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

Case No. ADJ4276340 RDG 0095395 ADJ7960157
Regular
Aug 15, 2013

David Sandrock vs. Independent Business Forms, Inc., Preferred Employers Insurance Company

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and amended a prior decision regarding David Sandrock's cumulative trauma claim. The WCAB found that Sandrock's cumulative trauma injury ending July 28, 2006, is not presumptively compensable because no claim form was filed with the employer, as required by Labor Code sections 5401 and 5402. The Board determined that the insurer, Preferred Employers, did not violate due process by submitting the case on briefs at a conference. The WCAB deferred the issue of injury arising out of and occurring in the course of employment (AOE/COE) and returned the matter to the trial level for further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderCumulative TraumaPresumptive CompensabilityClaim Form90-Day Investigation PeriodDue ProcessIndustrial InjuryAOE/COE
References
1
Case No. VEN 104138
Regular
Jul 08, 2008

CHANDRA DOSHI vs. BLUE CROSS OF CALIFORNIA by BROADSPIRE CLAIMS SERVICES

This case involves a lien claimant seeking reconsideration of a decision that denied a psychological injury claim. The Workers' Compensation Appeals Board granted reconsideration due to uncertainty regarding the administrative law judge's application of Labor Code sections 5402(b) (presumption of compensability for timely denial) and 3208.3 (threshold for psychiatric injury). The Board remanded the case for further proceedings to clarify whether the section 5402 presumption applies and, if not, to re-evaluate the psychiatric injury claim under section 3208.3 with a clear explanation of the reasoning.

Labor Code section 5402(b)presumption of compensabilitypsychiatric injurythreshold of compensabilitypredominant causeactual events of employmentcompromise and releaselien claimantcumulative traumamedical treatment
References
1
Case No. ADJ4433104 (ANA 0381115) ADJ4664599 (ANA 0381113)
Regular
Feb 02, 2016

JOSE CHONG (deceased) vs. SPORTS GRILL, EVEREST NATIONAL INSURANCE COMPANY, AMERICAN COMMERCIAL CLAIMS ADMINISTRATORS, INC., ZENITH INSURANCE COMPANY

This case involves a lien claimant seeking reconsideration of a decision denying applicant's cumulative and specific injury claims, finding a lack of medical evidence and credibility issues with the deceased applicant. The Workers' Compensation Appeals Board granted reconsideration to amend the original order concerning Labor Code section 5402. The Board affirmed the denial of the presumption of compensability, finding the lien claimant failed to meet its burden of proof regarding timely denial by the insurer Zenith. Issues related to Labor Code section 5402(c) were deferred.

WCABLien claimantPetition for ReconsiderationJoint Findings and OrderCumulative InjurySpecific InjuryAOE/COELabor Code section 5402Presumption of CompensabilityApplicant's Credibility
References
0
Case No. VNO 400907, VNO 400906
Regular
Jan 24, 2008

JORGE ESCOBEDO vs. WESTLAKE INN RESTAURANT & HOTEL, CALIFORNIA INDEMNITY INSURANCE COMPANY, SIERRA INSURANCE GROUP

This Workers' Compensation Appeals Board case involves applicant Jorge Escobedo seeking benefits for injuries presumed compensable under Labor Code section 5402. The Appeals Board affirmed the Administrative Law Judge's (WCJ) decision, finding that the defendant failed to rebut the presumption of injury and that applicant's injuries did not require further medical treatment or result in temporary disability, largely based on the WCJ's adverse credibility finding. A dissenting opinion argued that the WCJ's findings on no treatment or disability improperly abrogated the 5402 presumption and suggested appointing a "regular physician" to resolve conflicting medical opinions.

