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

Case No. ADJ2307991 (VNO 0427797) (MF) ADJ3536405 (VNO 0336819) ADJ487962 (VNO 0533632)
Regular
Jun 14, 2018

JACQUELINE AUSTIN vs. FIRST FOURSQUARE CHURCH OF VAN NUYS, GUIDE ONE MUTUAL INSURANCE COMPANY, FREMONT, CIGA, CYPRESS INSURANCE COMPANY, FOREST LAWN MEMORIAL PARK, SAFECO INSURANCE, TRAVELERS PROPERTY CASUALTY COMPANY

This case involves an applicant who sustained two separate cumulative trauma injuries to her neck, back, and gastrointestinal system, including GERD and fibromyalgia. The Workers' Compensation Appeals Board (WCAB) affirmed the findings that the applicant suffered distinct industrial injuries during employment with First Foursquare Church (insured by Cypress) and Forest Lawn Memorial Park (insured by Travelers). Defendant Cypress contested the dating of the injury and the finding of two separate cumulative trauma periods, while Travelers challenged the sufficiency of medical evidence for one injury. The WCAB found Cypress waived the issue of one versus two cumulative trauma injuries by failing to raise it timely. Ultimately, the WCAB adopted the WCJ's findings, confirming the two separate cumulative trauma periods and the respective carrier liabilities.

Workers' Compensation Appeals BoardReconsiderationCumulative TraumaDate of InjuryLabor Code Section 5412Labor Code Section 5500.5Findings of FactAward and OrderAdministrative Law JudgeCypress Insurance Company
References
9
Case No. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
1
Case No. ADJ6577328, ADJ7895770
Regular
Jan 21, 2014

CLAIRE AMMONS vs. REDLANDS COMMUNITY HOSPITAL, INTERCARE INSURANCE SERVICES

This case involves an applicant alleging two industrial injuries, a specific injury in 2007 and a cumulative trauma injury from 2003 to 2011, resulting in temporary and permanent disability, including a psyche injury. The defendant sought reconsideration, arguing the WCJ erred in identifying only two injuries and awarding temporary disability when a medical evaluator found maximum medical improvement earlier. The Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings to develop the medical record, particularly regarding the number of cumulative trauma injuries and apportionment of disability. The Board specifically directed further evaluation from Dr. Kent on injury dates and apportionment, and potentially from a psychiatric evaluator, due to conflicting medical opinions and potential insufficiencies in the existing reports.

ReconsiderationJoint Findings and AwardCumulative TraumaSpecific InjuryTemporary DisabilityPermanent DisabilityPanel Qualified Medical EvaluatorPQMEDr. KentDr. Lustig
References
23
Case No. ADJ2651648 (MON 0342704)
Regular
Jul 18, 2017

TERESA SANCHEZ vs. HAWTHORNE UNIFIED SCHOOL DISTRICT, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of an award granting applicant benefits for a 2006 industrial injury, arguing the prior disability rating was insufficient. The applicant had two industrial injuries: a 1997-2002 cumulative trauma and the 2006 specific injury, both causing fibromyalgia. The WCJ found the combined disability from both injuries exceeded the threshold for SIBTF benefits, based on her primary treating physician's rating. The Appeals Board affirmed the WCJ's decision, adopting the judge's report which found the applicant met the criteria for SIBTF benefits, and denied the SIBTF's petition.

Subsequent Injuries Benefits Trust FundSIBTFcumulative traumacompensable consequencefibromyalgiapermanent and stationaryAgreed Medical ExaminerAMA Guides1997 rating scheduleprimary treating physician
References
0
Case No. ADJ2719991 (VNO 0485134) ADJ1334047 (VNO 0428744)
Regular
Aug 20, 2009

Catalina Barajas vs. WELLPOINT HEALTH NETWORK, INC., ZURICH LOS ANGELES

This case involves an applicant who initially sustained a cumulative trauma injury to her upper extremities during a period covered by one insurer. After returning to work with modified duties, she experienced a recurrence and worsening of symptoms, necessitating further treatment and surgery, which the Board now recognizes as a separate cumulative trauma injury. The Workers' Compensation Appeals Board granted reconsideration, reversing the prior finding of a single cumulative trauma injury. The Board held that distinct periods of compensable temporary or permanent disability, as established by medical evidence and treatment, demarcate separate cumulative trauma injuries, aligning with the *Rodarte* precedent. Consequently, the applicant was found to have sustained two separate cumulative trauma injuries, each attributed to different insurance coverage periods.

cumulative traumaanti-merger doctrineLabor Code sections 3208.25303Rodartecompensable temporary disabilitypermanent disabilitywage lossmodified workbilateral upper extremities
References
3
Case No. ADJ2331238 (BAK 0137358) ADJ2292565 (BAK 0131673)
Regular
Feb 03, 2012

STEPHEN BROWN vs. NABORS INDUSTRIES, LIBERTY MUTUAL, CNA

The Workers' Compensation Appeals Board rescinded a prior decision and returned the case to the trial level. The WCJ had found two separate cumulative injuries for the applicant's spine, shoulders, knees, and psyche based on distinct periods of employment in Saudi Arabia and California. However, the Board found the WCJ's determination of two separate injuries inconsistent and lacking substantial medical evidence, especially given the deferral of apportionment and temporary disability issues. The Board mandated further proceedings to properly determine the number of cumulative injuries, the date of injury, and apportionment based on the statutory definitions and case law.

