.

Workers' Compensation Appeals BoardSarah ShippGottschalksSpecialty Risk ServicesJoint Findings and Awardindustrial injuryright shoulderleft shoulderright elbowthumb
References
Case No. ADJ10565692
Regular
Nov 08, 2018

BRIAN CLARK vs. LOS RIOS COMMUNITY COLLEGE DISTRICT, YORK RISK SERVICES GROUP

This case involves a sports athletic trainer, Brian Clark, who sustained head and psyche injuries at work. Both the applicant and the defendant sought reconsideration of the initial award. The applicant argued his occupational group was misclassified, while the defendant contended the judge wrongly rejected the medical evaluator's apportionment of permanent disability. The Workers' Compensation Appeals Board denied both petitions, upholding the original findings. The Board found the applicant failed to prove factual error in his occupational group classification and adopted the WCJ's reasoning regarding the apportionment.

WORKERS' COMPENSATION APPEALS BOARDLOS RIOS COMMUNITY COLLEGE DISTRICTYORK RISK SERVICES GROUPFindings and Awardsports athletic traineroccupational group 390occupational group 311permanent disability apportionmentPanel Qualified Medical Evaluator (PQME)substantial evidence
References
Case No. ADJ8610560
Regular
Sep 19, 2013

William Brown (Deceased), Annette Brown vs. SAVE MART SUPERMARKETS

This case involves a widow's petition for workers' compensation death benefits for her truck driver husband who died in a motorcycle accident after leaving work. The administrative law judge denied the claim, finding it barred by the going and coming rule. The applicant argued the special risk exception applied due to hazardous road conditions and a quantitatively greater risk compared to the general public. The majority of the Appeals Board denied reconsideration, agreeing with the WCJ that the risks were not exclusive to employment.

Going and Coming RuleSpecial Risk ExceptionDeath BenefitsMotor Vehicle AccidentIndustrial InjuryTruck DriverNegligencePublic RoadZone of DangerHazard
References
Case No. ADJ7412203
Regular
Jul 15, 2011

RIGOBERTO GARCIA vs. COLE RANCH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that the applicant's industrial injury was caused by a "sudden and extraordinary" event, thereby exempting it from the six-month employment rule for psychiatric injuries under Labor Code section 3208.3(d). The Board corrected a clerical error in the citation of the relevant statute. While the defendant argued the event was an inherent risk of the job, the applicant's uncontradicted testimony provided the only evidence suggesting it was not routine. A dissenting opinion argued that a simple fall from a ladder, without more, should not qualify as extraordinary, especially given the short employment duration and lack of evidence for truly unusual circumstances.

Workers' Compensation Appeals BoardRigoberto GarciaCole RanchState Compensation Insurance FundADJ7412203Opinion and Order Denying Petition for ReconsiderationCorrecting Clerical ErrorFindings and Ordersavocado pickerhigh tree worker
References
Case No. ADJ1402736
Regular
Jan 04, 2010

SANDY BASTIAN vs. COUNTY OF VENTURA

This case involves a firefighter diagnosed with breast cancer who claimed industrial injury under California Labor Code section 3212.1. The defendant employer argued the statutory presumption of industrial causation was rebutted by an Agreed Medical Examiner's opinion stating the cancer was non-industrial, citing a lack of studies linking female firefighter exposures to breast cancer. The Appeals Board affirmed the WCJ's decision, finding the applicant sufficiently demonstrated exposure to carcinogens and the defendant failed to meet its burden to prove the exposure was "not reasonably linked" to the cancer. The court clarified that the mere absence of specific epidemiological studies does not rebut the presumption under section 3212.1.

Labor Code section 3212.1firefightercancer presumptionindustrial injuryrebuttable presumptioncarcinogen exposureAgreed Medical Examiner (AME)non-industrial causationindustrial causationAppeals Board
References
Case No. ADJ13511723
Regular
Mar 29, 2023

SOFIA SEVILLANO vs. STATE OF CALIFORNIA, IHSS, LEGALLY UNINSURED, ADMINISTERED BY YORK RISK SERVICES GROUP, A SEDGWICK COMPANY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding a prior decision that found COVID-19 related illness to be industrially caused. The Board found the employer failed to rebut the statutory presumption of industrial causation under Labor Code section 3212.86 with sufficient "other evidence." Arguments regarding mask use, lack of proof of employer infection, and alleged roommate illness were deemed insufficient to overcome the presumption.

Labor Code 3212.86presumption of industrial causationCOVID-19 illnessrebuttal burdenaffirmative burden of proofnon-occupational risksclose interpersonal contactSan Antonio Regional Hospitalcredibility determinationsADJ13511723
References
Case No. ADJ9160815
Regular
Jun 10, 2014

ALMA CEDILLO vs. CEDARS SINAI MEDICAL CENTER, TRISTAR RISK MANAGEMENT

This case involves an applicant, Alma Cedillo, seeking workers' compensation benefits from Cedars Sinai Medical Center and Tristar Risk Management. The Workers' Compensation Appeals Board (WCAB) issued an order denying a Petition for Removal filed in the case. The WCAB adopted the reasoning of the workers' compensation administrative law judge (WCJ) in reaching its decision to deny removal. Therefore, the applicant's request to remove the case from the current process was rejected.

Petition for RemovalWorkers' Compensation Appeals BoardCedars Sinai Medical CenterTristar Risk ManagementAdministrative Law JudgeADJ9160815Van Nuys District OfficeAlma Cedillodenying removalworkers' compensation
References
Case No. ADJ9924024
Regular
Feb 01, 2016

JOHN RAMOS vs. COUNTY OF SONOMA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an administrative law judge's (WCJ) finding that the applicant's claim for occupational disease (non-Hodgkin's lymphoma) was not barred by the statute of limitations. The WCAB found the WCJ erred in determining the date of injury and statute of limitations had not begun to run. However, the WCAB noted the record raises the issue of whether the defendant is estopped from asserting the statute of limitations due to the actions of its claims administrator. Therefore, the case is returned to the trial level for further development of the record and decision specifically on the issue of estoppel.

Occupational diseaseNon-Hodgkin's lymphomaProbation officerStatute of limitationsLabor Code section 5412Date of injuryDisabilityEstoppelThird-party claims administratorNotice of Delay
References
Case No. SAC 0329980SAC 0329983
Regular
Jul 24, 2008

MICHAEL GUNTER vs. COUNTY OF SACRAMENTO

The Workers' Compensation Appeals Board granted reconsideration and amended a previous award, finding 50% apportionment of the applicant's knee disability to non-industrial factors, specifically overweight and malalignment. This amendment, based on medical opinion and recent case law regarding apportionment by causation, reduced the applicant's overall permanent disability from 54% to 33%. The Board affirmed the original finding regarding the occupational group number.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and AwardApportionmentPermanent DisabilityIndustrial InjuryNon-industrial FactorsOsteoarthritisOccupational Group NumberCumulative Trauma
References
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