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

Case No. ADJ9549773
Regular
Nov 13, 2015

EDWARD BAUTISTA vs. ARLON GRAPHICS, TRAVELERS

The Appeals Board dismissed the applicant's petition for reconsideration or removal, finding the WCJ's order was not a final determination. The WCJ correctly ordered the applicant to first discuss his anxiety symptoms and need for psychological referral with his primary treating orthopedist. Applicant is not entitled to a second opinion from a psychologist until the primary treating physician has diagnosed the anxiety or determined a referral is unnecessary. Commissioner Sweeney dissented, believing the applicant had an absolute right to an MPN second opinion for his psychiatric condition without first obtaining a referral from his orthopedist.

ADJ9549773Arlon GraphicsTravelersPetition for ReconsiderationPetition for RemovalWorkers' Compensation Appeals BoardWCJLabor Code Section 4616.3Labor Code Section 4616.4Administrative Director Rules
References
Case No. SAL 0103596
Regular
Jan 07, 2008

CHRISTIE GAYNES vs. GRANITE ROCK COMPANY, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration. The applicant sought to have a medical evaluation by an anesthesiologist or neurologist, arguing the chosen Agreed Medical Evaluator (AME), an orthopedist, lacked the necessary expertise for her specific nerve pain. The Board found the petition untimely and upheld the WCJ's recommendation for dismissal.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Compelling AttendanceMedical EvaluationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)WCJReport and RecommendationDismissed PetitionTimeliness
References
Case No. ADJ6913767
Regular
Jul 05, 2012

YOLANDA BARCENAS vs. IN HOME SUPPORT SERVICES (IHSS), STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, finding that the applicant's psychiatric reports were inadmissible. The primary treating physician, an orthopedist, did not review or incorporate the reports from the applicant's treating psychiatrist, nor did he designate the psychiatrist to provide opinions. Consequently, the Board struck the finding of injury to the psyche and amended the permanent disability award to 28%, solely based on orthopedic findings.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityPrimary Treating PhysicianOrthopedistPsychiatristAdmissibility of ReportsLabor Code Section 4061.5Injury to Psyche
References
Case No. ADJ635934
Regular
Sep 09, 2010

FRANCES LARUE vs. NORDMAN, CORMANY, HAIR & COMPTON, STATE COMPENSATION INSURANCE FUND

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's award finding permanent total disability and no apportionment for an applicant's back injury. The Board rescinded the award, finding the judge erred by relying on an orthopedist's opinion that failed to properly apportion disability to pre-existing scoliosis. The case is remanded for further proceedings to incorporate the apportionment opinion of the defendant's medical expert, who found 70% of the disability attributable to non-industrial scoliosis. A dissenting opinion argued that the defendant's medical expert's apportionment was also insufficient.

ApportionmentPermanent Total DisabilityQualified Medical EvaluatorOrthopedistDegenerative ScoliosisCausationLabor Code Section 4663Senate Bill 899Substantial EvidenceFindings and Award
References
Case No. ADJ7735457, ADJ6720971, ADJ7722714, ADJ7336302, ADJ6841161
Regular
Jan 25, 2013

JOHN HARRIS vs. CALIFORNIA DEPARTMENT OF JUSTICE, STATE COMPENSATION INSURANCE FUND, COUNTY OF SACRAMENTO, TRISTAR INSURANCE

The Workers' Compensation Appeals Board dismissed John Harris's Petition for Reconsideration because it was not taken from a final order, as the prior decision did not determine substantive benefit entitlement. Furthermore, the petition was deemed successive, as it sought to re-litigate an issue previously denied under a different procedural designation. The Board had previously denied applicant's request for removal regarding an orthopedist evaluation of his right knee, finding no significant prejudice. Therefore, the Petition for Reconsideration was dismissed.

Petition for ReconsiderationPetition for RemovalNon-final orderSuccessive petitionSubstantive issueEntitlement to benefitsOrthopedist evaluationSignificant prejudiceIrreparable harmWCJ denial
References
Case No. ADJ7574646
Regular
Jan 25, 2012

HEATHER YARBOROUGH vs. JENNY CRAIG, AIG INSURANCE c/o SEDGWICK CMS

The Workers' Compensation Appeals Board dismissed the defendant's petition for removal and reconsideration as untimely, as it was filed 34 days after the order was served. The petition argued the administrative law judge erred by ordering treatment outside the Medical Provider Network, but the board found the petition was filed beyond the jurisdictional time limits. Furthermore, the board noted that the order compelling the defendant to arrange for a PQME evaluation and other examinations was not a final order, which is required for reconsideration. Therefore, both petitions were dismissed.

WCABPetition for RemovalPetition for ReconsiderationUntimely FilingMPNMedical Provider NetworkNeurosurgeonOrthopedistNeurologistTreating Doctor
References
Case No. ADJ361383
Regular
Apr 17, 2009

LINNIE WALLIN vs. COUSIN GARYS FACTORY BUILT HOMES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and amended an administrative law judge's finding, specifically removing the finding of industrial injury to the applicant's left shoulder. While the applicant experienced left shoulder symptoms due to a fall, medical evaluations did not establish causation or a need for treatment for the shoulder itself. However, the Board affirmed the prior finding of 20% permanent disability, based on the applicant's neck injury, as detailed in the judge's report.

Workers' Compensation Appeals BoardLINNIE WALLINCOUSIN GARYS FACTORY BUILT HOMESZENITH INSURANCE COMPANYAmended Findings and AwardRECONSIDERATIONINDUSTRIAL INJURYNECKLEFT SHOULDERPERMANENT DISABILITY
References
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
Case No. ADJ11085853
Regular
Sep 23, 2019

DAVID GONZALEZ vs. STIX HOLDINGS, LLC, PICK UP STIX, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and amended the original decision to award additional temporary disability benefits. The applicant is entitled to temporary disability from August 8, 2018, to June 30, 2019, totaling $22,977.68, as supported by medical evidence and employer acknowledgments. The defendant's petition for reconsideration was based on a claim of offering modified work, which was not found to negate the applicant's entitlement to these benefits. Jurisdiction is reserved for any future disputes regarding further temporary disability.

Petition for ReconsiderationTemporary disabilityModified work offerPrimary treating physicianOrthopedistEvidentiary recordDerotational knee braceStipulationFindings and AwardWCAB jurisdiction
References
Case No. FRE 0219842
Regular
Mar 11, 2008

ELBEY LONERO vs. MERCED TRANSPORTATION, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) reversed an administrative law judge's decision regarding the applicant's temporary disability end date, finding it should be March 24, 2005, based on an agreed medical evaluator's opinion. The WCAB affirmed the use of the 1997 Permanent Disability Rating Schedule, finding that a treating physician's pre-2005 report indicated permanent disability. Finally, despite the adjusted temporary disability period, the defendant was denied credit for overpayments, as the applicant acted in good faith and the payments were continued after receiving the AME's report.

WORKERS' COMPENSATION APPEALS BOARDELBEY LONEROMERCED TRANSPORTATIONINC.STATE COMPENSATION INSURANCE FUNDCase No. FRE 0219842OPINION AND DECISION AFTER RECONSIDERATIONbus driverindustrial injurylow back
References
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