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

Case No. ADJ6527507
Regular
Oct 18, 2010

Wayne Moore vs. EAST BAY MUNICIPAL UTILITY DISTRICT, ATHENS ADMINISTRATORS

The Appeals Board granted reconsideration, finding the WCJ improperly substituted his medical judgment for the Qualified Medical Evaluator's (QME) regarding the applicant's industrial sleep disturbance. The WCJ's finding of no industrial sleep impairment, despite the QME's opinion indicating such, was deemed erroneous. The Board rescinded the original award and remanded the case for a new rating that incorporates the QME's findings on sleep disturbance. Additionally, the WCJ must correct an identified occupational group number error in future rating calculations.

Workers' Compensation Appeals BoardWayne MooreEast Bay Municipal Utility DistrictAthens Administratorsmachinist maintenance workermachinistmachinist maintenancepermanent disabilityapportionmentQualified Medical Evaluator
References
0
Case No. ADJ7037201
Regular
Apr 22, 2013

Eddie Avakian vs. CITY OF BALDWIN PARK, ADMINSURE

This case involves an applicant police officer seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that awarded 72% permanent partial disability. The applicant contended the WCJ erred by excluding sleep disturbances and sexual dysfunction from the disability rating and by apportioning his cardiovascular disability. The WCAB granted reconsideration, rescinded the original award, and found the applicant's sexual dysfunction and sleep disorder compensable. The matter was returned to the trial level for a new decision, with the WCAB stating it would not disturb other findings, including the hypertension apportionment.

Workers' Compensation Appeals BoardEddie AvakianCity of Baldwin ParkPermissibly Self-InsuredAdministered By ADMINSUREADJ7037201Opinion and Order Granting ReconsiderationDecision After ReconsiderationFindings and Award and OrderAdministrative Law Judge
References
0
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The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior award finding applicant suffered a 23% permanent disability, including 12% for sleep disturbance.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. 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. ADJ1997686 (MON 0358806)
Regular
May 24, 2011

JAVIER GUTIERREZ vs. COOPER INDUSTRIES, INC., ACE AMERICAN INSURANCE COMPANY

The Appeals Board reversed the WCJ's award of 16% permanent disability for a neck injury. Dr. Brickman's report, which supported the award, was deemed unsubstantial as it relied on an incorrect medical history and erroneous legal theory regarding the cause of the applicant's sleep disturbance. The Board found that the applicant's sleep issues stemmed from a non-compensable psychological condition, not neck pain. Consequently, the Board adopted the opinion of PQME Dr. Portnoff, who concluded the applicant sustained a cervical strain with no resulting permanent disability.

Workers' Compensation Appeals BoardEAMS processing delayFindings and Awardindustrial injuryneck injuryassemblertemporary disabilitypermanent disabilityself-procured careAMA Guides
References
3
Case No. ADJ3896064 (SAL 0121108)
Regular
Aug 08, 2012

BRUCE AYERS vs. GRANITE ROCK COMPANY, ZURICH AMERICAN INSURANCE COMPANY

This Workers' Compensation Appeals Board order denies reconsideration of a prior award finding permanent and total disability. The applicant's treating physician and vocational experts opined that the applicant's multiple impairments, including chronic pain, medication side effects, and sleep disturbances, render him unemployable. The Board found the defendant failed to present a fair and complete picture of the medical evidence regarding the applicant's employability, specifically omitting key portions of the physician's opinion. The Board also noted the defendant's attempt to reopen discovery regarding sleep medication was without merit, as the applicant's testimony was credible and the existing evidence supported his ongoing disability.

Workers' Compensation Appeals BoardGranite Rock CompanyZurich American Insurance CompanyPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeSleep StudySleep MedicationEarning CapacitySuitable and Gainful EmploymentVocational Experts
References
1
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. ADJ8699740
Regular
Jan 09, 2015

Francisco Herrera vs. West-Tech Mechanical, Inc., Star Insurance Company

The Workers' Compensation Appeals Board granted reconsideration and amended a prior decision concerning Francisco Herrera's workers' compensation claim against West-Tech Mechanical, Inc. The Board affirmed the finding that Herrera sustained an injury to his neck, back, shoulders, and sleep disturbance arising from his employment. However, the Board clarified that Herrera's claim for injury to the psyche is barred by Labor Code section 3208.3(d).

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationAdministrative Law JudgeOpinion and OrderDecision After ReconsiderationInjury to neckInjury to backInjury to shouldersSleep disturbanceCourse of employment
References
0
Case No. ADJ8996451
Regular
Mar 25, 2016

ROGELIO VELASQUEZ vs. MOLOFSKY BUILDERS, INC., EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration, upholding the Workers' Compensation Judge's decision. The Judge correctly excluded permanent disability for sleep disturbance as the QME failed to provide an apportionment opinion as required by statute. Furthermore, the Judge properly rejected the QME's *Almaraz/Guzman* rating for the left knee injury, finding it unpersuasive and lacking in specific ADL deficits. Therefore, the Judge's original findings on permanent disability were affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportEpworth Scalesleep disturbancepermanent disabilityQualified Medical Evaluator (QME)apportionmentleft knee injuryAlmaraz/Guzman
References
0
Case No. ADJ3135090 (SAC 0355157) ADJ6834808
Regular
Sep 12, 2019

GUY LEE vs. UOP/MCGEORGE SCHOOL OF LAW, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Workers' Compensation Appeals Board affirmed the WCJ's decision denying benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF). Applicant's prior stipulation dismissing claims for sleep disturbance, sexual dysfunction, and psychiatric injury bound him from pursuing these for SIBTF benefits. Even without those dismissals, applicant's permanent disability rating for the subsequent injury, after adjustments, did not meet the 35% threshold required for SIBTF eligibility. The WCJ's finding that the industrial injury was not the predominant cause of the claimed psychiatric injury also contributed to the denial.

Subsequent Injuries Benefits Trust FundLabor Code section 4751permanent partial disabilitystipulated dismissalpredominant causepsychiatric injurybilateral carpal tunneldiminished future earning capacityWCJWorkers' Compensation Appeals Board
References
4
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