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

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
1
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
17
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
2
Case No. ADJ9822757, ADJ9826854
Regular
May 05, 2017

MIREYA CASILLAS vs. CVS PHARMACY, INC.

The Workers' Compensation Appeals Board denied CVS Pharmacy's Petition for Reconsideration. The Board adopted the WCJ's report, finding that a single physician's opinion can constitute substantial evidence, even if conflicting. This decision upholds the WCJ's findings regarding industrial injuries, including dyspepsia, fibromyalgia, rheumatological arthritis, and psyche, as reported by various medical experts. The Board specifically noted that apportionment issues were not at the forefront of the current "body parts" determination.

WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATION DENIEDSUBSTANTIAL EVIDENCEWCJ REPORTAPPORTIONMENTPSYCHERHEUMATOID ARTHRITISFIBROMYALGIADYSPEPSIAGASTROINTESTINAL
References
1
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
0
Case No. ADJ4648071
Regular
Oct 24, 2013

JOYCE SIMON vs. COUNTY OF ORANGE, YORK RISK

The Workers' Compensation Appeals Board denied Joyce Simon's petition for reconsideration. The Board adopted the Workers' Compensation Judge's report, which found substantial medical evidence supported apportioning 25% of Simon's permanent disability to factors predating the May 20, 2003 injury. This apportionment was based on the opinions of Dr. Danzig, regarding the orthopedic injury, and Dr. Levine, the Panel Qualified Medical Examiner in rheumatology. Simon's additional petitions were also rejected as untimely or successive.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ ReportSupplemental PetitionSuccessive PetitionApportionmentPermanent DisabilityDr. DanzigDr. LevinePanel Qualified Medical Examiner
References
1
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
8
Case No. ADJ865311 (LAO 0880913)
Regular
Sep 19, 2016

MARIA AGUILERA vs. COLLINS CHIROPRACTIC GROUP, STATE COMPENSATION INSURANCE FUND

The Board denied the applicant's petition for reconsideration, affirming its prior decision to reduce her permanent disability from $100\%$ to $88\%$ after apportionment. The Board found the applicant's vocational expert's opinions unsubstantial and contrary to the well-reasoned opinions of the Agreed Medical Evaluators (AMEs). Specifically, the Board rejected Dr. Bluestone's opinion due to a failure to account for duplication in impairment factors between rheumatologic and psychiatric conditions. While one Commissioner dissented, believing the applicant to be $100\%$ permanently disabled based on Dr. Bluestone's findings and other evidence, the majority upheld the apportionment.

Workers' Compensation Appeals BoardOpinion and Order Denying Petition for ReconsiderationFindings and AwardPermanent Total DisabilityApportionmentAgreed Medical Evaluators (AMEs)Dr. BluestoneDr. FreemanDr. MajcherDr. Fedder
References
3
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