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

Case No. GRO 23394 GRO 29090
Regular
Mar 18, 2008

LUISA H. GARCIA vs. FOSTER ASSESSMENT, STATE COMPENSATION INSURANCE FUND

The applicant sought reimbursement for a vocational expert's report used to challenge the applicable permanent disability rating schedule. The Appeals Board affirmed the WCJ's finding that the defendant was not liable for the cost of the report because the applicant failed to prove its necessity at the time it was incurred. The Board cited precedent holding that such costs are only reimbursable if reasonable and necessary, and the applicant did not demonstrate necessity for this particular report.

Workers' Compensation Appeals BoardPetition for Reconsiderationpermanent disability rating scheduleLabor Code section 5811reimbursement for costsvocational rehabilitation expertdiminished earning capacityMandatory Settlement Conferenceaffirmative burden of proofjudicial authority
References
1
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. MISSING
Regular Panel Decision

Durakovic v. Building Service 32B-J Pension Fund

Bejaze Durakovic sued 'the Funds' under ERISA after being denied disability benefits, citing chronic back and neck pain from a 1999 car accident. The Social Security Administration had found her disabled in 2004. The Funds, relying on independent medical examiners Dr. Ludmilla Bronfin and Dr. Ira Rashbaum, and a vocational assessment by Apex Rehab Management, concluded she could perform sedentary work. Durakovic challenged this, arguing inadequate vocational assessment and conflict of interest. The court granted the Funds' motion for summary judgment, finding their decision was not arbitrary or capricious, despite some misgivings about the vocational assessment, emphasizing the broad discretion accorded to plan administrators.

ERISADisability Benefits DenialSummary Judgment GrantedArbitrary and Capricious ReviewConflict of InterestVocational CapacitySedentary EmploymentIndependent Medical ExaminationTreating Physician RuleSocial Security Disability
References
20
Case No. ADJ8482608
Regular
Jul 25, 2018

PATRICIA MCMAHON vs. ALL HOME CARE, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the WCJ's decision and returned the case for further development of the record. This action was taken due to insufficient medical explanation supporting the orthopedic physician's conclusion of total permanent disability and the vocational experts' opinions being incomplete. The Board requires further medical reports from the treating physicians and updated vocational assessments to determine the applicant's permanent disability.

Workers' Compensation Appeals BoardDecision After ReconsiderationPermanent DisabilityApportionmentPanel Qualified Medical EvaluatorAMA GuidesVocational ExpertsRehabilitationMedical EvidenceFurther Development
References
9
Case No. ADJ8772254
Regular
Jul 20, 2017

Lorenzo Hernandez vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION, NORTH KERN STATE PRISON, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied Lorenzo Hernandez's petition for reconsideration, upholding the original award of 24% permanent disability for a right shoulder injury. The applicant argued that a vocational expert's report should have rebutted the scheduled disability rating, but the Board found this report insufficient. Relying on *Ogilvie* and *Dahl*, the Board determined that an applicant's amenability to vocational rehabilitation precludes using vocational expert testimony to challenge a scheduled rating based on lost earning capacity. Therefore, the vocational expert's opinion was deemed not substantial evidence to overcome the QME's scheduled rating.

Workers' Compensation Appeals BoardPermanent DisabilityVocational ExpertQualified Medical EvaluatorScheduled RatingReconsiderationLabor Code §4660.1AMA Guides 5th EditionAmenability to Vocational RehabilitationDiminished Future Earning Capacity
References
3
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. ADJ7682218
Regular
Aug 05, 2015

RICHARD ROSSI vs. BINKS MANUFACTURING COMPANY, TIG INSURANCE COMPANY, ZENITH [RIVER STONE GROUP], HARTFORD INSURANCE, ACE INSURANCE COMPANY, COMMERCE AND INDUSTRY INSURANCE, AIG DOMESTIC CLAIMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, AMERICAN MOTORISTS INSURANCE COMPANY, AMERICAN MANUFACTURERS MUTUAL INSURANCE COMPANY, LUMBERMEN'S MUTUAL CASUALTY, ILLINOIS TOOL WORKS, FINISHING BRANDS, ZURICH AMERICAN INSURANCE COMPANY, BROADSPIRE

The Appeals Board granted reconsideration to address applicant's contentions regarding the admissibility of vocational expert reports and his disability level. The Board reversed the exclusion of applicant's vocational expert reports, finding they should have been admitted into evidence despite CIGA's claims of insufficient notice. Issues regarding applicant's permanent disability exceeding 79%, entitlement to additional attorney's fees, and CIGA's liability for the vocational expert's costs were deferred. The case was returned to the trial level for further proceedings and decisions on these deferred issues.

CIGAvocational expertpermanent disabilityindustrial injurycancerlatency perioddue processsubstantial evidenceadmissibilityreconsideration
References
10
Case No. ADJ6788617
Regular
Mar 02, 2020

JOSE MURILLO vs. ROYAL PAPER BOX COMPANY, LIBERTY MUTUAL INSURANCE COMPANY

In this workers' compensation case, the defendant appealed the finding of permanent total disability for applicant Jose Murillo, arguing the vocational evidence was unsubstantial and improperly considered non-industrial factors. The Board affirmed the Administrative Law Judge's (WCJ) decision, finding the vocational expert's report constituted substantial evidence. The report concluded Murillo's multiple industrial impairments rendered him unable to participate in vocational rehabilitation or compete in the labor market. The Board specifically found the defendant's apportionment arguments unpersuasive.

WCABPetition for ReconsiderationPermanent Total DisabilityVocational ExpertDiminished Future Earning CapacityAgreed Medical ExaminerApportionmentContra Costa County v. DahlVocational RehabilitationResidual Functional Capacity
References
1
Case No. ADJ7399938 ADJ7068967
Regular
Jun 23, 2015

OLENA GARCIA vs. RESIDENCE INN, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PENNSYLVANIA

The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further development of the record. The initial award found permanent total disability based on a vocational expert's opinion, but the Board found this opinion lacked substantial medical evidence. Specifically, the medical expert's supplemental report was not based on a current evaluation, and the vocational expert's conclusions, relying on that report, were therefore also flawed. The matter is remanded to allow for a current medical evaluation and reassessment of vocational rehabilitation and diminished earning capacity.

Workers' Compensation Appeals BoardPermanent Total DisabilityJoint Findings and AwardVocational ExpertSubstantial EvidenceScheduled RatingFunctional Capacity EvaluationAgreed Medical ExaminerApportionmentModified Work
References
0
Case No. ADJ9025732
Regular
Apr 07, 2023

ALBERT MATA vs. STATE OF CALIFORNIA - DEPARTMENT OF CORRECTIONS & REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding of 100% permanent total disability for the applicant, Albert Mata. The defendant argued that the applicant's vocational counselor's reports and medical reports did not constitute substantial evidence for total disability. However, the Board affirmed the Administrative Law Judge's decision, finding the vocational expert's opinions were substantial evidence, not based on speculation, and correctly applied California's 2005 Permanent Disability Rating Schedule for psychiatric impairments. Therefore, the Board concluded the applicant was precluded from vocational rehabilitation and participating in the labor force.

Permanent total disabilityPsychiatric injuryVocational Rehabilitation CounselorAmerican Medical Association GuidesGlobal Assessment of FunctioningPermanent Disability Rating ScheduleSubstantial evidencePetition for ReconsiderationAdministrative Law JudgeAgreed Medical Examiner
References
7
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