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

Case No. ADJ8418862
Regular
Aug 26, 2018

CARMEN MEJIA vs. COUNTY OF ORANGE

This case involves an applicant seeking workers' compensation for a psychiatric injury and orthopedic issues against the County of Orange. The Appeals Board denied the defendant's petition for reconsideration regarding the psychiatric injury, finding the defendant failed to prove the injury was substantially caused by good faith personnel actions. The Board granted the applicant's petition, deferring orthopedic injury issues to the trial level due to insufficient medical evidence and contradictory expert opinions. The matter is returned for further development of the record regarding back, chest, and other orthopedic claims, as well as permanent disability and future medical treatment.

Labor Code section 3208.3psychiatric injurypredominant as to all causesactual events of employmentlawful nondiscriminatory good faith personnel actionsubstantial causetotality of circumstancesqualified medical evaluator (QME)panel qualified medical evaluator (PQME)cumulative trauma
References
15
Case No. ADJ4145263 (VEN 0120366) ADJ2903274 (OXN 0124883)
Regular
Jul 16, 2012

SHARON ANGELL vs. MARYMOUNT ACADEMY, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) by its servicing agent SEDGWICK CMS, for FREMONT INDEMNITY in liquidation

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original decision, remanding the case for further proceedings. The primary issue is whether applicant's fibromyalgia should be rated separately from her orthopedic injuries. The Board found no clear evidence in the record supporting the WCJ's conclusion that fibromyalgia was solely a consequence of the orthopedic conditions. On remand, the WCJ must determine the causation of the fibromyalgia and whether it warrants separate rating. The Board deferred ruling on other issues raised by the parties.

Workers' Compensation Appeals BoardCIGAFremont Indemnityliquidationreconsiderationfibromyalgiaorthopedic injuryapportionmentvocational evidencetemporary disability
References
3
Case No. ADJ72 02827
Regular
Apr 14, 2016

Luz Castro vs. Sharp Health Care, ACE American Insurance Company, ESIS, INC.

This case involves an applicant seeking workers' compensation benefits for industrial injuries to her neck, back, and psyche. The Appeals Board granted reconsideration because neither the applicant's nor the defendant's medical evidence sufficiently supported findings on psychological injury or permanent disability. Due to the unreliability of the orthopedic medical opinions and the psychologist's reliance on them, the Board deferred the issues of permanent disability and injury to the psyche. The matter is returned for further proceedings, including selecting a new orthopedic evaluator, before determining these deferred issues and attorney's fees.

Workers Compensation Appeals BoardPetition for ReconsiderationRemovalFindings and AwardVacating SubmissionNew and Further DisabilityIndustrial InjuryPermanent DisabilityPsycheApportionment
References
0
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. MISSING
Regular Panel Decision

American Fur Liners Contractors Ass'n v. Lucchi

The court considered whether Civil Practice Act section 882-a typically permits framing issues for a contempt proceeding. It was determined that under ordinary circumstances, it does not. However, the appellants, having themselves objected to proceeding without framed issues, were precluded from raising an objection on that ground. The court found the framed issues sufficient to address the questions presented in the case. Consequently, the order under appeal was unanimously affirmed, with associated costs and disbursements.

contempt of courtframing issuesappellate procedurecivil practice actunanimous affirmationprocedural objectionappellate costsjudicial review
References
0
Case No. ADJ9557817, ADJ9684289, ADJ9683105
Regular
Jul 15, 2015

TOBY WALSH vs. STATE FARM INSURANCE COMPANIES, ACE USA INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision by the Workers' Compensation Judge (WCJ) concerning applicant Toby Walsh's three injury claims. The WCJ had ordered the parties to develop the record by selecting an Agreed Medical Evaluator or Qualified Medical Evaluator in orthopedics to address industrial causation. The WCAB amended the WCJ's order, finding that the issue of QME specialty was not properly before the WCJ as it was not an issue for trial and was agreed to be deferred. The case is returned to the trial level for a hearing on the QME specialty issue.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Ordersinjury arising out of and occurring in the course of employmentAgreed Medical EvaluatorQualified Medical Evaluatororthopedic specialtydue processnoticeopportunity to be heard
References
0
Case No. ADJ1167311 (LBO 0303498) ADJ749429 (LBO 0296277)
Regular
Apr 29, 2011

