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

Case No. ADJ1230451 (LAO 0812240)
Regular
Nov 12, 2008

SUSANA RAMIREZ (OCHOA) vs. WATCH L.A., EVEREST NATIONAL INSURANCE COMPANY

The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings. The Board found that the applicant's psychological injury is compensable, contrary to the prior award which only recognized a low back injury. Further proceedings will allow for development of the record regarding both the psychological injury and the applicant's claim for additional temporary disability benefits stemming from it.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryTemporary DisabilityPermanent DisabilityCompensable Psychological InjuryTreating PsychologistPermanent and Stationary DateBladder Urinary Complaint
References
Case No. ADJ3907382 (AHM 0133851)
Regular
Aug 28, 2009

Mayekal andREW WAGNER vs. WALMART, AVIZENT BENTONVILLE

The Workers' Compensation Appeals Board dismissed the lien claimant's petition for reconsideration because it was not verified as required by law. The applicant's own petition, initially filed as a complaint against the judge, was also denied due to its lack of specificity regarding grounds and supporting evidence. The Board noted the applicant may have intended to file a judicial ethics complaint instead. Therefore, both petitions were ultimately rejected, upholding the original June 12, 2009 Findings, Award, and Orders.

Lien claimantPetition for reconsiderationVerified petitionLabor Code section 5902Judicial ethics complaintComplaint About a Workers' Compensation Administrative Law JudgeWCJFindings Award and OrdersUnlawful or unjustMaterial evidence
References
Case No. ADJ10800397
Regular
May 20, 2019

MARILYN RAMIREZ GALVEZ vs. NIAGARA BOTTLING LLC, SAFETY NATIONAL INSURANCE CO.

The applicant sought a QME panel in psychology for a claimed psychiatric injury after orthopedic and internal medicine evaluations. The WCJ denied the request, finding no substantial medical evidence for a psychological QME. The Appeals Board granted removal, rescinded the WCJ's order, and found good cause for a psychological QME panel. This decision allows the applicant to pursue necessary medical-legal discovery regarding her disputed psychological injury claim.

Petition for RemovalFindings and OrderQualified Medical EvaluatorQME panelpsychologypsychiatric injurydiscoveryinternal medicineorthopedic QMEhypertension
References
Case No. ADJ8845443; ADJ8845444
Regular
May 26, 2015

SHUN LIAO vs. MACY'S WEST STORES, INC.

The Appeals Board granted Macy's Petition for Removal due to a lack of proper record and evidence. The prior Workers' Compensation Judge's orders regarding psychological treatment and temporary disability were rescinded. The case is returned to the trial level for proper documentation of issues, stipulations, and admitted evidence. The Board expressed no opinion on the merits of the disputed claims.

Petition for RemovalDecision After RemovalWCJpsychological complaintsorthopedic injurycausationpsychiatric injurysubstantial evidencecompensabilityApplication for Adjudication of Claim
References
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. 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. ADJ13030119
Regular
Apr 28, 2023

MARIA YESENIA JARAMILLO JIMENEZ vs. EL POLLO LOCO, TECHNOLOGY INSURANCE administered by AMTRUST

Lien claimant Nogales Psychological Counseling appealed an administrative law judge's decision disallowing its lien for services. The Workers' Compensation Appeals Board granted reconsideration to further review the matter. Subsequently, the parties entered into a stipulation, agreeing to settle the lien claim for $6,500.00. The Board rescinded the original decision and approved the stipulation as the final resolution of the dispute.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings of Fact and OrderWCJDisallowed LienStipulationSettlementRescindedApproved
References
Case No. ADJ9368263, ADJ9380293
Regular
Sep 15, 2015

JOSE MELCHOR vs. BRUTOCAO VINEYARDS, STAR INSURANCE COMPANY

This case involves a defendant's petition for removal regarding an order for a second Qualified Medical Examiner (QME) panel concerning the applicant's head injury. The Workers' Compensation Appeals Board (WCAB) granted removal to correct a clerical error in the original order. The WCAB affirmed the necessity of a second QME to further develop the medical record on the head injury claim, specifically in the specialty of Psychology-Clinical Neuro Psychology.

Petition for RemovalSecond QME PanelHead InjuryMedical Record DevelopmentWCJ Duty to Develop RecordPQME SpecialtyPSNPsychology-Clinical Neuro PsychologyMandatory Settlement ConferenceLack of Diligence
References
Case No. ADJ7197363
Regular
Feb 11, 2014

NARCISO NOVA vs. JC SALES, dba SHIMS BARGAIN, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a lien claimant, California Psychological Associates, seeking reconsideration for disallowed costs of psychological treatment for applicant Narciso Nova. The Workers' Compensation Appeals Board denied the petition, adopting the Administrative Law Judge's report. The judge found no evidence of an injury to the psyche or that the psychological treatment was medically necessary for the admitted cervical spine injury. Furthermore, the psychological reports were not incorporated into any primary treating physician reports, and treatment began nearly two years after the applicant reached maximum medical improvement.

WCABPetition for ReconsiderationPsychological treatmentMedical necessityPrimary treating physicianMaximum medical improvementLien claimantStipulations with Request for AwardPermanent disabilityReferral
References
Case No. ADJ2972614 (VNO 0551694) ADJ3199572 (VNO 0558860)
Regular
Jan 31, 2012

ALI POURFARZAD vs. PALMIRA ASSOCIATES, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

This case involves an applicant claiming industrial injuries to his spine, psychological system, and central nervous system (sleep disorder) from two separate dates of employment. The administrative law judge initially found injury to the psychological and central nervous systems but required further development of the record for permanent disability and apportionment. The Appeals Board determined that neither party presented substantial evidence regarding the causation and permanency of the claimed psychological and central nervous system injuries. Consequently, these issues are deferred, and the record will be developed further, potentially through an Agreed Medical Evaluator or a court-appointed physician.

Petition for ReconsiderationPartial Joint Findings of FactPanel Qualified Medical Evaluator (QME)Substantial EvidenceDevelop the RecordAgreed Medical Evaluator (AME)Regular PhysicianLabor Code Section 5701CausationPsychological Injury
References
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