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

Case No. VNO 348369 VNO 348370 VNO 348371 VNO 348372
Regular
Feb 13, 2008

RUBEN C. GONZALEZ vs. L.A.C.M.T.A.

The Workers' Compensation Appeals Board (WCAB) denied LACMTA's Petition for Removal, adopting the Workers' Compensation Administrative Law Judge's (WCJ) report. The WCJ recommended denial because LACMTA failed to demonstrate significant prejudice or irreparable harm, and the medical record needed further development regarding the applicant's new diabetes diagnosis and its potential industrial relation. Therefore, the petition was formally denied by the WCAB.

WORKERS' COMPENSATION APPEALS BOARDLACMTAMedical Record DevelopmentDiabetes DiagnosisIndustrially Related ConditionReasonable Medical ProbabilityPetition for RemovalWCAB Rule 10843Significant PrejudiceIrreparable HarmWorkers' Compensation Administrative Law Judge
References
Case No. ADJ7485185, ADJ9885267
Regular
Sep 18, 2017

LAURA ORTIZ vs. FARMERS INSURANCE GROUP, MID CENTURY INSURANCE

This Workers' Compensation Appeals Board decision denies a petition for reconsideration, affirming the applicant's timely invocation of jurisdiction to seek additional benefits. The Board adopted the WCJ's reasoning that the applicant's filings of an Application for Adjudication of Claim and an Amended Application, along with documented medical evidence of worsening condition, satisfied the requirements for reopening and seeking further compensation. These actions put the defendants on notice of the applicant's intent to pursue increased benefits, even without a formal petition to reopen.

Petition for ReconsiderationLabor Code section 5410Application for Adjudication of ClaimRiel v. State of CaliforniaBeaida v. Workers' Comp. Appeals Bd.stipulated awardpro perfuture medical treatmentincreased symptomsworsening condition
References
Case No. ADJ11320525
Regular
Jul 01, 2019

LOURDES OCAMPO vs. SWEETWATER UNION HIGH SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration of the initial decision, finding the orthopedic QME's opinions did not constitute substantial evidence. Applicant contended the QME's opinions were inconsistent with medical literature regarding the acceleration of pre-existing conditions. The Board agreed that the QME seemed to conflate causing arthritis with aggravating a pre-existing condition. Therefore, the Board rescinded the original findings and returned the case for further development of the record, specifically regarding the extent of applicant's walking and a clearer medical opinion on causation.

AOE/COEQualified Medical Examiner (QME)Petition for ReconsiderationFindings and Order (F&O)substantial evidenceorthopedichip arthritisdegenerative joint diseaseindustrial causationacceleration of condition
References
Case No. ADJ1577836
Regular
May 04, 2009

JESUS GAVINO-REMIGIO vs. STRATUS SERVICES GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant injured when stepping on a metal hook, sustaining an admitted industrial injury to his right foot. The applicant sought reconsideration after the Workers' Compensation Judge (WCJ) denied findings that the injury also affected his internal systems (diabetes), eyes, and psyche, along with associated disability. The Board denied reconsideration, finding the defendant's medical expert's opinion on non-industrial diabetes causation to be substantial evidence, while deeming the applicant's medical experts' opinions insufficient. A dissenting commissioner argued the applicant's medical evidence sufficiently supported industrial causation for diabetes aggravation, warranting reconsideration.

Workers' Compensation Appeals Boardindustrial injuryright footinternal systemseyespsychediabetes mellituspermanent disabilitytemporary disabilityGerald Markovitz M.D.
References
Case No. ADJ401125 (LAO 0843257)
Regular
Dec 24, 2010

ORETHA BOYD vs. SERVICE CRAFT LOGISTICS, COLONIAL RISK

The Workers' Compensation Appeals Board granted reconsideration to reverse the finding of temporary total disability and the need for future medical treatment for the applicant's heart condition and hypertension. The Board found insufficient substantial medical evidence to support that these pre-existing conditions, aggravated by work stressors, caused the claimed period of disability. Applicant's prior carpal tunnel injury and its ongoing treatment were identified as the primary cause of her absence from work. The award was modified to remove temporary disability and future medical treatment for the heart/hypertension, and attorney fees were adjusted accordingly.