RAMON ZIEBA vs. BAILLY SHOWCASE, SAFECO INSURANCE COMPANY

The Workers' Compensation Appeals Board denied lien claimant Dr. Halote's petition for reconsideration. Dr. Halote sought reimbursement for psychiatric treatment, arguing it was separate from a psychiatric injury claim. However, the only issue presented at trial was whether the applicant sustained a psychiatric injury arising out of and occurring in the course of employment. The Board found that the issue of the reasonableness of psychiatric treatment, for admitted orthopedic injuries, was not raised at trial and was therefore waived. Thus, the Board denied reconsideration as Dr. Halote could not raise this new issue for the first time on appeal.

Workers' Compensation Appeals Boardpsychiatric injuryAOE/COElien claimantPetition for ReconsiderationFindings of Factadministrative law judgeLabor Codecompensabilitypsychiatric treatment
References
2
Case No. ADJ9796670
Regular
Aug 05, 2016

Virginia Lopez vs. California Pizza Kitchen, Travelers Insurance

Applicant Virginia Lopez sought removal after an administrative law judge (WCJ) invalidated a chiropractic QME panel, ordering an orthopedic replacement. The Workers' Compensation Appeals Board (WCAB) granted removal, finding the original chiropractic panel was properly issued and defendants waived their right to object by failing to follow proper procedures. The WCAB amended the WCJ's decision to affirm the chiropractic panel, deeming removal necessary to prevent substantial prejudice. The WCAB affirmed the WCJ's order to issue a replacement panel in the "specialty previously issued," which was chiropractic.

Petition for RemovalQualified Medical Evaluator (QME)Specialty DesignationCompensability ExamLabor Code § 4060Rule 30(b)Rule 31.1(b)Written ObjectionMedical Director ReviewWaiver of Objection
References
6
Case No. ADJ9944770
Regular
Oct 19, 2018

Sam Zavalata vs. Conifer Value Based Care, LLC

This case involves applicant Sam Zavaleta's workers' compensation claim for psychiatric and orthopedic injuries against Conifer Value Based Care, LLC. The Workers' Compensation Appeals Board (WCAB) rescinded the trial judge's decision, finding that the medical opinions from both the orthopedic and psychiatric evaluators required further development. Specifically, issues exist regarding the orthopedic causation of cumulative trauma injury to the applicant's psyche, back, neck, and wrist, as well as the substantial causation of the psychiatric injury in relation to the defendant's good faith personnel action defense. The matter is returned to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPsychiatric InjuryCumulative TraumaPersonnel Action DefenseGood FaithCausationMedical OpinionApportionment
References
12
Case No. MISSING
Regular Panel Decision
Jan 20, 2015

GATTI, SARAHANN v. SCHWAB, RODGER J.

This case involves an appeal from an order denying summary judgment in an action for damages related to serious injuries sustained in a motor vehicle accident. Plaintiff Sarahann Gatti alleged serious injuries, while the unnamed defendant contended that her spinal injuries were pre-existing from an earlier work-related incident. The Supreme Court's order was modified on appeal, with the appellate court granting the defendant's motion to dismiss the 90/180-day serious injury claim, a category the plaintiff had abandoned. However, the denial of summary judgment for other serious injury categories was affirmed, as the plaintiff successfully raised a triable issue of fact concerning causation through her treating orthopedic surgeon's opinion. The surgeon's testimony attributed Gatti's C6-7 disc injury and the aggravation of pre-existing neck and lower back issues to the accident in question, thus presenting a genuine issue for the trier of fact to resolve.

Motor vehicle accidentSerious injurySummary judgmentCausationSpinal injuriesDisc injuryAggravation of injuryOrthopedic surgeonWorkers' Compensation BoardAppellate review
References
10
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