Case Law

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Sep
4
2009
2005 PDRS, Almaraz / Guzman, AMA Guides, Case Law, Ogilvie, Permanent Partial Disability, Workers Compensation Resources

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Ogilvie and Almaraz/Guzman - lets cut to the chase
Ogilvie and Almaraz/Guzman - let's cut to the chase

First off, if you haven’t already downloaded Ogilvie II and Almaraz/Guzman II, do so now!

As I mentioned previously, each of these cases is about 50 pages long, so there is clearly no substitute for reading them for yourself.  However, here’s Ogilvie II and Almaraz/Guzman II in five sentences:1

  • Ogilvie v. WCAB II:
    • The WCAB ruled the original Ogilvie (I) formula is still valid.
    • The WCAB appears to have created a right to reopen a case for “individualized proportional earnings loss.”
    • Vocational testimony is not an appropriate way to dispute the DFEC portion of the 2005 Permanent Disability Rating Schedule.
    • (Bonus Dissent Summary: The lone dissent by Caplane says that vocational testimony should be considered proper rebuttal to an entire permanent disability rating.)
  • Almaraz/Guzman II:
    • The WCAB ruled that a doctor must issue reports within the “four corners” of the AMA Guides 5th Edition to comply with Labor Code Section 4660(c). 2
    • However, either party may obtain rebuttal evidence in the form of supplemental reports and depositions regarding the use of any other chapter, method, or table within the AMA Guides.
    • (Bonus Dissent Summary:  The dissenting opinion from Brass, Caplane, and Moresi says they would affirm their decision in Almaraz/Guzman I.)

What do these cases mean for the practitioner?

  • The WCAB has created a new right to reopen for a higher than expected “individualized proportional earnings loss.”
  • The Ogilvie Mathematical Proof of 18 Point Add-Ons still stands.
  • I see even more doctor depositions in my future.
  • My phone is going to be ringing off the hook tomorrow.
  1. Photo courtesy of Scallop Holden [↩]
  2. Here, the phrase “four corners of the AMA Guides” just means the parties are restricted to the actual text of the AMA Guides and cannot use analogies and evidence from outside the AMA Guides. [↩]
Sep
3
2009
Almaraz / Guzman, Case Law, Ogilvie, PDRater, Permanent Disability Rating Schedule, Workers Compensation Resources

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The Board is back!
The Board is back!

Need a FREE sample Ogilvie analysis brief complete with citations?

The Workers’ Compensation Appeals Board is back with their en banc decisions on Ogilvie and Almaraz/Guzman after reconsideration. 1  Download the Ogilvie/Almaraz/Guzman decisions all in one place:

Each of these four is about 50 pages.  Read them carefully, there will be a test later.

  1. Photo courtesy of arturodonate [↩]
Jul
17
2009
2005 PDRS, Case Law, DFEC Rebuttal, Ogilvie, Workers Compensation Resources

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Ogilvie for Dummies
Ogilvie for Dummies

UPDATE: DOWNLOAD THE MATHEMATICAL PROOF AS A PDF!

Get ready to stop paying people to do Ogilvie calculations, recycle your Gearheart/Gerlach handouts, and delete your Frost Excel spreadsheet.1  We’re about to go all “Beautiful Mind.”

Yesterday while at the Oakland WCAB an Applicant’s attorney mentioned he noticed an interesting trend in the Ogilvie formula. 23 He said that whenever he does an Ogilvie calculation for someone with a 100% earnings loss and a modest WPI, the WPI is always increased by 18. 4

I ran a number of test calculations on this theory and it appeared to be right.  My calculations show that up to a WPI of 44 the increase appears to always be 18.1, but the last “0.1” always gets rounded down.  However, appearing to be right just isn’t good enough for me.  And, because I am just truly that nerd, here’s the fully mathematical proof:

Let’s break down the calculations at the heart of Ogilvie:

  1. Earnings Loss56
    1. = (PIESSE – PIEA) / PIESSE
    2. = ($1.00 – $0.00) / $1.00
    3. = $1.00 / $1.00
    4. = 1
    5. = 100%
  2. Individualized Proportional Earnings Loss
    1. = (WPI / Earnings Loss) / 100
    2. = (WPI / 100% )/100
    3. = (WPI / 1) / 100
    4. = WPI / 100
    5. Thus, for any WPI less than 45 and a total loss of earnings, the Individualized Earnings Loss will always be less than 0.450 in Table A.
  3. DFEC Adjustment Factor
    1. = ([1.81/a] * .1) + 1
    2. = ( (1.81 * .1)/a) + 1
    3. = (.181/a) + 1
    4. = 1 + (.181/a)
  4. Ogilvie DFEC Adjusted Rating
    1. = WPI * DFEC Adjustment Factor
    2. = WPI * (1 + (.181/a) )
    3. = WPI * (1 + (.181 / Individualized Proportional Earnings Loss) )
    4. = WPI * (1 + (.181 / (WPI / 100) ) )
    5. = WPI * (1 + (.181 * 100 / WPI ) )
    6. = WPI * (1 + (18.1/ WPI ) )
    7. = WPI * ( (WPI/WPI) + (18.1/ WPI ) )
    8. = WPI * (WPI + 18.1/ WPI )
    9. = WPI * (WPI + 18.1/ WPI )
    10. = WPI + 18.1
  5. Conclusion
    1. If you have an Applicant with a 100% post injury earnings loss and a WPI of 44 or less, you should rebut the FEC and arrive at an adjusted WPI that is equal to the original WPI plus 18.1.

