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

Case No. ADJ3190249 (SFO 0500553)
Regular
Mar 24, 2010

Quintella Eutsey vs. CITY & COUNTY OF SAN FRANCISCO, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted removal, dismissing the defendant's petition for reconsideration. The Board found the prior administrative law judge's order improperly limited discovery into the applicant's psychiatric injury claim. The Board rescinded the previous order, allowing further deposition to explore the applicant's full medical history relevant to her psyche claim, as this is discoverable when a psychological injury is at issue. Both parties were admonished to conduct themselves professionally during future discovery.

removalpetition for reconsiderationdiscovery disputepsyche injurydeposition testimonyright lower extremityindustrial injurypersonal lifefamily lifepast history
References
Case No. ADJ8424952
Regular
Sep 10, 2014

ALFONSO CRUZ vs. SIERRA CIRCUITS, INC.; THE HARTFORD

This case involves an applicant's petition for removal regarding deposition questions about medical history and insurance coverage. The Workers' Compensation Appeals Board (WCAB) granted the petition in part, allowing questions about medical insurance and personal doctors, as these are discoverable under CCP § 2017.010. However, the WCAB found questions about past medical treatment paid by others and prior hospitalizations to be overbroad, as they could infringe on the physician-patient privilege regarding unrelated conditions. The Board ordered the applicant to answer specific questions but requires defendants to reframe broader questions concerning medical history to avoid privileged information.

Petition for RemovalFifth AmendmentFirst Amendmentphysician-patient privilegeconfidential communicationindustrial injurymedical historydeposition questionsCode of Civil Procedure section 2017.010Evidence Code sections 990
References
Case No. ADJ9805248
Regular
Aug 30, 2017

FRANCISCO PEREZ vs. MASSIVE PRINTS, HARTFORD/ SENTINEL INSURANCE COMPANY

The Appeals Board granted reconsideration of the WCJ's award due to questions regarding the substantiality of the Qualified Medical Evaluator's (QME) opinion. The Board found the QME's report and deposition testimony unreliable due to an incorrect work history, inadequate examination, and potentially flawed application of disability rating guidelines. Consequently, the Board affirmed the original award but deferred issues of permanent disability, apportionment, and attorney fees, returning the case to the WCJ for further proceedings and potentially a new medical evaluation.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentAttorney FeesQualified Medical EvaluatorAgreed Medical ExaminerSubstantial EvidenceMedical Opinion
References
Case No. ADJ8067157
Regular
Nov 30, 2012

MARISOL PERALTA vs. FROZEN YOGURT OF VALLEY VILLAGE, INC., STAR INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further develop the record regarding applicant Marisol Peralta's alleged industrial injury. The WCAB rescinded the prior decision finding an injury, citing that the medical opinions were not substantial evidence as they lacked definitive causation findings and weren't based on complete medical histories. Crucially, neither physician reviewed applicant's full medical records, and one deferred causation due to pregnancy while the other awaited X-ray results. The case is returned to the trial level for further proceedings and a new decision by the WCJ.

Workers' Compensation Appeals BoardMarisol PeraltaFrozen Yogurt of Valley VillageInc.Star Insurance Co.Illinois Midwest Insurance AgencyLLCADJ8067157Opinion and Order Granting ReconsiderationDecision After Reconsideration
References
Case No. ADJ10968178
Regular
May 24, 2019

MIRNA GUERRA vs. KENNERLEY SPRATLING, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior award finding applicant sustained bilateral wrist and hand injury AOE/COE. The WCAB found that neither the applicant's treating physician, Dr. Mirza, nor the defense qualified medical examiner, Dr. Roth, provided substantial medical evidence. Dr. Roth's report failed to address aggravation of any pre-existing condition by the applicant's work duties. Dr. Mirza's reports suffered from inconsistencies, inadequate medical history, and lack of reasoning. Therefore, the WCAB rescinded the award and returned the case to the WCJ for further record development.