ReconsiderationRebuttable presumptionCompensabilityLabor Code 5402Medical treatmentTemporary disabilityPermanent disabilityApportionmentAttorney's feesSubstantial evidence
References
4
Case No. ADJ967988 (VNO 0449090)
Regular
Jul 01, 2009

MARIA G. MAYA vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying her claim for cumulative trauma injury to various body parts, arguing the employer failed to deny her claim within 90 days, thus triggering a presumption of compensability under Labor Code section 5402. The WCAB denied reconsideration, affirming the trial judge's finding that section 5402's 90-day period does not commence until a claim form is properly filed. The Board noted that the applicant did not provide proof of when the relevant claim form was received by the employer, and an earlier claim form pertained to a different, specific injury. Therefore, the applicant failed to establish the basis for the presumption of compensability.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationAdministrative Law JudgeIndustrial InjuryPermanent DisabilityFurther Medical TreatmentLabor Code Section 5402Presumed CompensableCumulative Trauma
References
2
Case No. ANA 0403219
Regular
May 15, 2008

PHILLIP EVANS vs. COAST GENERAL TIRE, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Appeals Board granted reconsideration, finding the applicant's injury presumed compensable under Labor Code section 5402 due to the employer's untimely denial and failure to provide a claim form. The applicant's unrebutted testimony establishes the industrial nature of the fall and injury. However, the nature and extent of the injury require further medical evaluation through the panel QME process.

Labor Code section 5402presumption of compensabilityequitable estoppelclaim formuntimely denialpanel QMEmedical-legal evaluationindustrial injuryStatute of Limitationsfindings and order
References
3
Case No. ADJ717785 (MON 0357270) ADJ2210479 (MON 0357271) ADJ4156131 (MON 0357272) ADJ2088727 (MON 0357273)
Regular
Oct 12, 2009

GABRIELA MEDINA vs. INNOVATIVE FACILITY SERVICES, GALLAGHER BASSETT ELK GROVE

The Appeals Board granted reconsideration, rescinded the WCJ's decision of July 27, 2009, and returned the matter for further proceedings due to insufficient evidence on applicant's termination date, impacting the application of Labor Code section 3600(a)(10). The Board also noted the need for evidence regarding employer liability under Labor Code section 5402(c).

Workers' Compensation Appeals BoardGabriela MedinaInnovative Facility ServicesGallagher Bassett Elk GroveLien ClaimantArthur Malkin D.C.Joint Findings and OrderLabor Code Section 3600(a)(10)Post-Termination FilingsWCJ
References
0
Case No. STK 0176810
Regular
Apr 22, 2008

YOLIOUS T. SHAHI vs. WEST AGRO, LUMBERMEN'S MUTUAL INSURANCE, BROADSPIRE CLAIMS SERVICES

This case involves an applicant seeking reconsideration of a decision that denied his workers' compensation claim. The applicant argued the presumption of industrial injury under Labor Code section 5402 applied, a point the judge initially claimed was not raised. The Appeals Board granted reconsideration, finding the issue was indeed raised at trial, and remanded the case for the judge to address the presumption's applicability.

Labor Code section 5402presumption of industrial injuryapplicant take nothingFindings and OrdersPetition for ReconsiderationWCJrescindedreturned to trial levelindustrial injurylaborer/chemical worker
References
0
Case No. ADJ9719037
Regular
Nov 27, 2017

MICHELS, William vs. UNIVERSITY OF CALIFORNIA SAN FRANCISCO

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration. The employer sought to challenge a finding that no documents related to the Labor Code section 5402 presumption of compensability were generated after the hearing date. The Board found this objection was based on a stipulation the employer itself made and had not previously contested. Therefore, the employer's petition was denied as it essentially objected to its own prior agreement.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and OrderFindings and OrderAdministrative Law JudgeLabor Code section 5402presumption of compensabilitystipulationrejecting liabilityself-insured
References
0
Case No. VNO 0458244
Regular
Nov 07, 2007

MARIA TORRES vs. WELMARK TEXTILE, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior order denying a lien claimant's claim for reimbursement under Labor Code section 5402(c). The Board found the lien claimant waived the issue by not raising it at trial, and further failed to meet their burden of proof by not demonstrating a claim form was filed or the claim was accepted. Consequently, the lien claimant was ordered to take nothing.

Workers' Compensation Appeals BoardLien ClaimantCumulative TraumaCompromise and ReleaseDeferred IssueLien ConferenceBurden of ProofLabor Code Section 5402(c)SB 899Prospective Application
References
2
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