Therefore, I propose a new Ogilvie formula that will be easy for anyone to remember:

  • Step 1: If the injured worker has a 100% earnings loss and a WPI of 44 or less, add 18.1 to the WPI and round down.
  • Step 2: If the injured worker has less than 100% earnings loss or a WPI of 45 or higher, go to Step 3.
  • Step 3: For heaven’s sake, just make your life easier and use the calculators here at PDRater.com.

What do you think?  Leave a comment or drop me a line.

  1. Sorry Jeff, Mark, Mark, and Ray! [↩]
  2. Thank you “S”!  Unfortunately, he did not want to be named. [↩]
  3. Man, I *wish* I could take credit for this observation. [↩]
  4. Not multiplied by 18, but an addition of 18. [↩]
  5. PIESSE = Post Injury Earnings of Similarly Situated Employees [↩]
  6. PIEA = Post Injury Earnings of Applicant [↩]
Jun
27
2009
2005 PDRS, Almaraz / Guzman, AMA Guides, Articles, Case Law, DFEC Rebuttal, Ogilvie, Vocational Rehabilitation, Workers Compensation Resources

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Always room for guest articles at PDRater!
Always room for guest articles at PDRater!

Emily Tincher has recently provided a vocational expert’s perspective on the Ogilvie and Almaraz/Guzman decisions.

Have you got an article on workers’ compensation you’d like to see published?  Drop me a line and let me know.1

Thanks Emily!

P.S. For those of who keeping score at home, this is my 200th post!!!  That’s 200 posts in 357 days or roughly a post every 1.7 days.

  1. Photo courtesy of Stephen Cummings [↩]
Jun
12
2009
Case Law, PDRater, Vocational Rehabilitation, Website Updates, Workers Compensation Resources

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WCAB: Throwing babies out with the bathwater since 1965
The WCAB: Throwing babies out with the bathwater since 1965

For context, its best to see the prior post about the WCAB’s Weiner v. Ralph’s (en banc) decision.  There’s even a link to the Weiner v. Ralphs (en banc) decision for download – just so you can play along at home.

The question in the title of the post is really a question about the WCAB’s rationale – not their end legal justification behind Weiner.  I believe the Weiner case hints that the WCAB is going to go the other way and uphold their rulings in Almaraz/Guzman and Ogilvie.

However, I think the WCAB’s rationale for ending vocational rehabilitation was because of the potential for enormous retroactive vocational rehabilitation maintenance allowance awards at the temporary total disability rate outside the cap (VRTD).12

  1. Photo courtesy of Stephane Raymond [↩]
  2. You see, I’m suggesting that the bathwater is VRTD and the baby itself is vocational rehabilitation.  Kinda kills the metaphor, eh? [↩]
Jun
11
2009
Case Law, PDRater, Vocational Rehabilitation, Website Updates, Workers Compensation Resources

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Weiner v. Ralphs spells the end of rehab
Weiner v. Ralphs spells the end of rehab

The Workers’ Compensation Appeals Board recently solicited amicus briefs regarding the Weiner v. Ralphs case.  After review of the amicus briefs on the topic of the repeal of Labor Code Section 139.5 and vocational rehabilitation, the WCAB has just issued their en banc opinion.1

Download a copy of Weiner v. Ralphs (en banc) right here:

Obviously, you’ll need to read and interpret Weiner v. Ralph’s for yourself.  Here’s the Board’s own summary:

  1. The repeal of section 139.5 terminated any rights to vocational rehabilitation benefits or services pursuant to orders or awards that were not final before January 1, 2009
  2. A saving clause was not adopted to protect vocational rehabilitation rights in cases still pending on or after January 1, 2009
  3. The vocational rehabilitation statutes that were repealed in 2003 do not continue to function as “ghost statutes” on or after January 1, 2009
  4. Effective January 1, 2009, the WCAB lost jurisdiction over non-vested and inchoate vocational rehabilitation claims, but the WCAB continues to have jurisdiction under sections 5502(b)(3) and 5803 to enforce or terminate vested rights; and
  5. Subject matter jurisdiction over non-vested and inchoate vocational rehabilitation claims cannot be conferred by waiver, estoppel, stipulation, or consent.

What does Weiner v. Ralph’s mean to you?

