California Supreme Court denies review of workers’ comp case

August 31, 2011

San Francisco – The California Supreme Court on Aug. 24 declined to review a controversial ruling that gives doctors leeway in determining workers’ compensation disability ratings.

The ruling involved the case of State Compensation Insurance Fund v. Workers’ Compensation Appeals Board, also known as Almaraz.

The case concerned truck driver Mario Almaraz, who filed for workers’ comp after sustaining a back injury on the job. His physician rated his disability at 12 percent using the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5th edition, but noted that the rating did not adequately capture the severity of the injury.

Almaraz appealed to the Workers’ Compensation Appeals Board, arguing that doctors should have latitude in rating disabilities. The board sided with Almarez and ruled that doctors could depart from the schedules in the AMA Guides as long as they stayed within the “four corners” of the Guides. The board’s ruling was affirmed by the state’s 5th Circuit Court of Appeals.

The State Compensation Insurance Fund appealed the board’s ruling, but the Supreme Court’s decision not to review the case means the ruling allowing physician discretion will stand.