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

Case No. MISSING
Regular Panel Decision

Fernandez v. North Shore Orthopedic Surgery & Sports Medicine, P.C.

Frank Fernandez, an x-ray technician, sued his former employer, North Shore Orthopedic Surgery & Sports Medicine, P.C., for retaliation under Title VII after filing a national origin discrimination complaint. A jury found in favor of Fernandez, awarding back pay, front pay, and punitive damages. North Shore subsequently moved for judgment as a matter of law, a new trial, and to modify the damage awards. The court denied North Shore's motions for judgment and a new trial, affirmed the jury's back pay award, but vacated and reduced the front pay award from $160,000 to $50,000, and the punitive damages award from $100,000 to $50,000.

RetaliationTitle VIIEmployment DiscriminationBack PayFront PayPunitive DamagesMitigation of DamagesFederal Rules of Civil ProcedureJudicial DiscretionEquitable Relief
References
27
Case No. ADJ1228787 (VNO 0533101) ADJ676900 (VNO 0533097) ADJ780789 (VNO 0548546)
Regular
Apr 07, 2011

IRMA SANCHEZ vs. LONG BEACH UNIFIED SCHOOL DISTRICT, TRISTAR RISK MANAGEMENT

The Appeals Board granted reconsideration and rescinded the prior award finding industrial causation for hypertension and kidney disease. The Board found Dr. Lipper's opinion, which supported applicant's claim, lacked substantial evidence due to incomplete medical record review and speculative, conditional reasoning. Conversely, the Board found PQME Dr. Majcher's opinion, concluding the conditions were pre-existing and non-industrial, to be well-supported by evidence. Therefore, the matter was returned to the WCJ to re-determine benefits based solely on admitted orthopedic injuries.

Labor Code section 4628substantial medical evidenceindustrial injurybilateral upper extremitiesbilateral forearmsbilateral elbowshypertensionkidneyspermanent disabilityapportionment
References
2
Case No. ADJ655912 (SDO 0342137) ADJ677760 (SDO 0342143)
Regular
Feb 11, 2009

MARIA E. GARCIA vs. SAN DIEGO UNIFIED PORT DISTRICT, AMERICAN HOME ASSURANCE COMPANY, AIG DOMESTIC CLAIMS

The Workers' Compensation Appeals Board denied both the applicant's and defendant's petitions for reconsideration. The Board upheld the trial judge's decision to deny massage therapy, finding it not medically necessary per ACOEM guidelines and not supported by the treating physician's reports. Conversely, the Board affirmed the need for a sleep study and orthopedic/psychiatric consults based on the primary treating physician's consistent recommendations, rejecting the defendant's challenges to the exclusion of PQME reports and admission of other evidence. Ultimately, the Board found substantial medical evidence supported the original award and denied both parties' requests for review.

Workers' Compensation Appeals BoardIndustrial InjuryRight ShoulderNeckFurther Medical TreatmentSleep StudyOrthopedic ConsultPsychiatric ConsultMassage TherapyPanel Qualified Medical Examiner
References
1
Case No. ADJ7253987
Regular
Jun 29, 2012

Anna Medel vs. Employment Development Department, State Compensation Insurance Fund

The defendant sought reconsideration of an order granting the applicant a new Qualified Medical Evaluator (PQME). The defendant argued their communication with the PQME was not an ex parte violation and that the objection was untimely. The Board dismissed the reconsideration petition, finding the order was procedural, not final. The Board denied the removal petition, agreeing that the defendant's communication violated Labor Code Section 4062.3 by failing to serve the applicant 20 days prior to the PQME evaluation. Therefore, the applicant was correctly awarded a new PQME panel.

