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

Case No. ADJ7432904
Regular
Sep 24, 2012

NEDA MOTAVAKEL vs. FANTASTIC SAM'S, TOWER SELECT INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, STAR INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, ENDURANCE WORKERS' COMPENSATION, SOUTHERN INSURANCE CO., FIRSTCOMP OMAHA

This case involves an appeal by Star and Tower Insurance Companies regarding a workers' compensation award. The primary issue is the applicant's average weekly earnings, specifically the inclusion of tip income, which was not adequately substantiated by documentary evidence. The Appeals Board found the initial decision lacked substantial evidence regarding earnings and rescinded the award. The matter is remanded for further proceedings to properly develop the evidentiary record on earnings and insurance coverage dates before a new decision is issued.

Workers' Compensation Appeals BoardNeda MotavakelFantastic Sam'sTower Select Insurance CompanyStar Insurance CompanyIllinois Midwest Insurance AgencyLLEndurance Workers' CompensationSouthern Insurance CompanyFirstComp Omaha
References
Case No. SRO 0135735
Regular
Nov 06, 2007

ROBERT ANUSEWICZ vs. JOINT INDUSTRY BOARD OF PLUMBING, dba KONOCTI HARBOR INN AND RESORT, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant's entitlement to temporary disability indemnity beyond the standard 104-week limit. The Appeals Board rescinded the prior award, ruling that the applicant's hip and knee replacement surgeries did not constitute "amputations" as defined by Labor Code section 4656(c)(2)(C). Therefore, the applicant is limited to 104 weeks of temporary disability indemnity from the commencement of payments, precluding indemnity beyond January 31, 2007.

Workers' Compensation Appeals BoardRobert AnusewiczJoint Industry Board of PlumbingKonocti Harbor Inn and ResortState Compensation Insurance FundSRO 0135735Opinion and Decision After Reconsiderationtemporary disability indemnityindustrial injuryleft knee
References
Case No. LAO 0848876
Regular
Dec 27, 2007

MARIA MURILLO vs. HI POINT/NORCO RANCH, REPUBLIC INSURANCE by CRAWFORD AND COMPANY

The Workers' Compensation Appeals Board (WCAB) determined that a diskectomy is not an amputation under Labor Code section 4656(c)(2)(C), limiting temporary disability to 104 weeks. The WCAB affirmed the finding that temporary disability should have been paid from October 6, 2006, to November 24, 2006, but reversed the decision to extend benefits beyond the statutory 104-week limit due to a delay in authorizing surgery. Therefore, the applicant is entitled to additional temporary disability indemnity only for the specified period, with the last payment due November 24, 2006.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardMachine operatorIndustrial injuryBilateral shouldersBack injuryTemporary disability indemnityLabor Code section 4656Amputation
References
Case No. ADJ3722656 (BAK 0145213)
Regular
Jul 24, 2014

WILLIAM CASTO vs. GENE WATSON CONSTRUCTION, COMMERCE & INDUSTRY INSURANCE COMPANY BY CHARTIS

This case concerns an applicant suffering severe burns who sought further temporary disability (TD) indemnity after the initial award expired. The Appeals Board overturned the WCJ's 104-week TD cap, finding the 240-week cap for severe burns applicable, extending TD entitlement to August 6, 2007. The Board also adopted the WCJ's calculation of the third-party credit but clarified its application based on the established total civil damages and defendant's comparative negligence. Consequently, the award was amended to reflect the extended TD period and the 240-week statutory cap.

Workers' Compensation Appeals BoardPetition for ReconsiderationTemporary Disability IndemnityPermanent and StationaryLabor Code Section 4656104-week cap240-week capSevere BurnsSubstantial EvidenceMedical Opinion
References
Case No. ADJ4151507 (SFO 0487197)
Regular
Feb 02, 2020

Tracy Sullivan vs. Café Amsterdam, State Compensation Insurance Fund

The Appeals Board granted reconsideration and amended the previous award, finding the applicant's burn injury did not qualify for the "severe burns" exception to the temporary disability indemnity limit under Labor Code section 4656(c)(3)(D). Consequently, temporary disability indemnity is limited to 104 weeks from the commencement of payments on August 10, 2004. The Board affirmed the WCJ's finding that the applicant's psychiatric injury was compensable, meeting the "sudden and extraordinary" employment condition exception. Clerical errors in the original findings were also corrected.