Workers' Compensation Appeals BoardOretha BoydService Craft LogisticsColonial RiskAmended Findings and Awardindustrial injuryheart conditionhypertensiondiabetestemporary total disability
References
Case No. ADJ324819 (SAL 0120615) ADJ3483975 (SAL 0119560)
Regular
Jul 20, 2010

KATHERINE GONZALES vs. COUNTY OF MONTEREY, LIBERTY MUTUAL

This case concerns an injured worker's attempt to continue treatment with her physician, Dr. Klassen, after he left the defendant's Medical Provider Network (MPN). The defendant argued that the worker's condition did not meet the criteria for continued treatment with a non-MPN physician under Labor Code section 4616.2. The Workers' Compensation Appeals Board (WCAB) granted reconsideration because there was insufficient medical evidence to determine if the worker's condition qualified. The WCAB rescinded the prior decision and returned the case for further proceedings, ordering the trial judge to obtain a report from Dr. Klassen regarding the necessity of continued treatment.

Workers' Compensation Appeals BoardMPNMedical Provider NetworkLabor Code section 4616.2continuity of treatmentprimary treating physicianacute conditionserious chronic conditionterminal illnessauthorization
References
Case No. ADJ2590975 (STK 0190237)
Regular
Sep 12, 2011

RAFAEL DELEON vs. STATE OF CALIFORNIA, CDCR, MULE CREEK PRISON, adjusted by STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the Appeals Board affirmed a prior award granting medical treatment for applicant's diabetes. Despite the defendant's argument that diabetes treatment was for a non-industrial condition, the Board found it necessary to prevent worsening of the applicant's industrially caused heart disease. Medical evaluators concluded that controlling diabetes is an essential component of treating industrial heart conditions, making the treatment compensable. The decision hinges on the principle that treatment for non-industrial conditions is covered when essential to cure or relieve the effects of an industrial injury.

Workers' Compensation Appeals BoardIndustrial InjuryHeart ConditionDiabetesGastrointestinal DifficultiesAgreed Medical EvaluatorTreating PhysicianCardiologistMedical TreatmentLabor Code Section 4600
References
Case No. ADJ8501790
Regular
Jul 29, 2015

Kelly Chase vs. St. Louis Blues Hockey Club, Federal Insurance Company

The Workers' Compensation Appeals Board (WCAB) reversed a prior finding of industrial injury for a professional hockey player against the St. Louis Blues. The WCAB found insufficient connection to California for jurisdiction, citing the player's limited games in the state compared to his overall career. This decision followed the precedent set in *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*, which requires a legitimate and substantial connection to the state for jurisdiction. The WCAB concluded that 21 games out of 485 did not meet this standard for a cumulative injury claim.

WCABSt. Louis Blues Hockey ClubFederal Insurance CompanyADJ8501790Opinion and Decision After Reconsiderationcumulative industrial injuryprofessional hockey playersubject matter jurisdictionstatute of limitationssubstantial medical evidence
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ7091661
Regular
Apr 02, 2014

JOSE CONTRERAS vs. SPECIALTY MEATS, INC., TRAVELERS CASUALTY & SURETY COMPANY, COMPWEST INSURANCE COMPANY

This case involved Jose Contreras alleging a continuous trauma injury to multiple body parts while employed as a butcher. The Workers' Compensation Appeals Board denied his Petition for Reconsideration, adopting the findings of the administrative law judge (WCJ). The WCJ found no industrial injury, relying on Qualified Medical Evaluator (QME) reports that attributed the conditions to pre-existing or degenerative issues. The WCJ also found Contreras to be not credible due to inconsistencies and similarity to prior claims, and denied his attempt to elect against a specific defendant on the trial date.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJIndustrial injuryFinal orderRemovalSpecialty MeatsInc.Travelers Casualty & Surety CompanyCompWest Insurance Company
References
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