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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Pizzo v. Barnhart

Plaintiff Kathleen Pizzo appealed the Commissioner of the Social Security Administration's final determination denying her disability insurance benefits. The District Court reviewed the ALJ's decision, which had assigned no weight to the treating physician's opinion and significant weight to a consulting physician's report. The court found that the ALJ erred by failing to give appropriate weight to the treating physician's opinion, not adequately developing the administrative record to obtain missing medical notes, and giving undue weight to the consulting physician's report which did not explicitly support the capacity for sedentary work. Consequently, the Commissioner's determination was remanded for further administrative proceedings consistent with the District Court's decision, granting the plaintiff's motion for judgment on the pleadings to the extent of the remand and denying the Commissioner's cross-motion.

Social Security ActDisability Insurance BenefitsAdministrative Law JudgeTreating Physician RuleResidual Functional CapacitySedentary WorkMedical EvidenceRemandSubstantial EvidenceRecord Development
References
23
Case No. ADJ6575307
Regular
Jan 21, 2011

NANCY ANDREWS vs. LAW OFFICES OF KENNETH REYNOLDS, OAK RIVER INSURANCE COMPANY

This case involves a workers' compensation applicant who sustained industrial injuries to her back and upper extremities. The defendant sought reconsideration of a prior award, arguing they were not obligated to conduct utilization review or obtain a second opinion regarding a spinal surgery recommendation from Dr. Anderson. The Appeals Board denied the petition, finding the defendant failed to timely object or initiate the required processes after Dr. Anderson recommended the same surgery previously suggested by a second-opinion physician. The Board clarified that utilization review and second opinion obligations extend to any physician's treatment recommendations, not solely the primary treating physician.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryBack InjuryUpper ExtremitiesPrimary Treating PhysicianUtilization Review (UR)Second Opinion ProcessLabor Code Section 4062
References
1
Case No. ADJ7207861
Regular
May 06, 2011

STEVE TORDINI vs. JAMES DIEDRICH, PREFERRED EMPLOYERS INS. CO.

The Workers' Compensation Appeals Board granted reconsideration to address the defendant's contention that the WCJ erred in relying on the treating physician's opinion over the PQME's regarding permanent disability and apportionment. The Board found the treating physician's opinion unsubstantiated, as it included unqualified legal conclusions and improperly utilized AMA Guides criteria for apportionment. Consequently, the WCAB rescinded the prior award and returned the case for a new decision, directing the WCJ to base findings on the PQME's report. A dissenting opinion argued that both medical opinions were flawed and recommended further medical development.

PQMEWCJWPIapportionmentLabor Code sections 46634664Almaraz IIAMA GuidesDRE Lumbar Category IVdisc protrusion
References
4
Case No. ADJ3321482 (SAC 0347549)
Regular
May 29, 2012

MARYLOU SMITH vs. COUNTY OF SACRAMENTO

This case involves an applicant seeking workers' compensation for sinus injuries allegedly caused by workplace mold exposure. The defendant, County of Sacramento, sought reconsideration after an administrative law judge found the injury AOE/COE, relying on the applicant's treating physician's opinion. The defendant argued that the agreed medical examiner's opinion should have prevailed and that there was insufficient evidence of a materially greater workplace mold exposure. The majority of the Workers' Compensation Appeals Board denied reconsideration, finding the treating physician's opinion persuasive and sufficiently supported by medical evidence.

Agreed Medical ExaminerCausationMold ExposureFungal SinusitisIndustrial InjuryOccupational NexusMedical ProbabilitySubstantial EvidenceWorkers' Compensation Appeals BoardReconsideration
References
7
Case No. VNO 483286
Regular
Jul 16, 2007

ROBERT WALKER vs. MARSHALLS, CNA CLAIM PLUS, INC.

The Appeals Board granted reconsideration and rescinded the prior award, finding that the medical evidence regarding causation and apportionment was critically flawed. Neither the applicant's treating physician nor the defendant's QME adequately addressed these issues with sufficient reasoning and complete medical histories. The case is returned to the trial level for further development of the medical record, including obtaining supplemental opinions from physicians, before a new decision is made.