Workers' Compensation Appeals BoardPanel Qualified Medical EvaluatorPQMESection 4062.3Ex Parte CommunicationReconsiderationRemovalCumulative Trauma InjuryCervical SpineBilateral Upper Extremities
References
15
Case No. ADJ10917207
Regular
Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute
References
9
Case No. ADJ7264915
Regular
Jul 15, 2013

ANA GONZALES vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

This case involves an applicant who sustained industrial psychiatric injury but whose orthopedic claims were denied due to insufficient medical evidence. The Appeals Board denied the applicant's petition for reconsideration, finding the applicant failed to present substantial medical evidence of industrial causation for her orthopedic complaints. A dissenting commissioner argued that the primary medical evaluator's report was deficient and lacked substantial evidence, warranting further development of the record on orthopedic injuries and other claims. The dissent emphasizes the Board's duty to ensure substantial justice, suggesting it should have ordered further investigation on the denied orthopedic issues.

WCABPetition for ReconsiderationFindings and Orderindustrial injurypsychelow backneckright shoulderright wristright elbow
References
11
Case No. ADJ11629114
Regular
Sep 16, 2022

KATHLEEN PHILLIPS vs. SHORENSTEIN HAYS-NEDERLANDER THEATRES, LLC, STATE NATIONAL INSURANCE COMPANY, INC., MEADOWBROOK INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and modified a prior decision concerning applicant Kathleen Phillips' industrial hip injury. While affirming the finding that the Qualified Medical Examiner's (PQME) reports lacked substantial medical evidence, the WCAB rescinded the striking of those reports and the PQME's disqualification. The WCAB reasoned that striking reports and disqualifying a PQME requires specific legal grounds not present here, and the determination of substantiality relates to the weight of evidence, not admissibility. The WCAB emphasized that the PQME's reports remain part of the record, with the judge retaining discretion to assign them appropriate weight.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderQualified Medical Examiner (PQME)Substantial Medical EvidenceRemoval StandardThreshold IssueInterlocutory FindingAdmissibility of EvidencePrejudiced
References
5
Case No. ADJ85664607
Regular
Nov 01, 2013

YANET DUARTE ORTUNI vs. LA PERLA MEXICANA A CORPORATION, INSURANCE COMPANY OF THE WEST

This case involves a defendant's petition to remove the matter due to the Presiding Workers' Compensation Judge's alleged denial of an expedited hearing on a PQME specialty dispute. The applicant countered that the PQME appointment had been canceled. The Appeals Board dismissed the petition as moot because the cancellation of the PQME appointment resolved the underlying dispute. Therefore, the Petition for Removal was dismissed.

Petition for RemovalPresiding Workers' Compensation JudgeExpedited HearingPanel Qualified Medical EvaluatorPQME specialtymootcancelled medical appointmentWorkers' Compensation Appeals Board
References
0
Case No. ADJ9795000
Regular
Sep 15, 2015

JACQUITA HUNTLEY vs. A.H. 2005 MANAGEMENT, PENNSYLVANIA MANUFACTURERS ASSOCIATION INSURANCE COMPANY

The applicant sought removal of a WCJ's finding that the defendant's request for a Qualified Medical Examiner (PQME) was valid. Applicant argued her prior PQME request and the defendant's failure to attach proper documentation invalidated their request. The Board denied the removal petition, adopting the WCJ's report which noted the applicant stipulated to the invalidity of her own PQME request. Furthermore, the Board admonished applicant's attorneys for making false statements and potentially violating Labor Code section 5813.

Petition for RemovalQualified Medical Examiner (PQME)Labor Code section 4061Rule 31.1StipulationTreating PhysicianOrthopedic Surgical PanelChiropractic PQMEBad Faith ActionsFrivolous Tactics
References
0
Case No. ADJ7558173
Regular
Oct 28, 2014

JESSIE MOORE vs. PASADENA AREA COMMUNITY COLLEGE DISTRICT

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and found the applicant was not temporarily totally disabled after her retirement. The Board determined that while the applicant stated her retirement was reluctant, the primary reasons cited were hostile work environment and emotional stress, not solely orthopedic injuries. Medical evidence did not substantially support the claim that the admitted orthopedic injuries alone rendered her temporarily totally disabled. Consequently, temporary disability benefits were not awarded for the orthopedic injuries.

Workers' Compensation Appeals BoardJessie MoorePasadena Area Community College DistrictKeenan & Associatesstatute of limitationstemporary disabilitycumulative traumacervical spinelumbar spineleft wrist
References
7
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