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

Case No. ADJ7834593
Regular
Oct 06, 2014

GEORGE MOEN, III vs. COUNTY OF SAN BERNARDINO

The Appeals Board granted reconsideration of a WCJ's decision regarding a lien claim for a human tendon used in applicant's knee surgery. While the WCJ correctly found the services were necessary, neither party provided sufficient evidence to determine the reasonable value of the lien. The Board rescinded the WCJ's decision and returned the case for further development of the record. Lien claimant must prove its bill was not bundled and present evidence of a reasonable fee.

Workers' Compensation Appeals BoardLien ClaimantAccess MediquipIndustrial InjuryKnee InjuryDeputy SheriffACL Tendon ReplacementPatella Tendon AllograftHuman TendonBundled Payment
References
Case No. ADJ7775170
Regular
Jul 16, 2012

JUANA NEGRETE vs. SHURFLO, HAMPSHIRE INSURANCE COMPANY

This case involves an applicant's workers' compensation claim filed after layoff, triggering Labor Code Section 3600(a)(10). The Appeals Board granted reconsideration, finding the applicant met her burden of proof that she notified her employer of her injury prior to her layoff. The applicant's unrebutted testimony and supporting medical evidence demonstrated employer notice, thus overcoming the statutory bar to compensation. The case was remanded for further proceedings on the merits of the applicant's claim.

Workers' Compensation Appeals BoardJuana NegreteShurfloHampshire Insurance CompanyADJ7775170Opinion and Order Granting ReconsiderationDecision After Reconsiderationbilateral armsbilateral elbowssleep problems
References
Case No. ADJ11147927
Regular
Oct 23, 2020

RAY SLAUGHTER vs. WALSH SHEA CORRIDOR CONSTRUCTORS, ESIS

The Workers' Compensation Appeals Board denied reconsideration of a decision that halted permanent disability (PD) advances. The applicant argued for continued advances due to ongoing temporary total disability and a lack of a definitive PD estimate, despite exhausting temporary disability benefits. The Board found no legal basis to order further PD advances and stated the applicant could conduct further discovery and present new evidence on the issue. The applicant failed to meet his burden of proof for continuing these advances.

Workers' Compensation Appeals BoardPermanent Disability AdvancesTemporary DisabilityPetition for ReconsiderationWCJ reportAdditional EvidenceLabor CodePermanent Disability IndemnityMedical OpinionPost-Surgical Condition
References
Case No. ADJ3835932
Regular
Dec 17, 2010

BEVERLY SMITH vs. CEDARS SINAI MEDICAL CENTER, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a prior award. The applicant sought to reopen the case due to the retirement of an Agreed Medical Evaluator and alleged worsening of her condition. However, the Board found the applicant failed to demonstrate good cause, as her claims were unsubstantiated, contradicted by surveillance evidence, and she did not exercise due diligence in seeking further evaluation. Consequently, the prior findings of industrial injury to the psyche and achilles tendon, with 24% permanent disability after apportionment, were upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryPsycheAchilles TendonOrthopedic Agreed Medical Evaluator (AME)Permanent DisabilityApportionmentPetition to Reopen
References
Case No. MON 176608
Regular
Apr 23, 2007

MERCED F. POWER vs. MARRIOTT INTERNATIONAL

The applicant sought reconsideration of a workers' compensation award, arguing the administrative law judge erred by reducing permanent disability based on sub rosa films and by failing to rule on a motion for sanctions. The Appeals Board granted reconsideration, affirming the original award but amending it to defer the sanctions issue. The case is returned to the trial level for further proceedings.

Petition for ReconsiderationFindings and Awardpermanent disabilitysub rosa filmsmotion for sanctionsWCJAppeals Boardindustrial injurycashierfood server
References
Case No. ADJ8860181
Regular
Jul 16, 2015

GARY GATSON vs. BIMBO BAKERIES USA, INC., ACE AMERICAN INSURANCE COMPANY

This case involves a dispute over the Employment Development Department's (EDD) lien for temporary disability benefits paid to the applicant. The original award found the applicant sustained a cumulative trauma injury and awarded temporary disability benefits, but only allowed partial reimbursement to EDD. Both EDD and the employer sought reconsideration, with EDD arguing for full reimbursement and the employer challenging the EDD lien finding. The Appeals Board granted EDD's petition, denied the employer's, and will allow further proceedings to determine the correct amount of EDD's lien and temporary disability award.

