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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8994015 ADJ8994016
Regular
Mar 29, 2018

JOHN BEVINGTON vs. COUNTY OF MARIPOSA, permissibly self-insured, administered by TRISTAR RISK MANAGEMENT

This case concerns a petition for reconsideration filed by the defendant, County of Mariposa, challenging a workers' compensation award. The Appeals Board granted the petition, affirming the original award but deferring issues of permanent disability, job displacement vouchers, and attorney's fees. This deferral is to allow for further medical evaluation regarding the apportionment of the applicant's psychological injury between two distinct orthopedic injuries. The matter is remanded to the trial level for these necessary further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings of FactAwardOrderOpinion on DecisionWorkers' Compensation Administrative Law JudgeApplicantDefendantCounty of Mariposa
References
Case No. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ8210063
Significant

Grace Nunes, Applicant vs. State of California, DEPT. OF MOTOR VEHICLES, Legally Uninsured; STATE COMPENSATION INSURANCE FUND, Adjusting Agency, Defendants

The Appeals Board denied the applicant's Petition for Reconsideration, affirming its prior en banc decision that vocational evidence cannot substitute for valid medical apportionment from a physician, as mandated by Labor Code section 4663.

Labor Code Section 4663Vocational ApportionmentMedical ApportionmentPermanent DisabilityQualified Medical EvaluatorSubstantial EvidencePetition for ReconsiderationEn Banc DecisionWorkers' Compensation Appeals BoardApportionment Analysis
References
Case No. ADJ4552593 (MON 0258406) ADJ6674320
Regular
Jun 21, 2011

KIMBERLY DeNOVA-JOY vs. SANTA PAULA ELEMENTARY SCHOOL DISTRICT, CIGA On Behalf of FREMONT INSURANCE COMPANY In Liquidation, As Administered By CAMBRIDGE INTERGRATED SERVICES

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, remanding the case for further proceedings. The Board found the WCJ failed to fully address apportionment, a mandated issue. Specifically, the WCJ neglected to consider apportionment of orthopedic and psychiatric disability as determined by AMEs, beyond the rheumatologist's opinion on fibromyalgia. The Board also noted that existing medical reports may be stale, necessitating potential new evaluations.

Workers' Compensation Appeals BoardReconsiderationApportionmentPermanent DisabilityFibromyalgiaCumulative TraumaMedical EvidenceExpert Medical OpinionOrthopedicsPsychiatry
References
Case No. ADJ8240882; ADJ8240881; ADJ8615401
Regular
Apr 21, 2025

ROBERT S. HAPPENY vs. STATE OF CALIFORNIA, CALIFORNIA INSTITUTE FOR WOMEN

Applicant Robert S. Happeny sustained industrial injuries during his employment as a correctional officer, leading to a finding of permanent and total disability by the WCJ due to his inability for vocational retraining. The WCJ also issued an unapportioned award, concluding that apportionment to nonindustrial factors was not proven. Defendant challenged this decision via a petition for reconsideration, disputing the method of combining disabilities and the reliability of vocational reports. The Appeals Board granted reconsideration, affirming the WCJ's determination of permanent and total disability based on vocational infeasibility and the lack of established apportionment, ultimately rescinding the original decision and substituting new findings of fact.

ADJ8240882ADJ8240881ADJ8615401correctional officerindustrial injuryheartpsycheright wristrespiratory systemlumbar spine
References
Case No. ADJ383777
Regular
Apr 04, 2011

Roxanna Ortiz vs. ONE SOURCE, ESIS

The Workers' Compensation Appeals Board denied Roxanna Ortiz's petition for reconsideration of a prior findings and order. The initial ruling determined she sustained industrial injury only to her cervical spine as a janitor, not to other body parts or any resulting temporary/permanent disability or need for further medical treatment. Ortiz argued the judge erred by favoring defense medical reports and discrediting her testimony due to minor inconsistencies in her injury description. The Board adopted the WCJ's report, emphasizing deference to credibility determinations and that admissibility of medical reports should have been challenged at trial, not on reconsideration. A dissenting opinion argued the judge overemphasized minor variations in Ortiz's account and that medical evidence did not sufficiently support denial of other injuries or further treatment.

OrtizOne SourceESISWCABFindings and OrderPetition for ReconsiderationWorkers' Compensation Administrative Law Judgeindustrial injurycervical spineright arm
References
Case No. ADJ8210063; ADJ8621818
En Banc
Aug 29, 2023

GRACE NUNES vs. STATE OF CALIFORNIA, DEPT. OF MOTOR VEHICLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, affirming its prior en banc decision that permanent disability apportionment must be based on a physician's medical evaluation as mandated by Labor Code section 4663, and that vocational evidence cannot substitute an impermissible 'vocational apportionment' in place of a valid medical apportionment.

VOCATIONAL APPORTIONMENTMEDICAL APPORTIONMENTPERMANENT DISABILITYQUALIFIED MEDICAL EVALUATORLABOR CODE SECTION 4663SUBSTANTIAL EVIDENCEAPPEALS BOARD EN BANCFINDINGS OF FACT AND AWARDFINAL ORDERRECONSIDERATION DENIED
References
Case No. ADJ2628303
Regular
Apr 01, 2014

GLORIA CAIRES vs. SHARP HEALTHCARE, ACE AMERICAN INSURANCE

The Appeals Board rescinded the original award and returned the case for further proceedings due to insufficient medical evidence on apportionment. Specifically, the Board found that the opinions of the orthopedic and psychiatric medical evaluators regarding the apportionment of permanent disability lacked substantial medical evidence. The orthopedic evaluator's apportionment methodology, referencing an AMA Guides example, was deemed improper under current Labor Code sections 4663 and 4664. The psychiatric evaluator's apportionment was also found insufficient as it did not adequately explain how psychiatric permanent disability should be apportioned separately from injury causation.

Workers' Compensation Appeals BoardPermanent Disability ApportionmentQualified Medical Evaluator (PQME)Agreed Medical Evaluator (AME)American Medical Association Guides to the Evaluation of Permanent ImpairmentRange of Motion MethodDiagnosis-Related Estimate (DRE) MethodCompensable ConsequenceCausation of Permanent DisabilitySubstantial Medical Evidence
References
Case No. ADJ2621517
Regular
Mar 16, 2009

ELAINE ADAMSON vs. CENDANT MOBILITY

The Workers' Compensation Appeals Board granted reconsideration of a decision finding the applicant 100% permanently disabled. The Board found the judge may have erred by not applying the correct apportionment principles under SB 899 and by not fully considering the Agreed Medical Examiner's (AME) apportionment opinion. The judge also needs to re-evaluate permanent disability considering all industrial conditions and potential non-industrial apportionment, and clarify the basis for total disability if it extends beyond orthopedic injuries. The case is remanded for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationApportionmentPermanent Total DisabilitySB 899Labor Code Section 4663Industrial InjuryPsycheOrthopedic InjuriesDegenerative Disc Disease
References
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