Cumulative injuryDate of injuryApportionment of causationTemporary disabilityPermanent disabilitySubstantial medical evidenceReconsiderationFindings and OrderReport and RecommendationLabor Code Section 3208.1
References
8
Case No. ADJ9455453 ADJ9455451
Regular
Aug 17, 2018

RICHARD YUBETA vs. WEATHERBY FURNITURE, HARTFORD INSURANCE COMPANY, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES, AMERICAN ALTERNATIVE INSURANCE CORPORATION, PROCENTURY INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior decision, and returned the case to the trial level. The Board found the WCJ's determination of a new, unpled cumulative injury and its associated date of injury questionable. Specifically, the medical evidence, particularly from Dr. Schaffzin, leans towards a single cumulative injury rather than two separate ones. If a second cumulative injury is found on remand, the WCJ must re-evaluate the Labor Code section 5412 date of injury and the LC 5500.5 liability period based on actual disability and knowledge of the injury.

WCABReconsiderationCumulative InjuryDate of InjuryLabor Code 5412Labor Code 5500.5DisabilityWage LossMedical TestimonyDepositions
References
16
Case No. ADJ855136
Regular
Aug 14, 2017

ROSE SANTANA vs. STANFORD UNIVERSITY, ZURICH AMERICAN INSURANCE COMPANY, CIGA, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., RELIANCE INSURANCE COMPANY

In this workers' compensation case, CIGA sought reimbursement for benefits paid, arguing two cumulative trauma injuries were actually one and Zurich was liable. The Appeals Board affirmed the prior denial of CIGA's claim, finding CIGA was judicially estopped from disputing the existence of two distinct cumulative trauma injuries after previously stipulating to them. CIGA also failed to present sufficient medical evidence to prove that both injuries contributed to the need for temporary disability or medical treatment. Therefore, the arbitrator's original decision denying CIGA's petition for contribution/reimbursement was upheld.

Workers' Compensation Appeals BoardCIGAZurich American Insurance CompanyReliance Insurance Companyjudicial estoppelcumulative traumaapportionmentjoint and several liabilitycovered claimsinsolvent insurer
References
8
Case No. ADJ6693720
Regular
Mar 15, 2010

KERRY NECHODOM vs. CITY OF GROVER BEACH

The Workers' Compensation Appeals Board granted reconsideration to amend the date of injury for Kerry Nechodom's right shoulder injury in case ADJ6693720 from February 3, 2007 - September 10, 2009 to August 12, 2008 - September 10, 2009. This amendment acknowledges a separate cumulative trauma injury due to distinct periods of disability and lack of continuous treatment between injuries. The Board affirmed the original award, finding that the applicant sustained two separate cumulative trauma injuries causing distinct periods of temporary disability. The employer's arguments regarding the cumulative trauma period and Labor Code $\S 4656$ limitations were addressed and resolved by this clarification.

Workers' Compensation Appeals BoardKerry NechodomCity of Grover BeachADJ6693720ADJ5791464ReconsiderationJoint Findings and AwardIndustrial InjuryRight ShoulderCumulative Injury
References
11
Case No. ADJ7110663
Regular
May 09, 2016

WILLIAM BO MATTHEWS vs. SAN DIEGO CHARGERS, ZENITH INSURANCE COMPANY, NEW YORK GIANTS, INSURANCE COMPANY OF NORTH AMERICA/ACE USA, DENVER GOLD, THE NORTH RIVER INSURANCE COMPANY

This case involves a petition for reconsideration of an arbitrator's decision regarding workers' compensation liability for a professional football player's cumulative trauma injuries. The Workers' Compensation Appeals Board (WCAB) granted reconsideration and modified the arbitrator's award, finding the applicant sustained two separate cumulative trauma injuries due to distinct periods of employment exposure. Consequently, the WCAB ruled that the petitioner, Insurance Company of North America/ACE USA (ESIS), is not liable for contribution to another insurer, The North River Insurance Company (NRIC), which had mistakenly paid a portion of a settlement. The Board affirmed the finding of two injuries, citing a significant break in employment as creating separate compensable periods, but rescinded the award to NRIC, holding NRIC should recover nothing from ESIS.

WCABPetition for ReconsiderationArbitration DecisionContributionCumulative InjuryProfessional Football PlayerInsurance Company of North America/ACE USAZenith Insurance CompanyThe North River Insurance CompanyLabor Code Section 5500.5
References
9
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