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

Case No. ADJ7144980; ADJ8739287 ADJ9323498; ADJ9670512
Regular
Oct 27, 2015

Dean Giannetto vs. CITY OF STOCKTON, CORVEL CORPORATION

In this case, the Appeals Board granted the applicant's Petition for Removal, overturning a WCJ's order requiring reevaluation by the same Qualified Medical Evaluator (QME) for subsequent injury claims. The Board held that an employee is entitled to a new QME for new and separate injury claims, citing their precedent in *Navarro*. Requiring reevaluation by the original QME for subsequent claims, even with the same defendant and body parts, was deemed contrary to statute. The Board found that requiring the applicant to return to Dr. Fujimoto for subsequent injuries would cause prejudice and irreparable harm, thus justifying removal.

Workers Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationPanel Qualified Medical EvaluatorPQMEDr. FujimotoSubsequent InjuriesIndustrial InjuryLabor Code SectionsNavarro v. City of Montebello
References
6
Case No. MISSING
Regular Panel Decision

MATTER OF JASON B. v. Novello

This appeal addresses whether res judicata bars the New York State Office of Mental Retardation and Developmental Disabilities (OMRDD) from reevaluating an applicant's eligibility for developmental disability benefits. Petitioner Jason B. was initially deemed eligible in 2003, but OMRDD later terminated his services in 2006 following a reevaluation prompted by his service provider. After a fair hearing affirmed the termination, Jason B. initiated a CPLR article 78 proceeding, leading the Appellate Division to apply res judicata to the 2003 determination and annul the termination. However, the Court of Appeals reversed, clarifying that the 2003 eligibility finding was not a quasi-judicial determination and thus not subject to res judicata. The Court concluded that OMRDD's 2006 termination of benefits was supported by substantial evidence.

Res JudicataAdministrative LawDevelopmental DisabilityMedicaid EligibilityOMRDD ServicesHome and Community Based Services WaiverMental Hygiene LawCPLR Article 78 ProceedingSubstantial EvidenceAgency Review
References
11
Case No. FRE 0222374
Regular
Sep 20, 2007

JAMES ZERNIAL vs. PEPSI BOTTLING COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to address a dispute over which permanent disability rating schedule applied to the applicant's 2003 injury. The defendant argued the WCJ erred by using the old 1997 Schedule instead of the new 2005 Schedule. The Board rescinded the prior award and returned the case for a new decision after the WCJ reevaluates the schedule's applicability in light of a recent Court of Appeal ruling.

Permanent Disability Rating Schedule1997 Schedule2005 ScheduleLabor Code § 4660(d)Vera v. Workers' Comp. Appeals Bd.Industrial InjuryReconsiderationFindings and AwardRescindedReturned to Trial Level
References
1
Case No. ADJ6973321
Regular
Jan 24, 2012

CONSTANCE PHILLIPS vs. UNITED HEALTH CARE SERVICES, INC., UNITED STATES FIDELITY & GUARANTY INSURANCE

In this workers' compensation case, the defendant sought removal of an order denying their petition to compel the applicant to attend a medical evaluation with Dr. Blau. The defendant argued irreparable harm, as the prior QME was no longer serving and could not reevaluate the applicant's impairment. The Workers' Compensation Appeals Board denied the petition, adopting the reasoning of the WCJ and prior decisions. The denial upheld the order preventing the compelled medical evaluation.

Petition for RemovalOrder Denying Petition to Compel AttendanceLabor Code section 4050Qualified Medical EvaluatorDr. Robert Blausleep disorderincreased impairmentirreparable harmprejudiceWorkers' Compensation Appeals Board
References
0
Case No. ADJ1056275 (MON 0257175)
Regular
Sep 20, 2011

NATALIE RHYMES-MALLARD vs. COUNTY OF LOS ANGELES, DCFS DEPARTMENT

The WCAB dismissed the defendant's Petition for Removal as improperly filed, but granted reconsideration of the WCJ's order for a reevaluation by an AME. The Board rescinded the prior order and returned the case to the trial level due to an incomplete record, specifically the absence of crucial documents related to the applicant's husband's home health care lien. This allows for the proper creation and development of the record before addressing the substantive issues of the lien's necessity and reimbursement.