  1. Vocational rehabilitation is gone unless there is a “vested” right by way order that became final prior to 1/1/2009.
  2. If you already have a final order for vocational rehabilitation, the WCAB can still hear a dispute.
  1. Photo courtesy of larryfishkorn [↩]
May
11
2009
Case Law, Downloads, Workers Compensation Resources

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Smith/Amar Reversed
Smith/Amar Reversed

Oral argument on Smith v. WCAB (California Youth Authority) went forward on Smith out that on April 7, 2009.  Today, we have the result – Smith/Amar has been unanimously reversed by the California Supreme Court in case number S150528.  Download a copy and read it for yourself here:

For more background on Smith/Amar, check out my prior post discussing the oral argument.

Apr
14
2009
Case Law, PDRater, Vocational Rehabilitation, Website Updates, Workers Compensation Resources

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The WCAB is soliciting suggestions on vocational rehabilitation
The WCAB is soliciting input on vocational rehabilitation

The WCAB has just issued an “Order Allowing Amicus Briefs” (en banc) in the Weiner v. Ralph’s Company case.1 The Weiner case is about the effect of the legislature’s repeal of Labor Code Section 139.5 as of January 1, 2009.  The repeal of this statute may have the effect of terminating all rights to vocational rehabilitation.

For the curious, you can download a copy of the Order Allowing Amicus Briefs (en banc) here:

The Board is allowing until May 11, 2009 for any interested party to file their own amicus brief on these Weiner vocational rehabiltiation issues.

  1. Photo courtesy of Mathoov [↩]
Mar
17
2009
Almaraz / Guzman, Author, Business, Calculators, Case Law, COLA, Free, Ogilvie, PDRater, SAWW, Technobabble, Website Updates, Workers Compensation Resources

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Indy 500
Indy 500

Wow!  500 registered users!

Last month I mentioned that this website had a record number of new visitors.  I honestly thought that was an anomalous one day spike in traffic.  Instead we’ve had a sustained increase in new visitors and people signing up to use the workers’ compensation calculators for free.

Since February 13, 20091 I’ve enjoyed posting about:

Ever since I relaunched this website I’ve had this idea in the back of my mind that getting to 500 users would be a big deal.  There are literally hundreds of workers’ compensation professionals who rely on this website and its calculators to make their lives a little easier.  This certainly feels like a big deal to me.

  1. When the 400th user registered. [↩]
  2. I am keeping this calculator in beta testing until I get a little more feedback.  If you want to try it out, just drop me a line! [↩]
Mar
13
2009
Almaraz / Guzman, Case Law, Ogilvie, Workers Compensation Resources

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California Court of Appeals, Sixth Appellate District
California Court of Appeals, Sixth Appellate District

Just when you thought things couldn’t get any crazier in workers’ compensation than Ogilvie, Almaraz/Guzman, Benson, and XyzzxSJO2.  Yesterday I found out that on April 7, 2009 the case of Smith v. WCAB (California Youth Authority) is on calendar for oral argument.  As with Almaraz/Guzman, Smith v. WCAB dealt with similar legal issues across two particular workers’ compensation cases.  In case you missed it, here’s the court of appeal decision:

Smith involved an informal denial of medical treatment without a formal petition to terminate medical care under L.C. 4607, after an award of permanent disability. Eight years after Smith’s  award, SCIF refused to authorize epidural injections.  Smith’s attorney sought utilization review, Smith was reexamined by the AME who said the injections were necessary to relieve from the effects of the industrial injury.  Although SCIF then authorized the injections without the need for a hearing, Smith’s attorney sought fees under L.C. 4607.

The WCJ denied Smith’s attorney’s petition for fess since there was no formal petition to terminated medical care.  The WCAB denied reconsideration on the grounds that SCIF’s was not denying all medical treatment.

Amar is substantially similar to Smith, except that in Amar the workers’ compensation judge took the extra step of opining that SCIF’s denial of medical treatment was made in good faith, not unreasonable, and not improper.

However, the 2nd Appellate Court reversed the WCAB in Smith and Amar, stating in relevant part:

“We see no difference when a carrier informally denies some of the treatment that is a necessary part of medical care previously awarded. This is tantamount to a petition to deny medical care even though the carrier continues to provide treatment for some of applicant’s medical care.”

“Insurance carriers who fail to provide previously awarded medical care may not avoid attorney fees to successful applicants’ attorneys through the expedient of an informal denial, even when they do so in good faith.”

I would love to watch the oral argument on this case – but Los Angeles is a bit of a hike for me. 1  I am very very interested to see how this case shakes out.

  1. I last watched oral argument on the Mt. Diablo Unified School District v. WCAB (Rollick) case back on 8/5/2008.  It was particularly interesting for me since I was familiar with the applicant attorney, defense attorney, and facts of that case.  If nothing else, its always fun to watch judges get snarky. [↩]