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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. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ1315350 (VNO 0557111)
Regular
Apr 20, 2012

LINDA KAMBOW vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, VALLEY STATE PRISON FOR WOMEN, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation claim by an inmate laborer for orthopedic and psychiatric injuries. The Workers' Compensation Appeals Board denied reimbursement to Hepps Pharmacy for medications, as no prescription was provided. The Board also reversed an award to Southern California Mental Health Associates for psychiatric treatment, ruling that inmate psychiatric injuries are not compensable under Labor Code section 3208.3(j). The Board found that the psychiatric injury was a consequence of the industrial orthopedic injury, and thus not a compensable independent non-industrial condition requiring treatment to relieve orthopedic effects.

Workers' Compensation Appeals BoardPsychiatric injuryLabor Code 3208.3(j)Inmate laborerIndustrial orthopedic injuryNon-industrial psychiatric treatmentPrimary treating physicianSubstantial medical evidenceCompromise and Release AgreementLien trial
References
Case No. ADJ1564893 (OAK 0326092)
Regular
Mar 29, 2010

Harold Ott vs. KOHL'S DEPARTMENT STORE, LIBERTY INSURANCE CORPORATION

This case involves Harold Ott's claim for a psychiatric injury following a physical injury at Kohl's Department Store, where he had been employed for less than six months. The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision denying the psychiatric claim. This denial was based on Labor Code section 3208.3(d), which requires at least six months of employment for psychiatric injury claims unless caused by a "sudden and extraordinary employment condition." The WCAB found that while the box falling on the applicant was sudden, it was not extraordinary, citing testimony that boxes falling was not uncommon in the store's operations. Therefore, the psychiatric injury claim was barred.

Labor Code section 3208.3(d)psychiatric injurysudden and extraordinary employment conditionsix-month employment ruleadmitted industrial injuryconsequential psychiatric injurycompensabilityworkers' compensation judgeWorkers' Compensation Appeals Boardreconsideration
References
Case No. ADJ9162432
Regular
Oct 23, 2017

TEODORO LARIOS vs. EASTBAY EQUITIES, INC. dba WENDY'S OLD FASHIONED HAMBURGERS, AMTRUST NORTH AMERICA

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded lien claims for psychiatric treatment. The defendant argues that Labor Code section 3208.3(d) bars these claims due to insufficient employment duration and that the prior WCAB opinion is res judicata. The WCAB granted reconsideration, rescinded the WCJ's decision, and remanded the case for further proceedings. The WCAB clarified that while psychiatric conditions may be claimed as compensable consequence injuries post-January 1, 2013, they do not increase permanent impairment ratings, and the six-month employment requirement under section 3208.3(d) still applies unless the treatment was essential for a physical injury.

Workers' Compensation Appeals BoardLabor Code Section 3208.3(d)Res JudicataMedical Treatment Utilization Schedule (MTUS)Official Medical Fee Schedule (OMFS)Independent Bill ReviewCompensable Consequence InjuryPsychiatric InjuryPermanent ImpairmentLength of Employment
References
Case No. ADJ2012304 (STK 0213737)
Regular
May 27, 2014

HILARIO GONZALES vs. DIRK LIMAS CORPORATION, STATE COMPENSATION INSURANCE FUND

This case involved an applicant seeking reconsideration of a Workers' Compensation Judge's decision that denied his psychiatric injury claim due to insufficient employment duration and labeled his accident as not "sudden and extraordinary." The Appeals Board granted reconsideration, finding the psychiatric injury claim compensable because the applicant's testimony, uncontradicted by the defense, established the accident as a sudden and extraordinary employment condition. The Board also ruled the psychiatric expert's reports admissible and remanded the case for further proceedings on permanent disability and future medical care, particularly concerning cognitive and psychiatric conditions. The issue of apportionment of permanent disability was deferred pending further development of the record.

Labor Code section 3208.3(d)sudden and extraordinary employment conditionpsychiatric injurypermanent disabilityfuture medical carereconsiderationvocational expertApportionmentPQMEAME
References
Case No. AHM 095279
Regular
Jul 10, 2007

PATRICIA L. THOMPSON vs. ACOSTA SALES AND MARKETING, ROYAL & SUN ALLIANCE

The Appeals Board reversed the WCJ's finding that the applicant's psychiatric injury was barred by Labor Code section 3208.3(d), determining it resulted from a "sudden and extraordinary employment condition" (a severe car accident). However, they affirmed the WCJ's award of medical treatment for the psychiatric condition, as it was deemed necessary to cure or relieve the effects of the applicant's orthopedic injuries sustained in the same incident. The Board concluded that psychiatric treatment was reasonably required for the industrial orthopedic injuries, particularly due to a chronic pain disorder.

Workers' Compensation Appeals Boardpsychiatric injuryLabor Code section 3208.3(d)sudden and extraordinary employment conditionorthopedic injuriesAgreed Medical Examiner (AME)post-traumatic stress disorderpain disordersequelaeindustrial basis
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ9543550
Regular
Aug 06, 2018

JESUS CASTELLANOS VALENTE vs. KASO ENTERPRISES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the petition for reconsideration in this case, affirming the Administrative Law Judge's (WCJ) findings. The WCJ found the applicant sustained a cumulative trauma injury, resulting in aggravation of pre-existing diabetes and hypertension and development of a sleep disorder. The Board gave great weight to the WCJ's credibility determination, finding no substantial evidence to reject it. The Board also affirmed that the physical consequences of the cumulative trauma, such as the aggravated medical conditions and sleep disorder, were compensable despite the non-compensability of a separate psychiatric injury claim.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ credibility determinationGarza v. Workmen's Comp. Appeals Bd.specific injurycontinuing traumacumulative injuryorthopedic injurypsychiatric injuryLabor Code section 3208.3(d)
References
Case No. ADJ10275361
Regular
Jan 27, 2020

RUSSELL MCFADDEN (deceased); RENEE MCFADDEN, JAZMINE MCFADDEN, and RUSSELL MCFADDEN, II vs. KEOLIS TRANSIT AMERICA; LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a judge's decision denying a death benefit claim for Russell McFadden, who died by suicide. The applicant contended his death resulted from an industrial psychiatric injury due to occupational stress. Medical evidence indicated that industrial factors were only a 35% cause of the decedent's psychiatric disorder, with significant pre-existing conditions and drug use being the predominant causes. Furthermore, the Board found no evidence that the suicide was an irresistible impulse, distinguishing it from cases where an industrial injury directly causes a mental condition that prevents resistance to suicide. Therefore, the claim was denied based on the psychiatric injury not being predominantly industrially caused and the suicide not meeting the criteria for compensability.

Workers Compensation Appeals BoardRenee McFaddenKeolis Transit AmericaLiberty Mutual Insurance CompanyADJ10275361Opinion and Decision After ReconsiderationIndustrial Psychiatric InjuryOccupational Stress and StrainCompensable Death ClaimLabor Code Section 3600(a)(6)
References
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