AOE/COEPetition for ReconsiderationFindings of FactAward and OrderWCJbilateral wristsbilateral handscumulative traumaprimary treating physicianqualified medical examiner
References
Case No. ADJ8741844
Regular
Jan 14, 2014

CARLOS MIRANDA vs. PACIFIC EXCHANGE, HANOVER INSURANCE GROUP

The Appeals Board rescinded the prior finding of injury to the applicant's back, concluding it was not supported by substantial evidence. The Board found the medical report relied upon by the trial judge was based on an inaccurate and incomplete history provided by the applicant, inconsistent with other statements and undisputed trial evidence. Therefore, the applicant did not sustain an industrial injury to his back, and the case was returned for further proceedings on other alleged body parts.

WCABReconsiderationFindings of FactLabor CodeStatute of LimitationsIndustrial InjuryAOE/COESubstantial EvidenceInaccurate Medical HistoryIncomplete Medical History
References
Case No. ADJ9165986
Regular
Mar 04, 2016

SANTIAGO ZEPEDA vs. C.R. LAURENCE INTERNATIONAL, INC.; CHUBB GROUP OF INSURANCE COMPANIES, Administered By SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied Santiago Zepeda's Petition for Reconsideration. The Board affirmed the finding that Zepeda did not sustain an industrial injury, giving great weight to the WCJ's credibility determination. Zepeda's inconsistent testimony regarding past injuries and the WCJ's finding of his lack of credibility undermined his claim. Furthermore, the primary treating physician's reports were deemed not substantial evidence due to inadequate medical histories.

Workers' Compensation Appeals BoardIndustrial InjuryPetition for ReconsiderationFindings and OrdersWorkers' Compensation Administrative Law JudgeCredibility DeterminationSubstantial EvidencePrimary Treating PhysicianMedical HistoryAdmissible Evidence
References
Case No. ADJ9664450
Regular
Jun 05, 2015

PATRICIA AGUILAR vs. HARRIS RANCH BEEF COMPANY, TRISTAR RISK MANAGEMENT

This case concerns an applicant's petition for removal regarding discovery of her past sexual history in a workers' compensation claim for psychiatric injury due to sexual harassment. The Appeals Board granted removal, finding the applicant's past sexual history is constitutionally protected and that the defendant failed to demonstrate good cause for discovery under Labor Code section 3208.4. The Board limited discovery to medical records relevant to the applicant's psychiatric history, allowing the defendant to refile a petition for further discovery upon a proper showing of good cause after a medical evaluation. This decision aims to balance the applicant's right to privacy with the defendant's need for relevant information concerning causation and apportionment.

Labor Code section 3208.4Petition for RemovalFindings of Fact and OrderDepose applicantSexual harassmentSexual assaultMolestationGood causePrivacyPsyche injury
References
Case No. ADJ252083 (NOR 0166266) ADJ3827633 (LAO 0784953) ADJ3395707 (LAO 0784956) ADJ629194 (LAO 0849490) ADJ2985386 (LAO 0784955) ADJ2625573 (LAO 0784951)
Regular
Apr 12, 2011

CLAUDIA DYER vs. BOEING/McDONNELL DOUGLAS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CHARTIS INSURANCE

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the WCJ's findings of industrial injuries to the applicant's knees, neck, back, shoulders, hips, hands, and ankle across multiple dates. The Board found the WCJ's decision was supported by substantial evidence, specifically Dr. Nelson's well-reasoned medical opinions on causation and apportionment. CIGA's petition was also found deficient for failing to comply with procedural requirements for referencing the record. Finally, CIGA was estopped from asserting the statute of limitations defense due to the employer's knowledge of the injury and failure to provide notice of rights.

CIGAFremont InsuranceliquidationPetition for ReconsiderationJoint Findings and Awardindustrial injuryaircraft mechanickneesneckback
References
Case No. ADJ3288464 (LAO 0772800)
Regular
Mar 27, 2009

NACHUM SAGI vs. OLYMPIC HOLDING CORP., CIGA by its servicing facility BROADSPIRE CLAIMS SERVICES, SUPERIOR NATIONAL INSURANCE COMPANY in liquidation

The Workers' Compensation Appeals Board denied reconsideration of the applicant's petition. The denial was based on the WCJ's report, which found the applicant's testimony and reported medical history inconsistent and not credible. Specifically, the Board found that the Agreed Medical Evaluator's (AME) opinion did not constitute substantial evidence due to the flawed history provided by the applicant. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorSubstantial EvidenceVargas v. Atascadero State HospitalLabor Code section 5313CredibilityConflicting HistoriesMedical FileStipulated Award
References
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