ADJ4151507SFO 0487197Tracy SullivanCafé AmsterdamState Compensation Insurance FundPetition for ReconsiderationFindings Award and OrderWCJindustrial injurycervical spine
References
Case No. LAO 0854553
Regular
Oct 01, 2007

DANIEL A. LONG vs. RYANS EXPRESS MOTORCOACH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding that the applicant's temporary disability payments for a right shoulder injury terminated on February 28, 2007. The Board ruled that the surgical removal of a distal clavicle spur does not constitute an "amputation" under Labor Code Section 4656(c)(2), which requires severance of an external body part. Therefore, the applicant is not entitled to extended temporary disability benefits beyond the statutory 104-week limit.

Distal clavicleAmputation exceptionSection 4656(c)(2)Temporary disability termination104-week limitation240-week limitationRight shoulder surgeryRotator cuff tearJacob Tauber M.D.Hawkins v. Amberwood Products
References
Case No. SAC 0348804
Regular
May 09, 2008

CHESTER WILLIAMSON vs. RADNOR HOLDINGS, dba WINCUP, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the finding that his hip replacement surgery, which involved the removal of the femoral head, did not qualify as an amputation under Labor Code section 4656(c)(2)(C). Consequently, the applicant is limited to 104 weeks of temporary disability benefits. The Board followed its prior en banc ruling in *Cruz v. Mercedes-Benz*, which defined "amputation" as the severance of external body parts and not the removal of internal, non-projecting structures.

Labor Code section 4656(c)(1)amputation exceptiontemporary disability indemnityhip replacement surgeryfemoral head removalcommon sense interpretationCruz v. Mercedes-Benzen banc decisionRadnor HoldingsAIG Claims Services
References
Case No. ADJ14244909
Regular
Apr 25, 2025

YONGQUAN HU vs. AMERICAN ALLIANCE LOGISTICS, INC., LIANG YE, UNINSURED EMPLOYERS BENEFITS TRUST FUND

Applicant Yongquan Hu and defendant Uninsured Employers Benefits Trust Fund (UEBTF) both petitioned for reconsideration of an Amended Findings and Award. The WCJ's initial decision found an industrial injury resulting in permanent total disability and calculated average weekly earnings based on multiple employers. Applicant disputed the wage calculation method, while UEBTF identified an inadvertently omitted week of wages. The Appeals Board granted both petitions, adopting the WCJ's report and amending the decision to reflect corrected average weekly earnings of $1,462.15, leading to a temporary and permanent total disability rate of $974.77 per week.

Workers' Compensation Appeals BoardYongquan HuAmerican Alliance LogisticsInc.Uninsured Employers Benefits Trust FundAdjudication NumberVan Nuys District OfficeOpinion and OrderGranting Petitions for ReconsiderationDecision After Reconsideration
References
Case No. ADJ1379080 (VNO 0509816)
Regular
Jun 25, 2014

SUSAN STOCKTON vs. SPIRENT COMMUNICATIONS, AMERICAN HOME ASSURANCE, AIG CLAIM SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, returning the case to the trial level for further proceedings. The defendant argued the temporary disability award violated the 104-week limit and that the judge mischaracterized a medical examiner. The EDD sought reimbursement for overlapping benefits paid to the applicant. The Board agreed that the 104-week limitation applies and that the EDD's lien needs further review to determine any overlapping benefit payments.

Workers' Compensation Appeals Boardcumulative traumapermanent disabilitytemporary disabilityLabor Code section 4656104 week limitationAgreed Medical Examiner (AME)Qualified Medical Evaluator (QME)Employment Development Department (EDD)lien
References
Case No. ADJ8714258
Regular
Apr 30, 2015

NESTOR HERNANDEZ vs. FSP INC. SERVICES, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Removal and denied reconsideration. The defendant sought to credit payments made to the Employment Development Department against the 104-week temporary disability cap. The Board found the judge's prior clarification of a stipulation was a final order, making reconsideration the proper avenue, not removal. Since reconsideration was denied, the judge's interpretation that payments to EDD do not count against the 104-week cap remains in effect.

Petition for RemovalPetition for ReconsiderationWCJStipulationTemporary Disability Indemnity104-week capLabor Code section 4656(c)(2)EDD reimbursementDeclaration of Readiness to ProceedWCAB
References
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