Petition for RemovalPetition for ReconsiderationAgreed Medical EvaluatorHome Health CareLien ClaimPermanent DisabilityIndustrial InjuryPsycheInternal OrgansNeurological System
References
1
Case No. ADJ757155
Regular
Mar 21, 2013

FRANK KEY vs. TORRANCE MEMORIAL MEDICAL CENTER, MATRIX ABSENCE MANAGEMENT, INC.

The Workers' Compensation Appeals Board denied the Defendant's Petition for Reconsideration. The Defendant argued that the applicant's condition had improved post-surgery, necessitating reevaluation by medical and vocational experts. However, the Board upheld the WCJ's finding that the applicant's testimony was credible and that his chronic pain and unemployability were well-established. The Board agreed with the WCJ that further evaluations were unnecessary as pain management was ongoing and did not alter the applicant's permanent total disability status.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeCredibilityGarza v. Workers' Comp. Appeals Bd.PhlebotomistLumbar spineCervical spineLeft lower extremityPsyche
References
2
Case No. ADJ552778 (LBO 0362055)
Regular
May 10, 2015

PROYLAND CAMARILLO HURTADO vs. APL LOGISTICS

The Workers' Compensation Appeals Board denied the applicant's petition for removal, which sought to continue the trial date. The applicant wished to undergo further surgery and reevaluations to assess his final disability after an industrial injury to his back and knee. The Board found that these issues could be addressed by the trial judge on the scheduled trial date, who has the discretion to continue the matter if further discovery is deemed necessary. Therefore, the applicant's request to remove the case from the trial calendar was denied.

Petition for RemovalAgreed Medical EvaluatorQualified Medical EvaluatorWCJoff calendarrevaluationsfinal disabilityindustrial injuryforklift operatordriver
References
0
Case No. LAO 0759510, LAO 0759524
Regular
Dec 28, 2007

CONNIE ALVIZO vs. STATE OF CALIFORNIA, DEPARTMENT OF INDUSTRIAL RELATIONS, Permissibly Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address the defendant's challenge to a finding of permanent total disability, which was based on the now largely inapplicable "Wilkinson rule" for combining injuries. The Board rescinded the prior award and returned the case to the trial level for reevaluation in light of the recent *Benson* decision, which mandates apportionment based on causation. The defendant can raise their other contentions, such as regarding fibromyalgia and self-procured treatment, in the subsequent proceedings.

Wilkinson ruleBenson decisionapportionmentcausationcumulative injurypermanent total disabilitypermanent disability ratingfibromyalgiaself-procured medical carefurther medical treatment
References
2
Case No. ADJ4349043
Regular
Dec 10, 2010

FRANCISCO GONZALEZ vs. DELOACH RANCHES, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant's petition for reconsideration of a permanent disability rating. The Workers' Compensation Appeals Board granted reconsideration, finding the applicant to be 100 percent permanently disabled. This decision was based on a reevaluation of medical and vocational expert opinions, concluding the applicant is unable to compete in the open labor market due to his combined physical and psychological impairments. The matter was returned to the trial level for further proceedings on attorney fees and permanent disability indemnity.

QMEvocational expertpermanent disabilityindustrial injurylow backpsychereconsiderationFindings and AwardWCJLeBoeuf
References
6
Case No. ADJ4494422 (MON 0266457) ADJ8921983
Regular
Jun 08, 2017

BRYCE ROBB vs. E.L. YEAGER CONSTRUCTION, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For LUMBERMENS MUTUAL CASUALTY COMPANY, LIBERTY MUTUAL FIRE INSURANCE

The WCAB rescinded an award of 100% permanent total disability due to contested issues regarding cumulative injury, statute of limitations, and apportionment. The Board found the trial judge failed to address the statute of limitations and questioned the unapportioned award given the Agreed Medical Evaluator's consistent apportionment analyses. The case is returned for further proceedings, including potential appointment of a new AME to reevaluate apportionment and address psychiatric reports that were missing from the record.

Workers Compensation Appeals BoardCIGALumbermens MutualLiberty Mutual Fire Insurancepermanent total disabilityunapportioned awardcumulative injuryspecific injurystatute of limitationsAgreed Medical Evaluator
References
2
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