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

Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
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. BAK 0141141
Regular
Mar 07, 2008

Briant Certuche vs. TRANS-SYSTEMS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded the previous decision, finding insufficient consideration of whether the applicant's Valley Fever infection was industrially caused or solely due to living in the San Joaquin Valley. The case is returned to the trial level for further development of the medical record, specifically to address the relative likelihood of environmental versus occupational exposure. This decision acknowledges that employment need only be a contributory cause for injury compensability.

Workers' Compensation Appeals Boardindustrial injuryValley Fevercoccidiomycosisproximate causeoccupational exposuregeographic endemicmedical-legal expertsubstantial evidencecontributing cause
References
Case No. ADJ7730915
Regular
Sep 18, 2015

TODD PALOMBO vs. CITY OF COSTA MESA

This case involves a firefighter claiming industrial heart injury under Labor Code § 3212, which presumes such injuries are work-related unless rebutted. The defense argued pre-existing conditions and lifestyle choices caused the applicant's cardiac arrhythmia. However, the medical expert did not definitively state non-work-related factors were the *sole* cause of the heart trouble, failing to overcome the statutory presumption. Therefore, the Workers' Compensation Appeals Board affirmed the finding of industrial injury.

Labor Code section 3212firefighterheart troublepresumptionindustrial injurycirculatory systemcumulative periodPetition for ReconsiderationWCJagreed medical evaluator
References
Case No. ADJ10653999
Regular
Feb 11, 2020

Rodney McMillan vs. CITY OF RIVERSIDE

Applicant, a police officer, sought reconsideration after a WCJ denied his heart trouble claim under Labor Code § 3212.5. The parties stipulated the heart trouble presumption applied, shifting the burden to the employer to rebut it. While the Agreed Medical Examiner identified alcoholism as the probable cause of applicant's cardiomyopathy, he could not definitively state it was the "sole cause" or that employment played no role. The Appeals Board granted reconsideration, rescinded the original order, and remanded the case for further proceedings to determine if the presumption was adequately rebutted.

Heart trouble presumptionLabor Code section 3212.5Rebuttal of presumptionAgreed Medical ExaminerDilated cardiomyopathyNon-industrial alcoholismSole causeIndustrial causationPetition for ReconsiderationFindings of Fact and Order
References
Case No. ADJ7494670
Regular
Jun 01, 2012

JOSEPH CURRAN, Deceased, JERI CURRAN, Spouse vs. CITY OF SACRAMENTO

The Workers' Compensation Appeals Board denied reconsideration of a decision finding that the deceased firefighter, Joseph Curran, suffered a heart injury arising out of and in the course of employment. The Board affirmed that the Labor Code Section 3212 heart trouble presumption applied. The defendant failed to rebut this presumption by demonstrating that a contemporaneous non-work-related event was the *sole* cause of the heart trouble. Dr. Bellinger's testimony, while stating the presumption was necessary, did not affirmatively prove exclusive non-industrial causation.

Labor Code 3212heart trouble presumptionindustrial causationrebutted presumptionanti-attribution clausesole causenonwork-related eventcumulative injuryfirefighterdeath benefits
References
Case No. ADJ1635860 (ANA 0371188) ADJ3803325 (ANA 0371189)
Regular
Feb 20, 2018

SHERRY HOUGH vs. COOPERVISION, EMPLOYERS INSURANCE OF WAUSAU

This case involves an applicant seeking workers' compensation benefits for medical treatment recommended by her physician. The defendant contested responsibility, arguing a 2016 motor vehicle accident was the sole proximate cause of the need for treatment, not the applicant's 2002 industrial injury. The Board affirmed the finding that the treatment was at least partially related to the industrial injury but amended the order. This amendment defers the determination of medical necessity for the requested treatment pending further development of the record. Crucially, the defendant was precluded from utilizing the utilization review process due to their failure to properly notify the applicant and her attorney of their deferral decision.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and OrderRequest for Authorization (RFA)Utilization Review (UR)Intervening CauseProximate CauseAgreed Medical Examiner (AME)Causally RelatedCumulative Trauma
References
Case No. ADJ9190661 ADJ9735754 ADJ9735757
Regular
Nov 20, 2015

WILLIAM CRONIN vs. HONEYWELL INTERNATIONAL INC., XL SPECIALTY INSURANCE COMPANY as administered by MATRIX ABSENCE MANAGEMENT, INC.

The Workers' Compensation Appeals Board granted reconsideration and found that William Cronin sustained a psychiatric industrial injury arising out of and in the course of employment with Honeywell International. The Board affirmed that actual employment events were predominant causes of the injury. Defendant failed to prove the injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action, as the events cited did not constitute a substantial cause. The previous award was rescinded and substituted with this finding, deferring other issues.

Workers' Compensation Appeals BoardIndustrial InjuryPsychiatric InjuryActual Events of EmploymentPredominant CauseGood Faith Personnel ActionDue ProcessAdmissible EvidenceAgreed Medical ExaminerTreating Physician Reports
References
Case No. ADJ10384186 MF ADJ10404193
Regular
Mar 25, 2019

SCOTT MITCHELL vs. DENIHANA, ZURICH NORTH AMERICA

This case concerns a claim for psychiatric injury where the applicant, Scott Mitchell, alleged actual employment events were the predominant cause. The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board affirmed the WCJ's findings, giving great weight to credibility determinations and finding no substantial evidence to reject them. Crucially, the Board concluded the injury was not substantially caused by lawful, nondiscriminatory, good faith personnel actions, as required by Labor Code section 3208.3. The Board relied on the agreed medical examiner's opinion that employment stress predominantly caused the aggravation of the applicant's pre-existing condition.

Labor Code 3208.3predominant causepsychiatric injurygood faith personnel actionsubstantial causecredibility determinationsaggravation of pre-existing conditionagreed medical examinercumulative traumaanxiety disorder not otherwise specified
References
Case No. MON 0342844
Regular
Aug 20, 2007

DANNY HOPKINS vs. MCMAHAN'S FURNITURE STORES, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a decision that denied a psychiatric injury claim. The Board found the original judge did not properly apply the *Rolda v. Pitney Bowes* analysis to determine if a lawful personnel action was the substantial cause of the injury. The case is returned to the trial level for further analysis under *Rolda* and to allow for further development of the medical record, specifically regarding whether personnel actions were a substantial cause of the alleged injury.

Workers' Compensation Appeals BoardPsychiatric injuryLawful personnel actionRolda v. Pitney BowesInc.Labor Code section 3208.3Good faithNon-discriminatoryDemotionPredominant cause
References
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