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

Case No. 2020-02-0173
Regular Panel Decision
Mar 18, 2021

Ramey, Joshua v. Sleep Zone, Inc.

Mr. Ramey requested additional workers' compensation benefits from Sleep Zone, Inc., for injuries sustained from a fall while carrying a mattress. Sleep Zone denied the claim based on surveillance video and the authorized treating physician, Dr. Jody Helms, who determined Mr. Ramey’s complaints were not causally related to the fall. Mr. Ramey’s credibility was questioned, especially his argument that the surveillance video depicted his twin brother. The Court found no medical proof supporting his claim and denied his requests for medical and temporary disability benefits, concluding he was unlikely to prevail on the merits.

CredibilitySurveillance VideoMedical CausationTemporary Disability BenefitsExpedited HearingAuthorized Treating PhysicianMaximum Medical ImprovementInjury ClaimMedical Treatment ComplianceFraud Allegations
References
2
Case No. ADJ2000734
Regular
Apr 14, 2011

ESTELA OREGON (Deceased), ARMANDO SOTELO, et al vs. ENGLANDER TUALATIN SLEEP PRODUCTS, INC., & COMMERCE & INDUSTRY/AIG CLAIM SERVICE

The Workers' Compensation Appeals Board denied reconsideration of a prior decision in the case of Estela Oregon (Deceased) v. Englander Tualatin Sleep Products, Inc. The Board adopted the reasoning of the workers' compensation administrative law judge. Additionally, the petitioner was admonished for submitting new documents not presented at trial.

Petition for ReconsiderationWCJ ReportDeny ReconsiderationNew DocumentsNot Introduced in EvidenceTrialWorkers' Compensation Appeals BoardDeceased ApplicantDefendant InsurerAdministrative Law Judge
References
0
Case No. ADJ8136512 ADJ8136526
Regular
Apr 30, 2019

SOLANGE TUCKER vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS and REHABILITATION, PAROLE and COMMUNITY SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of a prior award. The original award found applicant sustained industrial injuries to her shoulder, knees, psyche, hypertension, headaches, and a sleep disorder, resulting in 73% permanent partial disability. The defendant argued against the findings regarding the sleep disorder, temporary disability, and the overall PD rating. The Board affirmed the WCJ's findings, finding substantial evidence supported the award for sleep disorder and temporary disability, and that the psychiatric impairment did not subsume the sleep disorder impairment.

Workers' Compensation Appeals BoardJoint Findings and AwardPetition for ReconsiderationIndustrial InjuryRight ShoulderRight KneeLeft KneePsycheHypertensionSleep Arousal Disorder
References
7
Case No. ADJ7295285
Regular
Dec 05, 2012

CARL SIRL vs. VSJ, INC., ENDURANCE INSURANCE COMPANY, FIRSTCOMP INSURANCE AGENCY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award finding applicant suffered a 23% permanent disability, including 12% for sleep disturbance. The PQME's reliance on the Epworth Sleepiness Scale for the sleep impairment rating was deemed insufficient without further explanation, particularly regarding the absence of formal sleep studies. The WCAB remanded the case to the trial level for further development of the medical record concerning the sleep disorder and its impairment rating. Defendants were directed to continue paying uncontested permanent disability indemnity for the applicant's back injury.

Workers' Compensation Appeals BoardPermanent DisabilitySleep DisturbanceEpworth Sleepiness ScalePQMEAMA GuidesWhole Person ImpairmentActivities of Daily LivingDue ProcessMedical Record Development
References
4
Case No. ADJ8782360
Regular
Jun 01, 2018

Eldridge Taylor vs. California Department of Corrections and Rehabilitation, STATE COMPENSATION INSURANCE FUND

The California Workers' Compensation Appeals Board denied a petition for reconsideration, affirming a prior award to Eldridge Taylor. The award included permanent disability for cumulative trauma injuries, sleep disorder, and hearing loss. The employer argued the sleep disorder rating was subsumed by orthopedic pain, the hearing loss lacked substantial evidence, and the WCJ failed to properly apportion non-industrial factors. The Board adopted the WCJ's report, finding sufficient medical evidence for the sleep disorder and hearing loss. The dissenting opinion argued the sleep disorder award should be rescinded as it stemmed solely from industrial pain already rated.

