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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
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. 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. ADJ532181 (SFO 0438716) ADJ250509 (SFO 0242560) ADJ6545137
Regular
Nov 14, 2014

MICHAEL THOMAS, vs. SAFEWAY STORES, INC. Permissibly Self-Insured,

This case involved an applicant seeking treatment from a highly specialized surgeon, Dr. Matsen, located in Seattle, for a complex shoulder revision. The original decision denied authorization for Dr. Matsen, deeming Seattle outside a reasonable geographic area, and excluded a crucial report from the applicant's treating physician, Dr. Osborn. The Appeals Board granted reconsideration, admitting Dr. Osborn's report, which strongly supported Dr. Matsen's expertise and the inadequacy of local Bay Area surgeons for this complex case. Based on the applicant's medical history and the availability of specialized treatment, the Board reversed the original decision, finding Dr. Matsen to be within a reasonable geographic area.

Workers' Compensation Appeals BoardReasonable geographic areaTreating surgeonAdministrative Director Rule 9780Labor Code section 4600Orthopedic surgeonTotal shoulder replacementRevision surgeryMedical historyPhysician competency
References
Case No. ADJ7785251
Regular
Nov 14, 2014

Jon Brothers vs. STATE OF CALIFORNIA, DEPARTMENT OF FORESTRY AND FIRE PROTECTION, COASTAL/NORTH REGION; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to clarify that the applicant's cumulative trauma orthopedic injury claim is still under development. The Board agreed with the WCJ that the defense's medical expert, Dr. Baldwin, failed to provide substantial medical evidence due to a misunderstanding of cumulative trauma principles. Dr. Baldwin improperly required documented prior specific injuries to opine on cumulative trauma, thereby failing to adequately assess the applicant's extensive work history. Therefore, the case is affirmed except for the amendment of a finding of fact to reflect that the orthopedic injury claim is contested and requires further medical evaluation.

Cumulative traumaQualified Medical EvaluatorIndependent Medical Evaluatorsubstantial medical evidenceorthopedic injurybinaural hearing losscardiovascular systemBattalion Chiefretired annuitantorthopedic cumulative trauma
References
Case No. ADJ7938670
Regular
Jun 20, 2012

ROSALINDA MAGANA vs. FIRST ALARM, INC., LIBERTY MUTUAL INSURANCE COMPANY

This case concerns an employer and insurer's unsuccessful petition for reconsideration to prevent an injured worker from changing her primary treating physician. The applicant injured her back and, after postponing recommended surgery, sought to switch to a pain management specialist within the employer's medical network. The Workers' Compensation Appeals Board denied reconsideration, adopting the judge's report which found the applicant could change physicians as the requested specialist's treatment was consistent with the original orthopedic surgeon's recommendations. The Board also admonished the defendants for delaying medical treatment.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedMedical treatmentPrimary treating physicianMedical Provider Network (MPN)Orthopedic surgeonChronic pain managementLabor CodeFindings Award and Orders
References
Case No. ADJ3206000 (LAO 0877236)
Regular
Aug 10, 2012

JENNIFER HESTER vs. TECHNICOLOR, Permissibly Self-Insured

The applicant sought reconsideration of a decision limiting the defendant's payment for hip surgery to the Official Medical Fee Schedule, which the applicant's surgeon deemed insufficient. The Appeals Board granted reconsideration due to the complex fee dispute, noting that while extraordinary circumstances existed regarding the surgeon's qualifications, the reasonableness of his requested fee was unproven. To resolve this, the Board ordered the appointment of an agreed physician to investigate the surgeon's usual fee and its reasonableness compared to others with similar expertise.

ReconsiderationFindings of FactAgreed PhysicianMedical TreatmentFee ScheduleExtraordinary CircumstancesUsual FeeHip ArthroscopyOsteoplastyChondroplasty
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. ADJ9099536
Regular
Sep 09, 2014

MARIA SOTO vs. CCC HOSPITALITY PISMO, LLC dba SEACREST OCEANFRONT HOTEL, STAR INSURANCE COMPANY

In this case, the defendant hospital sought removal after the WCJ ordered a chiropractic QME panel, arguing chiropractors were unqualified for the applicant's knee injury. The defendant had initially requested an orthopedic surgeon QME, but their request was rejected by the Medical Unit as incomplete. The Appeals Board found the defendant's initial request substantially complied with regulations and was improperly rejected. Therefore, the Board granted removal, rescinded the WCJ's order, and directed the Medical Unit to issue a panel of orthopedic surgery QMEs.

Petition for RemovalPQMEMedical UnitChiropractic QMEOrthopedic Surgery QMERequest for QME PanelAdministrative Director Rule 30(b)Labor Code section 4062.2Messele v. Pitco FoodsInc.
References
Case No. LBO 0383944
Regular
Apr 07, 2008

GABRIEL RODRIGUEZ vs. GARDENA NISSAN, SENTRY CLAIMS SERVICE

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the prior order was procedural and not final. However, the WCAB granted removal, rescinded the prior order, and authorized the defendant to obtain a second orthopedic QME. This decision was based on the necessity of obtaining crucial medical evidence regarding the applicant's orthopedic condition, which the current internal medicine QME could not address, thus preventing a just adjudication.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting RemovalDecision After RemovalSpecialty Physician Panel QMEOrthopedicsMedical UnitLabor Code section 4062.2Industrial InjuryLeft Shoulder
References
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