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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.
Reconsideration granted to address errors in permanent disability rating and apportionment. Matter returned for new rating considering walker use and clarifying apportionment.
In this workers' compensation case, the Applicant sustained an admitted industrial injury to the lumbar spine. The Applicant's primary treating physician (PTP) designated a secondary physician to evaluate permanent and stationary status and impairment, whose report the PTP adopted. The defense challenged the validity of this secondary physician's report, arguing only the Panel Qualified Medical Examiner's (PQME) report was properly obtained. The Workers' Compensation Appeals Board denied the Petition for Reconsideration, affirming that the PTP, or a physician designated by the PTP, is authorized to render opinions on medical issues, provided proper notice and procedural requirements are met. The Board found the designation and subsequent report were compliant with Labor Code and Administrative Director Regulations.
The applicant sought reconsideration of a denied authorization for Synvisc knee injections. The original Independent Medical Review (IMR) denied the request, finding no documentation of the applicant's osteoarthritis failing to respond to conservative treatment. The Appeals Board found this IMR determination was based on a plainly erroneous finding of fact, as medical records in the file directly contradicted this assertion. Therefore, the Board granted the applicant's appeal, rescinded the WCJ's decision, and remanded the case for a new IMR.
Applicant sought reconsideration of a $23\%$ permanent disability award, arguing the $40\%$ apportionment to non-industrial factors lacked substantial medical evidence. The Workers' Compensation Appeals Board denied reconsideration, adopting the trial judge's report. The Board found the Qualified Medical Evaluator's apportionment was based on substantial medical evidence, including applicant's pre-existing osteoarthritis and a prior knee replacement, which explained the causation for the permanent disability. The Board also confirmed timely action on the petition within the statutory 60-day period.
The Workers' Compensation Appeals Board granted reconsideration to further study the factual and legal issues. While the WCJ found an industrial aggravation of the applicant's arthritis due to cumulative trauma, there was insufficient evidence to determine which specific body parts were injured. The Board rescinded the initial Findings and Order, remanding the case to the trial level for further proceedings to develop the medical record and clarify the extent of the industrial injury. The existing medical opinions were deemed deficient, necessitating further investigation.
The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration regarding permanent disability and apportionment. While the applicant sustained an industrial injury, the Board found that the defendant presented sufficient secondary evidence to establish a prior 11.5% permanent disability award for a right hand injury. The case was remanded for further proceedings to allow for proper apportionment of the current permanent disability based on the prior award.
The Appeals Board rescinded the original award due to an insufficient apportionment of permanent disability. The Board found that the QME's opinion, which attributed 75% of the applicant's left knee disability to pre-existing osteoarthritis, lacked adequate reasoning and was not substantial evidence. Therefore, the case was returned for further development of the record regarding apportionment, specifically concerning the QME's rationale. The Board clarified that while the applicant sustained an admitted injury to her left knee, the extent of permanent disability and its causation require further medical evaluation.
The Appeals Board affirmed the WCJ's decision, finding applicant reached permanent and stationary status on October 3, 2008, based on Agreed Medical Evaluator (AME) Dr. Chun's substantial evidence. The Board also upheld the 90% apportionment of permanent disability to applicant's pre-existing degenerative osteoarthritis, finding Dr. Chun's opinion supported by Dr. Rimoldi's report. The applicant's arguments regarding the P&S date and apportionment were rejected as misplaced or not supported by substantial evidence.
Reconsideration granted, rescinding the July 7, 2008 Order Approving Compromise and Release due to potential Medicare Secondary Payer issues. Case returned for further proceedings.
The Workers' Compensation Appeals Board rescinded the prior award and returned the case for further proceedings because the administrative law judge improperly relied on a secondary treating physician's report. The judge failed to establish that the requested attendant care was authorized or constituted substantial medical evidence. The Board emphasized that the primary treating physician must issue opinions on medical issues and the record needs further development to determine entitlement to attendant care.
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