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

Case No. POM 0261983
Regular
Feb 08, 2009

SARA LARA vs. POMONA UNIFIED SCHOOL DISTRICT, CALIFORNIA COMPENSATION INSURANCE/BROADSPIRE

The lien claimant, Premier Outpatient Surgery Center, sought reconsideration of an administrative law judge's decision that reduced their billed costs for applicant's medical treatment. The Workers' Compensation Appeals Board denied the petition, upholding the judge's finding that the billed costs were unreasonable and that the lien claimant failed to present a persuasive case supporting their charges. The Board also found no evidence of a violation of Labor Code section 4603.2 regarding timely reimbursement.

Kunz v. PattersonWCABLien claimantAmended Findings of FactReasonable and necessary costsBilled costs unreasonableStipulations with Request for AwardIndustrial injuryBilateral upper extremitiesNeck injury
References
Case No. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. STK 188722
Regular
Dec 19, 2008

RICHARD JAMES vs. KRC HOLDINGS, INC. dba DSS COMPANY and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of RELAINCE INSURANCE, in liquidation, KRC HOLDINGS, INC. dba DSS COMPANY and ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration, upholding the original award. The WCJ correctly determined that while applicant's 1999 knee injury and 2001 ankle injury shared some overlapping disability factors, the ankle injury's unique limitation to half-time weight-bearing constituted a separate compensable disability. Therefore, CIGA remains liable for the 1999 injury's permanent disability, and Zurich for the 2001 injury's.

CIGAReliance InsuranceZurich North AmericaKRC HoldingsDSS Companypermanent disabilityoverlappsyche injuryright kneeleft ankle
References
Case No. ADJ3693493
Regular
Oct 01, 2008

RUSSELL STANSBERY vs. WESTSTAFF, INC, AETNA/TRAVELERS INDEMNITY COMPANY OF ILLINOIS

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration regarding the extent of permanent disability and attorney's fees. However, the WCAB granted the defendant's petition to reconsider the period of temporary disability. The WCAB amended the original award to reflect that temporary partial disability was payable from July 1, 1999, through December 6, 1999, acknowledging that the applicant did work modified duty for approximately one month after the injury.

WCABPetition for ReconsiderationFindings Award and OrderPermanent DisabilityTemporary Disability IndemnityAttorney's FeeQualified Medical ExaminerMedical-Legal ReportApportionmentTemporary Partial Disability
References
Case No. ADJ2711930 (OAK 0251340) ADJ1889959 (OAK 0318838)
Regular
Jul 21, 2015

MARK BAXTER vs. WASTE MANAGEMENT, INC., RELIANCE INSURANCE COMPANY, GALLAGHER BASSETT, PASCO SANITATION COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, FREMONT

This case involves complex workers' compensation claims with multiple defendants and insurers, including CIGA, regarding injuries in 1998 and 1999. The appeals board granted reconsideration, rescinded the WCJ's decision, and returned the matter to the trial level. Key issues include the proper application of Insurance Code section 1063.1, the apportionment of liability between successive injuries, and the clarity of the liable entity for the 1999 injury. Further proceedings are needed to address these disputed issues.

Workers' Compensation Appeals BoardReconsiderationFremont Indemnity Insurance CompanyLiquidationCalifornia Insurance Guarantee Association (CIGA)Self-insurance deductibleTransient exacerbationJoint and several liabilityApportionment of liabilitySuccessive injury
References
Case No. ADJ2369949
Regular
Jun 24, 2010

JAHAD AFRIDI vs. HOME SECURITY INC., SETH D. HALLEN

This case involves a workers' compensation claim for an industrial injury to the applicant's spine, psyche, and left elbow sustained on December 3, 1999. The defendant sought reconsideration, arguing the applicant was not an employee at the time of injury as employment allegedly terminated on December 1, 1999. The Board granted reconsideration, amended the defendant's name, but affirmed the original award. The Board found sufficient evidence supported the WCJ's determination that the applicant was an employee on the date of injury, despite some credibility issues with witnesses.

Petition for ReconsiderationFindings and AwardIndustrial InjuryLumbar SpineCervical SpinePsycheLeft ElbowService TechnicianTemporary DisabilityPermanent Disability
References
Case No. ADJ4702564 (RDG 0094598) ADJ6944237
Regular
Apr 17, 2018

CLAUDETTE GILBERT vs. DEPARTMENT OF SOCIAL SERVICES, INHOME SUPPORTIVE SERVICES, YORK RISK SERVICES, ADVENTIST HEALTH OF CALIFORNIA, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns a dispute over reimbursement for medical expenses following two lumbar spine injuries sustained by the applicant. The Department of Social Services (IHSS) sought reimbursement from Liberty Mutual Insurance Company for treatment costs after the applicant's 2008 injury, arguing the 1999 injury contributed to the need for care. However, the Appeals Board found Dr. Sommer's medical opinions lacked substantiality due to inconsistent apportionment and a failure to adequately explain the causal link between the 1999 injury and the 2008 treatment needs. Consequently, IHSS failed to meet its burden of proof, and their claims for reimbursement and shared medical expenses were denied.

Workers' Compensation Appeals BoardReconsiderationIn-Home Supportive Services (IHSS)Legally UninsuredYORK RISK SERVICESADVENTIST HEALTH OF CALIFORNIALIBERTY MUTUAL INSURANCE COMPANYlumbar spine injuryapportionmentmedical opinions
References
Case No. ADJ 8560911
Regular
May 02, 2016

TIM MCDONALD vs. SAN FRANCISCO 49ERS, TIG SPECIALTY COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, rescinding the original award of 73% permanent disability and attorney fees. The Board determined that the 2005 Permanent Disability Rating Schedule, not an older schedule, should be used for rating the applicant's cumulative trauma injury claim filed in 2012. The case is returned to the trial level for a new determination of permanent disability using the 2005 schedule, affirming findings on injury and medical treatment.

Workers' Compensation Appeals BoardSan Francisco 49ersTIG Specialty Companyindustrial injuryprofessional athletefootball playerstrong safetycumulative traumapermanent disabilityapportionment
References
Case No. ADJ3093587
Regular
Jan 16, 2009

ROBERT BABCOCK vs. CROWN DISPOSAL, STATE COMPENSATION INSURANCE FUND

Lien claimants' reconsideration petition denied for lack of substantial medical evidence showing need for home health care services from 1996-1999.

Lien claimantshome health caremedical treatmentcontemporaneous medical evidencesubstantial medical evidenceapplicant's spouseapplicant's daughterpetition for reconsiderationfindings and orderadministrative law judge
References
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