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

Case No. MISSING
Regular Panel Decision

Claim of Steuber v. Home Properties, Inc.

Claimant applied for workers' compensation benefits after a March 2010 work fall, establishing injuries to his back, left knee, and left hip. After thoracic spine surgery in 2011, the employer and its workers' compensation carrier objected to coverage, arguing it was not causally connected to the initial claim. The Workers’ Compensation Board agreed, a decision which the appellate court affirmed. The court credited an independent medical examiner's opinion that the thoracic condition and subsequent falls were unrelated to the compensable accident, despite the claimant's orthopedic surgeon's testimony suggesting otherwise.

Workers' Compensation BenefitsCausal RelationThoracic Spine InjuryDegenerative ConditionIndependent Medical ExaminationSubsequent FallsBoard DecisionAppellate ReviewCredibility AssessmentSubstantial Evidence
References
3
Case No. ADJ9709726
Regular
Jun 25, 2015

LAURA NUNEZ vs. SUTTER PACIFIC MEDICAL FOUNDATION, SUTTER HEALTH

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the finding of industrial injury AOE/COE for thoracic outlet syndrome, arguing it wasn't an issue for trial and the medical evidence was insufficient. The Board found that thoracic spine injury was an issue and that Dr. Avery's opinion provided substantial medical evidence to support the thoracic outlet syndrome finding. Any potential defects in the original WCJ opinion were cured by the WCJ's subsequent report.

Thoracic outlet syndromeAOE/COEPetition for Reconsiderationsubstantial medical evidenceG. James Avery M.D.Steven Bratman M.D.industrial injuryapportionmentWCJlabor code 5313
References
1
Case No. 2021-06-0210
Regular Panel Decision
Mar 27, 2024

Dawson, Beandy v. Optum services, Inc.

Brandy Dawson, a nurse for Optum Services, Inc., sustained injuries in June 2019 after a fall. While Optum accepted the initial claim, Dawson later developed symptoms consistent with thoracic outlet syndrome, which her authorized physicians struggled to diagnose or relate to her employment. Despite an authorized physician's referral to a brachial plexus specialist, Optum denied further specialized treatment. Dawson sought her own expert, Dr. Robert Thompson, who diagnosed neurogenic thoracic outlet syndrome and causally linked it to her work fall, recommending surgery. The Court found Dr. Thompson's opinion compelling, concluding that Dawson's thoracic outlet syndrome is work-related and that Optum unjustly denied treatment, thus granting medical treatment with Dr. Thompson and temporary total disability benefits.

Thoracic Outlet SyndromeNeurogenic TOSBrachial Plexus InjuryWork-Related InjuryMedical Treatment DisputeTemporary Disability BenefitsExpert Medical OpinionCausationPhysician ReferralDenial of Benefits
References
5
Case No. 2019-03-0262
Regular Panel Decision
Mar 11, 2021

Mays, April v. Fast Pace Medical Clinic, PLLC

April Mays, an employee, fell at work and initially received treatment for her neck and cervical spine. She sought additional treatment for her lumbar and thoracic spine, which Fast Pace Medical Clinic, PLLC, denied. The Court reviewed conflicting medical opinions from Dr. Paul Johnson, the panel-selected physician, and Dr. C.M. Salekin, an independent medical examiner. Dr. Salekin diagnosed lumbosacral radiculopathy and probable rod displacement related to the fall, recommending further evaluation. The Court found Ms. Mays presented sufficient proof to rebut Dr. Johnson's causation opinion, which stated the lumbar and thoracic pain was unrelated to the work injury without detailed explanation. Therefore, the Court granted Ms. Mays's claim for the requested lumbar and thoracic MRIs and an orthopedic evaluation.

Workers' CompensationExpedited HearingMedical Treatment DenialCausation DisputeIndependent Medical Examination (IME)Pre-existing Condition AggravationLumbar Spine InjuryThoracic Spine InjuryCervical RadiculopathyOrthopedic Evaluation
References
1
Case No. 2016-06-1026
Regular Panel Decision
Sep 26, 2016

Bailey, Sr., Jerry W. v. Team Construction, LLC

This case concerns Jerry W. Bailey, Sr.'s request for an expedited hearing regarding medical treatment, reimbursement for past medical treatment, and temporary disability benefits, following a workplace back strain and the subsequent discovery of a thoracic mass. The central legal question revolved around whether the thoracic mass was caused by or aggravated by the workplace accident, thereby necessitating additional medical care and resulting in his inability to work. The Court, presided over by Judge Joshua Davis Baker, found that Mr. Bailey failed to provide sufficient expert medical proof to establish a causal relationship between his workplace accident and the thoracic mass, especially in light of Dr. Daniel Burrus's opinion. Consequently, the Court denied Mr. Bailey's requested relief, concluding that he was unlikely to succeed on the merits without countervailing medical evidence.