Workers' Compensation Appeals BoardEldridge TaylorCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8782360Cumulative TraumaCorrectional OfficerParole OfficerSleep Disorder
References
1
Case No. MISSING
Regular Panel Decision

Dement v. Kelly

Petitioner William Dement, a former NYPD lieutenant and 9/11 first responder, challenged the denial of his World Trade Center (WTC) line-of-duty accident disability retirement (ADR) pension. Dement developed multiple conditions, including severe sleep apnea and gastroesophageal reflux disease (GERD), after his WTC exposure. The Medical Board repeatedly denied his WTC-ADR application, attributing his disability solely to sleep apnea unrelated to WTC exposure, despite evidence linking GERD and heavy metal poisoning (recognized WTC conditions) to his sleep apnea and overall disability. The Supreme Court upheld the denial. However, the appellate court reversed this decision, finding that the respondents failed to rebut the WTC presumption of causation. The court determined that Dement's disabling sleep apnea was attributable to WTC exposure and exacerbated by his WTC-related GERD, as supported by medical literature. The case was remanded for an award of a WTC-ADR pension, emphasizing the legislative intent to protect 9/11 workers.

WTC Disability RetirementFirst Responder HealthCausation StandardPresumptive EvidenceMedical Board ReviewSleep Apnea DisabilityGastroesophageal Reflux Disease (GERD)Heavy Metal ToxicityPolice Pension BenefitsArticle 78 Proceeding
References
12
Case No. ADJ6550105; ADJ6777358 ADJ6777361; ADJ6976802
Regular
Jun 24, 2014

ESTHER GARCIA vs. ANTELOPE VALLEY UNION HIGH SCHOOL DISTRICT, YORK INSURANCE SERVICES GROUP

This case involves an applicant with multiple workers' compensation claims. At a mandatory settlement conference, the judge ordered a sleep study, which the defendant challenged. The Appeals Board granted the defendant's petition for removal, finding the order for the sleep study premature. The Board rescinded the sleep study order, stating that such an order cannot be made before the case is tried or submitted, and before it's established that specific medical opinions are deficient.

Petition for RemovalDecision After RemovalMandatory Settlement ConferenceSleep StudyDiscovery OrderMedical Record AugmentationPanel Qualified Medical EvaluatorThreshold MatterDevelop the RecordAdmission of Evidence
References
0
Case No. ADJ6772869
Regular
Jan 17, 2012

Michelle Jones vs. CITY OF LONG BEACH

This case involves a worker seeking compensation for a sleep disorder in addition to her admitted industrial shoulder injury. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award. The Board found that the applicant's hypersomnia was not a separate ratable sleep disorder, but rather a consequence of pain from her industrial shoulder injury. Therefore, the case was returned for a new permanent disability rating that excludes the sleep disorder.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjurySleep DisorderPermanent DisabilityRight ShoulderHypersomniaAMA GuidesPain Questionnaire
References
1
Case No. MON 0340665
Regular
Jul 02, 2008

DANIEL EARL PETERSON vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, legally uninsured and adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to further develop the record, specifically ordering a formal sleep study. This action rescinded the previous award because the medical evidence presented regarding the applicant's sleep disturbance was deemed unsubstantial, lacking a formal sleep laboratory diagnosis as required by AMA Guides. The Board also noted potential correct contentions by the defendant regarding indemnity rates and overlapping temporary and permanent disability payments.

Workers' Compensation Appeals BoardAgreed Medical EvaluatorAMESleep StudyPermanent DisabilityFindings and AwardReconsiderationSubstantial Medical EvidenceEpworth Sleepiness ScaleAMA Guides
References
0
Case No. ADJ7683112
Regular
May 16, 2016

EUFEMIA TELLEZ vs. PEREZ CONTRACTING, EVEREST NATIONAL INSURANCE COMPANY

The Appeals Board granted the applicant's petition for reconsideration, reversing the judge's exclusion of a medical report and remanding issues of hypertension and sleep disorder for further development of the record. While the judge correctly excluded the late-filed medical report, substantial medical evidence was lacking regarding the industrial causation of the applicant's hypertension and sleep disorder. The Board affirmed the judge's findings on other accepted injuries and permanent disability but deferred issues related to hypertension and sleep disorder, returning the case for further proceedings on those specific conditions.

AOE/COEPetition for ReconsiderationFindings Award and Orderssubstantial medical evidenceinadmissible evidencedevelopment of the recordPQMEhypertensionsleep disorderdiabetes
References
0
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