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

Case No. ADJ9755370
Regular
Aug 10, 2017

BERNARDINO GARDEA vs. CITY OF PASADENA

This case concerns the City of Pasadena's request for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision regarding the applicant's occupational group number. The WCJ initially recommended dismissal of the reconsideration petition as untimely. However, the defendant has now requested leave to file a supplemental petition to address issues raised in the WCJ's report. The WCAB has granted the defendant's request to file this supplemental petition. The defendant is ordered to file the supplemental petition within 20 days, either by mail or via EAMS, to avoid rejection.

Workers' Compensation Appeals BoardSupplemental PetitionReconsiderationOccupational Group NumberAdministrative Law JudgePetition for ReconsiderationWCAB Rule 10848Electronic Adjudication Management SystemEAMSCity of Pasadena
References
0
Case No. MISSING
Regular Panel Decision
Feb 21, 2006

Rivera v. Barnhart

Plaintiff Russell Rivera, Jr. challenged the Commissioner of Social Security's decision denying him Supplemental Security Income (SSI) benefits. The case was referred to Magistrate Judge Frank Maas, who issued a Report and Recommendation to remand the action for further administrative proceedings, citing deficiencies in the plaintiff's hearing. After defendant objected to a time limit, an Amended Report and Recommendation was issued, omitting the disputed time limitation. District Judge Richard J. Holwell, finding no clear error, adopted the Amended Report in its entirety, granting the Commissioner’s motion. The court's decision was based on the Administrative Law Judge's failure to fully develop the administrative record and adequately consider the treating physician’s opinion, Dr. Asbury, whose findings differed from a nonexamining medical consultant.

Social Security BenefitsSupplemental Security IncomeDisability DeterminationAdministrative Law Judge (ALJ) ReviewRemand OrderTreating Physician RuleMedical AssessmentHIV/AIDS ImpairmentHepatitis C DiagnosisProcedural Error
References
15
Case No. MISSING
Regular Panel Decision
Aug 18, 1995

Miller v. Chater

Plaintiff initiated this action to seek review of the Secretary of Health and Human Services' decision establishing June 1, 1992, as the onset date for Supplemental Security Income (SSI) benefits due to alleged disability from mental retardation. Magistrate Judge Carol E. Heckman issued a Report and Recommendation, advising denial of the Secretary's motion for judgment on the pleadings and remand for reconsideration. The Magistrate Judge found errors in the Administrative Law Judge's (ALJ) assessment of the plaintiff's functional limitations, particularly regarding social domain, and noted the ALJ's failure to consider the retroactivity inference from the Zebley class action stipulation. District Judge Arcara reviewed the Report and Recommendation, and with no objections filed, adopted its findings. Consequently, the defendant's motion for judgment on the pleadings was denied, and the case was remanded to the Secretary for further reconsideration, emphasizing a misapplication of post-Zebley requirements for adjudicating children’s SSI benefits claims.

Supplemental Security Income (SSI)Disability BenefitsMental RetardationChild Disability ClaimsAdministrative ReviewSocial Security ActAge-appropriate functioningMedical EvidenceFunctional LimitationsOnset Date
References
12
Case No. ADJ8691809
Regular
Apr 14, 2017

NICOLE BORAGNO vs. STATE OF CALIFORNIA, CDCR - CENTRAL CALIFORNIA WOMEN'S FACILITY CHOWCHILLA, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

This case involves Nicole Boragno's workers' compensation claim against the State of California, CDCR. The applicant sought reconsideration of a decision denying the admission of a supplemental medical report. The WCAB denied reconsideration, adopting the WCJ's report which found the supplemental report inadmissible. This was because discovery had closed at the mandatory settlement conference, and the defendant failed to establish good cause for introducing evidence not previously disclosed. The WCJ noted there was no change in circumstances to warrant the late-filed report, distinguishing it from precedent that allows such reports.

WORKERS' COMPENSATION APPEALS BOARDPetition for Reconsiderationmandatory settlement conferencediscovery closureLabor Code section 5502(d)(3)good causesupplemental reportPQMEapportionmenttimeliness
References
2
Case No. ADJ6704462
Regular
Sep 26, 2013

GÉRARDO ALVAREZ vs. SC ASSOCIATES, INC., STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for removal challenging an order for supplemental medical reports. The Appeals Board denied removal, holding that the WCJ acted appropriately in allowing QME reports to be supplemented due to potential deficiencies in their adherence to regulations concerning the review of prior medical records and reporting of information considered. The Board found that the alleged non-compliance with specific procedural rules related to report preparation does not automatically render the reports inadmissible, and that further development of the record is permissible when no substantial evidence exists. Furthermore, the defendant failed to demonstrate irreparable harm or substantial prejudice required for the extraordinary remedy of removal.