WCABcumulative traumaAchilles tendonpermanent disabilitytemporary disabilityEDD lienreconsiderationsubstantial evidencestandingLabor Code section 4904
References
Case No. ADJ8910001
Regular
Jan 30, 2018

CHARLES LEWTER vs. COUNTY OF KERN

The Workers' Compensation Appeals Board (WCAB) rescinded the original Findings and Award due to inconsistencies and lack of substantial evidence in the Qualified Medical Evaluator's (QME) reports and testimony. The QME, Dr. Darakjian, provided conflicting opinions regarding the cause of the applicant's injury, switching between cumulative trauma and specific incident causation, and also vacillated on the issue of apportionment of disability. The WCAB determined that Dr. Darakjian's opinions failed to adequately explain the reasoning behind his conclusions, rendering them insubstantial. The case is remanded to the WCJ for further development of the record to properly address the injury, disability, and statute of limitations issues.

Cumulative traumaStatute of limitationsWhole person impairmentQualified Medical EvaluatorPetition for ReconsiderationFindings and AwardSubstantial evidenceMedical reportApportionmentTendon rupture
References
Case No. SFO 0494473
Regular
Apr 15, 2008

ROBERT HARRISON vs. ACADEMY OF ART COLLEGE, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the prior award because the Agreed Medical Evaluator's apportionment opinions lacked sufficient explanation regarding causation and calculation methodology. The Board remanded the case for further development of the medical record. The trial judge must then issue a new decision on permanent disability and apportionment after reviewing further medical evidence.

Workers' Compensation Appeals BoardRobert HarrisonAcademy of Art CollegeLiberty Mutual Insurance CompanyOpinion and Order Granting ReconsiderationFindings and AwardIndustrial InjuryShuttle VanRear-endedNeck Injury
References
Case No. ADJ3747523 (POM 0264468)
Regular
Oct 17, 2008

RICHARD E. GONZALES vs. DEPARTMENT OF YOUTH AUTHORITY, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded the WCJ's decision, returning the case to the trial level for further proceedings. The Board found the prior decision relied on an improper evidentiary basis by using a stipulation from a nearly identical case to determine the reasonableness of the facility fee. The matter must be re-evaluated with proper evidence and adherence to the guidelines set forth in *Scott Kunz v. Patterson Floor Coverings, Inc.* for determining reasonable facility fees.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFacility FeeReasonable ChargesOfficial Medical Fee ScheduleLabor Code Section 4600Kunz GuidelinesEvidentiary BurdenDiagnostic Arthroscopy
References
Case No. ADJ10362335
Regular
Mar 06, 2018

WILLIBALDO DURAN ESCANDON vs. VALLEYCREST LANDSCAPING MAINTENANCE, CHUBB GROUP OF INSURANCE, ESIS

The Workers' Compensation Appeals Board denied reconsideration of a Findings and Award, upholding the Administrative Law Judge's decision. The Applicant alleged a left shoulder injury sustained while employed as a landscaper on February 25, 2016. The Board found the WCJ's credibility determinations, based on observing witnesses, to be sound and supported by substantial evidence. The WCJ appropriately admitted an employer letter rebutting testimony about the date of injury and employment. Medical evidence from Dr. McCreesh supported an industrial injury, while Dr. Poon's opinions were deemed speculative and inflammatory.

WILLIBALDO DURAN ESCANDONVALLEYCREST LANDSCAPING MAINTENANCECHUBB GROUP OF INSURANCEESISRECONSIDERATION OF FINDINGS AND AWARDGarza v. Workmen's Comp. Appeals Bd.credibility determinationsADJ10362335Mandtory Settlement Conference (MSC)Pre-Trial Conference Statement
References
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