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

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
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. ADJ9625407
Regular
Sep 12, 2018

KEITH FIELD vs. CITY OF PINOLE

This case involves a firefighter who sustained bilateral carpal tunnel syndrome after retirement. The Appeals Board reversed the trial judge, holding that Labor Code section 4458.5 applies, entitling the applicant to permanent disability benefits calculated at the maximum indemnity rate. This applies regardless of the applicant's actual earnings or the fact that carpal tunnel syndrome is not a specifically enumerated presumptive injury. The case is remanded for determination of the precise date of injury to calculate the benefit rate.

Workers' Compensation Appeals BoardKeith FieldCity of PinolePermissibly Self-InsuredMunicipal Pooling AuthorityADJ9625407Opinion and Decision After Reconsiderationindustrial injuryfirefighterbilateral upper extremities
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ4503675 (MON 0306061)
Regular
Apr 18, 2011

ARTHUR WILSON vs. CAPISTRANO UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured, Administered By CORVEL CORPORATION

The Workers' Compensation Appeals Board granted reconsideration to rescind an award for dental treatment. The Board found the administrative law judge erred by admitting and relying on the reports of Dr. Esagoff, a non-treating dentist, as they were not obtained in compliance with relevant Labor Code sections regarding medical-legal procedures and treating physician reports. The case is returned to the trial level for applicant to obtain a proper report from a designated treating physician, with Dr. Esagoff's reports to be stricken. Issues of industrial causation for dental treatment must follow former Labor Code section 4062 procedures.

Workers' Compensation Appeals BoardCapistrano Unified School DistrictCORVEL CORPORATIONInjury to teethCompensable consequenceAdmitted industrial injuryRight kneeCustodianDr. Jacob EsagoffD.D.S.
References
Case No. ADJ5738297
Regular
Apr 13, 2011

Douglas Riedo vs. REGENTS OF UNIVERSITY OF CALIFORNIA, UCSB & SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal and rescinded an order compelling attendance at a medical evaluation. The WCAB found that the employer failed to comply with Administrative Director Rule 32(d) regarding the selection of a consulting physician and rejected the employer's reliance on Labor Code section 4064(d). The Board clarified that parties cannot obtain multiple evaluations on the same issue until they receive a favorable opinion, a practice known as "doctor shopping."

Petition for RemovalRescind OrderLabor Code section 4050Labor Code section 4060Labor Code section 4062Labor Code section 4062.2compensable consequence injuriesorthopedic qualified medical evaluator (QME)Administrative Director Rule 32(d)Labor Code section 4064(d)
References
Case No. ADJ3834810 (SRO 0121550)
Regular
Sep 03, 2009

MICHAEL RISCH vs. AT HOME NURSING, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's finding of 100% permanent disability for the applicant. The Board found substantial evidence supported the total permanent disability rating and the applicant's average weekly earnings. The 1997 Permanent Disability Rating Schedule was correctly applied due to pre-January 1, 2005 medical reporting indicating permanent disability. The Board also affirmed the WCJ's rejection of apportionment to pre-existing conditions, as the applicant had fully recovered and returned to strenuous work.

Workers' Compensation Appeals BoardMichael RischAt Home NursingState Compensation Insurance FundADJ3834810Opinion and Order Denying Petition for ReconsiderationFindings and Awardadministrative law judgecumulative traumaindustrial injury
References
Case No. ADJ6413657
Regular
Feb 26, 2009

LUIS PENA vs. CITY OF SANTA ROSA

The City of Santa Rosa sought reconsideration of a Stipulated Award that adjusted permanent disability payments under Labor Code section 4658(d) starting March 25, 2008. The Board denied the petition, finding the employer's argument that the 15% reduction applied retroactively to all payments was erroneous. The employer failed to comply with statutory requirements for providing notice of permanent disability status and commencing timely payments after temporary disability ended. Consequently, the employer is not entitled to the benefit of the Labor Code section 4658(d) reduction due to its own statutory non-compliance.

Workers' Compensation Appeals BoardStipulated AwardPermanent Disability IndemnityLabor Code section 4658(d)Police OfficerIndustrial InjuryLow BackPermanent and StationaryOffer of Regular WorkLabor Code section 4061
References
Case No. ADJ1481761 (SAC 0364589)
Regular
Oct 03, 2011

WANDA BOULT vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS; STATE COMPENSATION INSURANCE FUND

This case involves a correctional officer, Wanda Boult, seeking workers' compensation benefits for a cumulative trauma injury to her heart and cardiovascular system. The defendant, State of California, Department of Corrections, sought reconsideration of the finding that Ms. Boult is 100% permanently totally disabled. The Workers' Compensation Appeals Board denied reconsideration, adopting the judge's report. The court found that the defendant's argument regarding Labor Code section 4658(d)(3)(A) was inapplicable because the applicant's award was based on lifetime temporary disability indemnity, not the formula in section 4658(d)(1).

Workers' Compensation Appeals BoardPermanent DisabilityLabor Code section 4658(d)Labor Code section 4659(b)Labor Code section 4662Correctional Counselor II SpecialistCumulative traumaHeart and Cardiovascular systemPrimary pulmonary hypertensionChronic supraventricular arrhythmias
References
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
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