Petition for RemovalOrder Re Supplemental ReportsDr. Ronald ZlotolowDr. Noel LustigQME reportsLabor Code Section 4628WCAB Rule 10606medical-legal reportinadmissibilityprior medical records
References
4
Case No. ADJ1471935 (LAO 0872244)
Regular
Mar 26, 2014

JESUS RIOS vs. BRYAN JONES dba THE K GROUP, TOKIO MARINE, UNISURED EMPLOYERS BENEFITS TRUST FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to determine the admissibility of evidence obtained after the Mandatory Settlement Conference (MSC). The applicant sought to introduce supplemental medical reports from previously seen physicians and reports from new medical and vocational experts, arguing his condition worsened and the existing record was inadequate. The WCAB held that supplemental reports from the applicant's original physicians were admissible under Labor Code section 5502(d)(3) due to a changed condition, but reports from newly disclosed physicians and vocational experts were not. The majority affirmed the WCJ's decision to exclude the latter evidence, finding the applicant failed to demonstrate good cause or due diligence in obtaining it prior to the MSC.

Mandatory Settlement Conferencediscovery closurereopen recordsupplemental medical reportsvocational expertdue diligencegood causepermanent and stationaryAMA Guidesloss of earnings capacity
References
7
Case No. ADJ7242422
Regular
Sep 24, 2013

TRACIE WHITE vs. COUNTY OF SACRAMENTO, DEPARTMENT OF FINANCE

The Workers' Compensation Appeals Board denied the County of Sacramento's Petition for Removal. The County sought to replace a Qualified Medical Evaluator (QME) due to an allegedly untimely supplemental report. The Board affirmed the administrative law judge's denial, interpreting Administrative Director Rule 38(h) to grant QMEs sixty days for supplemental reports. The Board also noted the County objected to the report before receiving it.

Petition for RemovalQualified Medical EvaluatorQME panelsupplemental reportuntimely reportAdministrative Director Rule 38Report and RecommendationFajardo v. Workers' Comp. Appeals Bd.WCJoff calendar
References
1
Case No. ADJ9292791
Regular
Sep 29, 2015

HIEP LE NGOC NGUYEN vs. OAKS CLUB ROOM, NATIONAL CASUALTY COMPANY, NATIONWIDE AGRIBUSINESS INSURANCE COMPANY

This case concerns applicant's petition for removal after the WCJ denied their request for a new Qualified Medical Examiner (QME) panel. The denial was based on the original QME's failure to issue a timely supplemental report despite two requests. Although the QME claimed non-receipt of the requests, the supplemental report has now been provided. The Appeals Board denied removal, finding that issuing a new panel would only cause further delay given the report is now available.

Petition for RemovalQualified Medical ExaminerSupplemental ReportRule 38(i)Administrative Law JudgeWCJ ReportPrejudiceIrreparable HarmUntimely ReportPanel Qualified Medical Examiner
References
2
Case No. ADJ6950792
Regular
Sep 01, 2015

LILLIAN DUNN vs. COUNTY OF SAN BERNARDINO

This case concerns a petition for reconsideration and removal from a Workers' Compensation Appeals Board order. The Board denied the petition, adopting the reasoning of the Workers' Compensation Administrative Law Judge (WCJ). The WCJ determined that a Qualified Medical Examiner's (QME) report was not substantial evidence due to a failure to issue a supplemental report after reviewing additional medical records. Because the QME was unavailable to provide a supplemental report, the WCJ ordered a replacement QME, a decision upheld by the Board.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalReplacement PanelQualified Medical ExaminerQMESupplemental ReportLabor Code Section 4062.5Rule 38Apportionment
References
1
Case No. ADJ4696795 (SJO 0266117)
Regular
Aug 10, 2012

RUDOLPH GARCIA vs. PEPSI BOTTLING GROUP, OLD REPUBLIC INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted removal and rescinded a WCJ's order for a replacement QME panel. The WCAB found that the applicant's attorney erred in sending a request for a supplemental report to an incorrect address for the QME, despite the QME's report listing two addresses. Consequently, the QME did not receive the request and did not issue a supplemental report within 60 days. The WCAB determined that allowing a new panel would cause prejudice and unnecessary cost to the defendant.

Workers' Compensation Appeals BoardRemovalQME panelsupplemental reportcompensable consequenceindustrial injurydelivery driveradministrative law judgePetition for Removalfindings and order
References
4
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