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

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. ADJ10256108, ADJ10255968, ADJ10256212, ADJ10256223, ADJ10489875
Regular
Sep 23, 2022

JOSEPH RYAN vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the finding of permanent and total disability for the applicant, Joseph Ryan, stemming from industrial injuries sustained while employed as a correctional captain. However, the Board remanded the matter for further proceedings to specifically address apportionment of the permanent disability under Labor Code section 4663, considering the Agreed Medical Evaluator's opinion on pre-existing spinal disease. The Board found that the applicant's specific and cumulative trauma injuries to his spine resulted in intertwined disabilities, justifying a combined award, but that Dr. Hasday's apportionment findings require further development and determination at the trial level.

Workers' Compensation Appeals BoardJoseph RyanCalifornia Department of CorrectionsLegally UninsuredState Compensation Insurance FundADJ10256108ADJ10255968ADJ10256212ADJ10256223ADJ10489875
References
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
Case No. ADJ3924904
Regular
Jan 06, 2009

MARIO CHAVEZ-PINEDA vs. COR-O-VAN/EMPLOYERS LEASING CO., ST. PAUL/TRAVELERS INSURANCE

Reconsideration granted to amend clerical error in findings of fact regarding defendant's liability for temporary disability; interim attorney fees rescinded; matter returned for compliance with second opinion process for spinal surgery.

WORKERS' COMPENSATION APPEALS BOARDMARIO CHAVEZ-PINEDACOR-O-VAN/EMPLOYERS LEASING CO.ST. PAUL/TRAVELERS INSURANCEADJ3924904OPINION AND ORDER GRANTING RECONSIDERATIONTEMPORARY DISABILITYMEDICAL TREATMENTSPINAL SURGERYUTILIZATION REVIEW
References
Case No. ADJ3699477 (OAK 0345390)
Regular
Jul 05, 2011

GARY TOMEI vs. BAY ALARM COMPANY, TRAVELERS PROPERTY AND CASUALTY INSURANCE COMPANY

This case involves an applicant seeking authorization for cervical surgery, which was denied based on the treating physician's request not being properly formatted per AD Rule 9792.6(o). The Appeals Board granted reconsideration, finding the initial denial was due to the applicant's attorney adding a notation to the physician's report instead of the physician clearly marking it as a spinal surgery authorization request. The Board rescinded the original award, deferring the cervical surgery issue and ordering an expedited second opinion from a designated orthopedic surgeon or neurosurgeon.

Workers' Compensation Appeals BoardGary TomeiBay Alarm CompanyTravelers Property and Casualty Insurance CompanyADJ3699477Opinion and Order Granting Reconsiderationcervical surgerylumbar spineAdministrative Director Rule 9792.6(o)treating physician
References
Case No. ADJ8513866
Regular
Oct 11, 2013

GARY HICKS vs. COUNTY OF SACRAMENTO

The Appeals Board granted reconsideration of an award for future medical treatment, including spinal surgery, stemming from a 1996 industrial injury. The defendant employer argued that no reporting doctors addressed causation for the surgery. The Board noted the defendant's violation of rules by submitting unadmitted exhibits. Consequently, the Board amended the award to defer the issue of whether the 1996 injury contributes to the need for surgery, returning the matter for further proceedings to develop the record on causation.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFuture Medical TreatmentSpinal SurgeryCausationLabor Code section 4062 (b)Substantial EvidencePropria PersonaPanel Qualified Medical Examiner (QME)
References
Case No. FRE 191206
Regular
Nov 20, 2007

MARY SEPEDA vs. SEPEDA BROTHERS DAIRY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY, in liquidation, REPUBLIC INDEMNITY

This case involves an applicant seeking reconsideration of a workers' compensation award concerning a low back injury sustained through July 13, 1995. The applicant, supported by her treating physician, argued for additional disc replacement surgery at the L4-5 level beyond the previously awarded L5-S1 spinal fusion. The Workers' Compensation Appeals Board granted reconsideration and amended the award to include the L4-5 disc replacement surgery, finding it reasonably required to cure or relieve the applicant's injury based on the treating physician's opinion.

CIGAFremont IndemnityRepublic Indemnitylow back injurypermanent disabilityfurther medical treatmentspinal surgeryL5-S1 fusionL4-5 disc replacementtreating physician
References
Case No. ADJ370366 (VNO 0526012)
Regular
Jun 24, 2009

JUAN ZAMANO vs. DIVERSE STAFFING, F. A. RICHARDS AND ASSOCIATES

This case involved a dispute over an applicant's entitlement to temporary disability benefits and recommended neck surgery following an admitted industrial injury. The employer sought reconsideration, arguing the medical evidence supporting the WCJ's award was insufficient and that a different statutory scheme for medical treatment disputes should apply. The Appeals Board found the employer's arguments regarding statutory interpretation unpersuasive and, critically, that the employer's utilization of the correct dispute resolution process for spinal surgery, specifically whether Utilization Review (UR) was properly conducted under Labor Code section 4610, was unclear. Consequently, the Board rescinded the WCJ's decision and remanded the case to the trial level to determine if the employer engaged in UR, instructing the WCJ to issue a new decision based on that determination and relevant case law.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuryTemporary DisabilityNeck SurgerySpinal SurgeryQualified Medical EvaluatorLabor Code Section 4062Labor Code Section 4610Utilization Review
References
Case No. ADJ6933983
Regular
Dec 04, 2015

MARIA CHEVEZ vs. SAP AMERICA, AIG

This case concerns a dispute over further spinal surgery for an applicant with an industrial back injury. The applicant appealed a denial of surgery based on an Independent Medical Review (IMR) decision. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the prior finding, and returned the case to the trial level. The WCAB determined that the applicant's appeal of the IMR is permissible regardless of service timeliness and that the Administrative Law Judge must assess if the IMR determination meets statutory standards and constitutes substantial evidence.

Workers Compensation Appeals BoardIndependent Medical ReviewMedical Provider NetworkLabor Code Section 4616.4Petition for ReconsiderationSpinal SurgeryDisc Replacement SurgeryAdministrative Director RulesSubstantial EvidenceTreatment Standards
References
Case No. ADJ4577451 (WCK 0063127) ADJ336675 (WCK 0063128)
Regular
Sep 10, 2013

EDUARDO GUERRA vs. POMEROY CORPORATION, TRAVELERS INSURANCE COMPANY

The Appeals Board granted reconsideration to review the WCJ's award of total temporary disability and future medical treatment, including spinal surgery. The Board rescinded the WCJ's decision because the record regarding the necessity of spinal surgery was not fully developed. Specifically, Dr. Harf's second opinion report was incomplete due to unobtained diagnostic tests, preventing a definitive recommendation on surgery. The case is returned to the trial level to further develop the medical evidence on the surgery issue and other deferred matters.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary Disability IndemnitySpinal SurgerySecond Opinion PhysicianUtilization ReviewPenaltiesDiscoveryDeclaration of Readiness to Proceed
References
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