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

Case No. ADJ1371205 (VNO 0557310)
Regular
Mar 10, 2011

VICTOR LOPEZ vs. GREYSTONE MANAGEMENT, ZENITH INSURANCE COMPANY

This case concerns a lien claimant, Unicare Diagnostic Center, seeking payment for sleep studies related to an applicant's claimed industrial injuries. The applicant settled their primary claim via Compromise and Release, but Unicare's lien remained unresolved. The trial judge ruled against the lien claimant, finding the insomnia claim non-industrial and the sleep studies medically unnecessary. The Appeals Board affirmed this decision after reconsideration, adopting the trial judge's reasoning.

Compromise and ReleaseLien ClaimantUnicare Diagnostic CenterIndustrial InjuryChestEarNoseHandsWristsHeadaches
References
0
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. ADJ9402316
Regular
Aug 02, 2019

OSCAR SANDOVAL vs. THE STRIP JOINT, INC., STATE COMPENSATION INSURANCE FUND

This case involves applicant Oscar Sandoval seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that denied his claim for injury to his head, jaw/teeth, psyche, and sleep disorder. The WCAB denied reconsideration, affirming the WCJ's finding that the medical reports submitted by applicant's physicians lacked substantial evidence. Specifically, the WCAB found that Dr. Schames' report was based on an inadequate medical history, Dr. Reichwald's report was internally inconsistent and lacked review of sufficient medical records, and Dr. Saeid's report did not sufficiently explain his diagnosis of insomnia.

AOE/COEPetition for ReconsiderationFindings and AwardWCJmedical-legal reportssubstantial evidenceorthopedicpsychologicalinternal medicinecervical spine
References
9
Case No. MISSING
Regular Panel Decision

Niles v. Astrue

Plaintiff Gary A. Niles applied for disability insurance benefits under the Social Security Act, alleging inability to work since November 2004 due to a spinal condition, depression, and anxiety. The Commissioner of Social Security denied his application, a decision which was upheld twice by an Administrative Law Judge (ALJ), with an interim remand by the Appeals Council. Plaintiff commenced this action seeking judicial review of the Commissioner's final decision. The Magistrate Judge identified errors in the ALJ's decision concerning the evaluation of the severity of Plaintiff's impairments (insomnia, sleep apnea, obesity), the determination of whether his impairments met or medically equaled Listing § 1.04A, and the assessment of his Residual Functional Capacity (RFC) regarding prolonged sitting. The Court granted Plaintiff's motion for judgment on the pleadings, denied the Commissioner's motion, and remanded the case for further administrative proceedings to address these deficiencies, particularly regarding the treating physicians' opinions and Plaintiff's credibility concerning sitting limitations.

Social Security DisabilityDisability Benefits ApplicationALJ Decision ReviewAppeals Council RemandResidual Functional CapacitySpinal ConditionDepressionAnxiety DisorderDegenerative ArthritisObesity
References
50
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

Arroyo v. Callahan

Plaintiff Mario Arroyo moved for judgment on the pleadings, challenging the Commissioner of Social Security's decision regarding the onset date of his disability. Arroyo sought Social Security Disability benefits, alleging disability from May 1987, but an Administrative Law Judge (ALJ) had set the onset date as January 17, 1992. The District Court found that the ALJ erred by not applying the correct legal standard, specifically by failing to consider lay and retrospective medical testimony regarding an earlier onset. The court concluded that the record overwhelmingly supported a May 1987 onset date for Arroyo's mental disability. Consequently, Arroyo's motion was granted, and the case was remanded to the Social Security Administration for the calculation and disbursement of benefits from May 1987 to January 17, 1992.

Social Security Disability Insurance (SSDI)Disability Onset DateMental DisabilityRetrospective Medical OpinionAdministrative Law Judge (ALJ) ReviewAppeals CouncilMedical EvidenceLay Witness TestimonyTreating Physician RuleRemand for Benefits Calculation
References
11
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
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