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

Case No. ADJ9683216
Regular
Sep 30, 2016

DUNIA DE LA CRUZ vs. SOOD ENTERPRISES, INC. dba JACK IN THE BOX, SECURITY NATIONAL INSURANCE COMPANY ADMINISTERED BY AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) denied defendant's petition for reconsideration and dismissed its petition for removal. The WCAB found that an additional Qualified Medical Examiner (QME) panel in rheumatology was appropriate to further develop the medical record on causation, as recommended by the initial orthopedic QME. Defendant argued the WCJ erred by ordering this without first determining applicant's credibility and AOE/COE, but the Board deemed the need for a rheumatological evaluation a critical issue justifying reconsideration. Therefore, the WCAB upheld the WCJ's order for an additional QME panel.

QME panelrheumatologyAOE/COEcredibilitymedical causationdepositionsupplemental evaluationgood causethreshold issuesreconsideration
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ8491619 ADJ9586677
Regular
May 17, 2019

Edward GAA vs. Intercare Holdings Insurance, The Hartford

The Workers' Compensation Appeals Board granted applicant's petition for removal, overturning a prior order that denied a rheumatological evaluation. While dismissing the petition for reconsideration, the Board found good cause for an additional QME panel in rheumatology, acknowledging the orthopedic QME's limited expertise in this specialty. The applicant must still attend a re-evaluation with the orthopedic QME, who must review a job analysis.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Rheumatological evaluationOrthopedic QMECumulative traumaIndustrial injuryMedical-legal issuesBias
References
Case No. ADJ1 0127152
Regular
Jun 26, 2017

ROBERT CARLOS vs. GENESIS LOGISTICS INC., NEW HAMPSHIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied applicant Robert Carlos's Petition for Removal. Carlos sought to rescind an order that took his case off calendar pending a supplemental report from an orthopedic QME and requested a rheumatology QME panel or a hearing. The WCAB adopted the Workers' Compensation Judge's report, finding that Carlos failed to demonstrate substantial prejudice or irreparable harm required for removal. Consequently, the WCAB affirmed the order and denied the petition.

WORKERS' COMPENSATION APPEALS BOARDPetition for RemovalWCJQualified Medical EvaluatorQME panelorthopedicrheumatologytaken off calendarsupplemental reportdiscretionary power
References
Case No. ADJ2580958 (MON 0351589)
Regular
Feb 16, 2016

ESTRELLA LOPEZ vs. OUTRIGGER LOGGING SERVICES, dba THE CRACIELA BURBANK, WAUSAU INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of an award of 100% permanent total disability. The Board found that the medical opinions supporting the award were not substantial evidence because they failed to consider the latest orthopedic report which identified some complaints as non-industrial. Furthermore, the vocational expert's report was deficient as it relied on inadmissible rheumatology reports and did not account for the orthopedic findings. Consequently, the award was rescinded, and the case was returned to the trial level for further proceedings to develop the record.

Workers Compensation Appeals BoardPetition for ReconsiderationDecision After ReconsiderationFindings and AwardPetition to ReopenNew and Further DisabilityPermanent Total DisabilityIndustrial InjuryPsycheBack
References
Case No. ADJ10633327
Regular
Jul 31, 2019

JUANITA PONCE DE LEON vs. SOUTHERN CALIFORNIA EDISON

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior Findings and Orders. The Board found that the applicant's physician's report was improperly excluded as evidence, as it did not rebut a prior QME's opinion but addressed a separate, unaddressed medical condition. Consequently, the Board overruled the objection to this report and the primary treating physician's subsequent report adopting its findings. The Board also found good cause for an additional Qualified Medical Evaluator panel in rheumatology to address the applicant's disputed fibromyalgia claim.

AOE/COEfibromyalgiaQME panelrheumatologyDr. SalickDr. AunadmissibilityLabor Codemedical evaluationreconsideration
References
Case No. ADJ6859121
Regular
Mar 24, 2016

ALVARO GIRON vs. ARI THANE FOAM PRODUCTS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) denied the applicant's Petition for Removal. Removal is an extraordinary remedy granted only upon a showing of substantial prejudice or irreparable harm. The WCAB found that the applicant failed to demonstrate such prejudice, particularly concerning a dispute over Dr. Laqui's deposition fees. The WCAB adopted the WCJ's report, which concluded that reconsideration would be an adequate remedy if necessary. Therefore, the petition for removal was denied.

Petition for RemovalWorkers' Compensation Appeals BoardQualified Medical EvaluatorQME panelinternal medicinerheumatologydepositionrecord reviewfee schedulesubstantial prejudice
References
Case No. ADJ3316075 (VNO 0426272)
Regular
May 20, 2011

CHRISTINE COLFER AUCHTERLONIE vs. RALPHS GROCERY COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address an applicant's 100% permanent disability award for cumulative trauma, including fibromyalgia. The defendant, Ralphs Grocery Company, argued for apportionment to a prior 44% permanent disability award, citing Dr. Silverman's conflicting medical reports on apportionment for fibromyalgia. The Board found Dr. Silverman's reasoning on apportionment unclear and contradictory between his 2000 and 2010 reports. Therefore, the case was returned to the trial level for further clarification on Dr. Silverman's apportionment opinions regarding the fibromyalgia disability.

ApportionmentCumulative TraumaFibromyalgiaPermanent DisabilityReconsiderationAgreed Medical ExaminerWCJLabor Code section 4664Labor Code section 4663Findings and Award
References
Case No. ADJ1920721
Regular
May 28, 2009

LINDA MCDONALD vs. COMMUNITY MEMORIAL HOSPITAL, MAJESTIC SAN DIEGO, TRAVELERS DIAMOND BAR

This case involves a petition for reconsideration of a Workers' Compensation Appeals Board decision awarding permanent total disability to the applicant. The defendant argued that the disability should be apportioned and the indemnity rate incorrectly calculated. The Board denied reconsideration, upholding the administrative law judge's findings based on the weight of medical evidence, particularly from an Agreed Medical Examiner, who concluded the applicant's fibromyalgia, arising from industrial orthopedic injuries, caused 100% permanent disability. The Board also affirmed the indemnity rate calculation, finding the evidence, including EDD records, properly supported the determination despite the defendant's objections.

FibromyalgiaAffective Spectrum DisorderCumulative TraumaPermanent and Total DisabilityApportionmentAgreed Medical ExaminerMedical EvidencePsychiatric InjuryOrthopedic InjuryRheumatology
References
Case No. ADJ237483
Regular
Nov 13, 2012

RAYEK J. FAHOUM vs. KAISER FOUNDATION HOSPITAL

The Workers' Compensation Appeals Board denied Rayek J. Fahoum's petition for reconsideration, upholding the findings of the Workers' Compensation Judge. The Judge's report found Fahoum sustained industrial injury to his neck and low back with secondary chronic pain syndrome, awarding 41% permanent disability. This decision relied on the opinions of the Agreed Medical Examiner and Dr. Renee Rinaldi, who concluded Fahoum experienced symptom magnification and that his condition was chronic pain syndrome, not fibromyalgia as claimed by Dr. Allen Salick. The Board extended great weight to the Judge's credibility findings regarding the medical opinions.

Workers' Compensation Appeals BoardReconsideration DeniedAgreed Medical ExaminerSubstantial Medical EvidenceFibromyalgiaChronic Pain SyndromeSymptom MagnificationOrthopedic InjuryLumbosacral StrainCervical Strain
References
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