Workers' Compensation Appeals BoardRobert WalkerMarshall'sCNA Claim PlusInc.Findings and AwardIndustrial InjuryBack InjuryFoot InjuryPermanent Disability
References
17
Case No. ADJ9343248
Regular
Dec 07, 2017

LONNY BUBAK vs. SOLANO COUNTY SHERIFFS DEPARTMENT

This case, concerning a workers' compensation claim by Lonny Bubak against Solano County Sheriff's Department, involves the application of Labor Code section 4062.9, which presumes the correctness of a treating physician's opinion. The Appeals Board denied the defendant's petition for reconsideration, affirming the administrative law judge's finding that the defendant failed to rebut this presumption. This means the defendant did not provide sufficient evidence to disprove the industrial nature of the injury as determined by the treating physician. Therefore, the Appeals Board was bound to accept the treating physician's opinion as correct.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgePresumptionLabor Code Section 4062.9Treating PhysicianBurden of ProofRebuttalIndustrial RelationshipSolano County Sheriffs Department
References
2
Case No. ADJ9744877
Regular
Sep 13, 2019

DALJEET HEERA vs. BANK OF AMERICA, CORVEL CORPORATION

Here's a summary of the case for a lawyer: The Workers' Compensation Appeals Board denied reconsideration of an applicant's claim for industrial injury to her right shoulder, left shoulder, and cervical spine. The Board affirmed the Workers' Compensation Judge's (WCJ) credibility determination, finding it supported by substantial evidence, and gave it great weight. The WCJ's report, adopted by the Board, found that the applicant's treating physicians' opinions constituted substantial evidence, outweighing the defense medical evaluator's conflicting conclusions. The Board emphasized that a single physician's opinion can be sufficient if it is well-reasoned and consistent with the record, even if other opinions differ.

Petition for ReconsiderationWCJ credibility determinationsubstantial evidencemedical opinionsapplicantdefendantindustrial injuryright shoulderleft shouldercervical spine
References
7
Case No. MISSING
Regular Panel Decision
Jul 22, 2016

Hooper v. Colvin

Plaintiff Deborah Hooper sought judicial review of a final determination by the Acting Commissioner of Social Security, Carolyn Colvin, denying her application for Disability Insurance Benefits and Supplemental Security Income. The U.S. Magistrate Judge, James L. Cott, found the ALJ's step three disability determination supported by evidence. However, the Court ruled that the ALJ failed to fully develop the administrative record at step four by not securing a comprehensive medical assessment of Hooper's mental impairments from a treating or consultative physician. The record lacked a complete and consistent medical opinion, particularly from Hooper's primary-care physician, Dr. Anna Timell, who provided inconclusive assessments. Consequently, the case was remanded for further proceedings to obtain necessary medical opinions and to reassess the need for a vocational expert.

Disability Insurance BenefitsSupplemental Security IncomeSocial Security ActJudicial ReviewAdministrative Law JudgeMedical OpinionFunctional LimitationsMental ImpairmentsBipolar DisorderImpulse Control Disorder
References
50
Case No. ADJ7957976
Regular
Nov 18, 2013

CHARLES TREJO vs. NORTHRUP GRUMMAN CORPORATION, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinding a prior award. The WCJ improperly relied solely on applicant's self-procured physician's report for findings on cervical and lumbar spine injury and permanent disability. Amended Labor Code section 4605 requires any self-procured medical opinions to be addressed by a Qualified Medical Evaluator (QME) or authorized treating physician, which did not occur. The case is returned for further medical development, specifically requiring the QME to address the self-procured physician's opinions.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMedical Provider Network (MPN)Self-Procured Medical TreatmentLabor Code Section 4605Qualified Medical Evaluator (QME)Panel Qualified Medical Examiner (PQME)Permanent Disability RatingWhole Person Impairment
References
3
Case No. MISSING
Regular Panel Decision
Jun 08, 2000

McNulty v. City of New York

This dissenting opinion addresses the legal duty of physicians and hospitals to non-patients in a medical malpractice case. Plaintiff Mary Ann McNulty sued several doctors and hospitals after contracting meningococcal meningitis from her friend, Robin Reda, following alleged misinformation and failure to warn about prophylactic treatment. The dissent argues that expanding a physician's duty beyond the established physician-patient relationship to a non-patient friend creates an unmanageable and potentially limitless scope of liability, citing precedent that narrowly defines such duties even for immediate family members. It contends that the hospitals' voluntary undertaking to contact at-risk individuals did not create a legal duty of care to Ms. McNulty. Therefore, the dissenting judge would dismiss all claims against the physicians and hospitals involved.

Medical MalpracticeMedical NegligenceDuty of CarePhysician-Patient RelationshipContagious DiseaseMeningitisSummary JudgmentAppellate ReviewThird-Party LiabilityForeseeability
References
24
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