Medical CausationThoracic MassBack StrainExpedited HearingTemporary Disability BenefitsMedical Treatment ReimbursementBurden of ProofExpert Medical TestimonyCausation TheoryOccupational Injury
References
7
Case No. ADJ6626529
Regular
Nov 05, 2015

NICOLAS WALKER vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to further study the issues in this case. The WCAB rescinded the prior Findings of Fact & Award, denied the defendant's motion to be relieved of stipulation regarding the thoracic spine, and found that the applicant sustained industrial injury to his cervical spine, shoulders, and thoracic spine. The WCAB deferred issues of permanent disability, apportionment, and attorney's fees, returning the matter to the WCJ for further record development.

Workers' Compensation Appeals BoardNicolas WalkerLos Angeles Unified School DistrictSedgewick Claims Management ServicesInc.ADJ6626529Opinion and Decision After ReconsiderationFindings of Fact & AwardWCJcervical spine
References
5
Case No. ADJ203727 (SRO 0140512)
Regular
Jan 29, 2013

CONRADO HERNANDEZ vs. JOHNNY FRANKLIN MUFFLER, BERKSHIRE HATHAWAY/REDWOOD FIRE AND CASUALTY COMPANY

In this workers' compensation case, the applicant sustained an industrial injury resulting in multiple impairments. Initially awarded 60% permanent disability, the applicant sought reconsideration, arguing the rating omitted the thoracic spine and advocating for total disability based on vocational expert testimony. The WCJ amended the rating to 63% after including the thoracic spine, finding no substantial evidence for total disability. The Appeals Board adopted the WCJ's recommendation, affirming the amended 63% permanent disability award and adjusting the attorney's fee.

Petition for ReconsiderationDecision After Reconsiderationindustrial injurycognitive impairmentpsycheconsciousness disorderpermanent disabilityapportionmentvocational expertamended rating
References
0
Case No. ADJ526691 (LBO 0329338) MF ADJ3636578 (VNO 0535001)
Regular
Feb 11, 2014

JITKA VAN DYNE-PARMET vs. UNITED AIRLINES

The applicant sought reconsideration of a WCJ decision that awarded 91% permanent disability for injuries to her neck, shoulders, fibromyalgia, and psychological system, but denied injury to her central nervous system (aneurysm). The Appeals Board granted reconsideration, rescinded the prior decision, and returned the case for further development of the medical record. This is primarily due to the ambiguity in a medical report regarding the industrial causation of the applicant's carotid aneurysm, which the Board found could be reasonably probable given the documented trauma. The Board also noted the WCJ's clerical error regarding the amount of permanent disability indemnity awarded.

Workers' Compensation Appeals BoardIndustrial InjuryFibromyalgiaCarotid AneurysmAgreed Medical ExaminersApportionmentPermanent DisabilityMedical TreatmentReconsiderationPetition for Reconsideration
References
2
Case No. MISSING
Regular Panel Decision

Claim of Richman v. NYS Unified Court System

This case concerns an appeal regarding a Workers' Compensation Board decision. The claimant suffered an unwitnessed injury at work, leading to a presumption of compensability under Workers' Compensation Law § 21 (1). The employer attempted to overcome this presumption with an expert's opinion suggesting the ruptured aneurysm was unrelated to employment. However, the Board found the expert's testimony not credible, particularly due to evasiveness regarding the role of work-induced stress and high blood pressure in the aneurysm's rupture. The Appellate Division affirmed the Board's conclusion, finding no basis to disturb the finding that the employer failed to present sufficient evidence to rebut the presumption of compensability.

Workers' CompensationAneurysmWork StressPresumption of CompensabilityExpert CredibilityUnwitnessed InjuryBlood PressureMedical OpinionBoard DecisionAppellate Review
References
4
Case No. MISSING
Regular Panel Decision

Employers' Casualty Co. v. Bratcher

Stacy Lee Bratcher, a toolpusher, died from a ruptured berry aneurysm while using the bathroom at a company trailer. His widow and minor son sought workers' compensation death benefits, arguing the death occurred in the course of employment under the personal comfort doctrine. The trial court granted summary judgment for the survivors. However, medical evidence suggested the aneurysm rupture was due to straining during defecation, deemed a natural cause of death, not work-related. The appellate court, while acknowledging the personal comfort doctrine, applied the positional risk or "but for" test, concluding that the death was due to a personal defect and not the conditions of employment. The court reversed the summary judgment.

Workers' CompensationDeath BenefitsPersonal Comfort DoctrinePositional Risk TestBerry AneurysmSubarachnoid HemorrhageSummary Judgment AppealCourse of EmploymentTexas LawPre-existing Condition
References
13
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