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

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. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. SAC 0284418
Regular
Apr 04, 2008

AARON CARTER vs. POLYMER TECHNOLOGIES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY

The Appeals Board granted reconsideration, finding that the California Insurance Guarantee Association (CIGA) is contractually obligated to pay U.C. Davis Medical Center's bill based on a prior compromise and release agreement. The Board rescinded the prior decision, ruling that CIGA's agreement to "hold harmless" the applicant from the UCD bill constituted a promise to pay it. The case was returned to the trial level for further proceedings to consider any defenses CIGA may have against the UCD bill.

Workers' Compensation Appeals BoardCIGAPolymer TechnologiesSuperior National Insurance CompanyU.C. Davis Medical CenterU.C. Davis Professional Medical Grouplien claimantscompromise and releasehold harmlesscollateral estoppel
References
Case No. ADJ9076626
Regular
Jul 17, 2015

CIPRIANO NIETO ROJAS vs. METALS, U.S.A., INC.; ACE U.S.A., Administered by GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration of a prior decision. This was done to allow the Board further opportunity to study the factual and legal issues presented. All future filings related to the petition for reconsideration must be submitted directly to the WCAB's Office of the Commissioners, not district offices or e-filed. This order ensures a thorough review for a just decision, and prohibits WCJs from acting on settlements while reconsideration is pending.

Petition for ReconsiderationWorkers' Compensation Appeals BoardADJ9076626Metals U.S.A. Inc.Ace U.S.A.Gallagher Bassett Services Inc.Opinion and OrderStatutory Time ConstraintsFactual and Legal IssuesJust and Reasoned Decision
References
Case No. ADJ9074637
Regular
Dec 03, 2018

ANA RAMOS vs. TRI-STATE EMPLOYMENT SERVICES/ DIAMOND STAFFING; LUMBERMEN'S UNDERWRITING ALLIANCE, in liquidation, administered by CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Appeals Board denied the Petition for Removal because the petitioner failed to demonstrate substantial prejudice or irreparable harm that reconsideration would not adequately address. Additionally, the lien claimant violated WCAB rules by including impermissible attachments to their petition. One attachment documented prohibited ex parte communications with the judge. The lien claimant was admonished to follow Appeals Board rules to avoid potential sanctions.

Petition for RemovalSubstantial PrejudiceIrreparable HarmReconsiderationEx Parte CommunicationLien ClaimantWCAB Rule 10842WCAB Rule 10324(c)SanctionsLabor Code Section 5813
References
Case No. SAC 0056952
Regular
Mar 07, 2008

EDWIN D. REES vs. CHEVRON U.S.A., INC.

This Workers' Compensation Appeals Board case involves a petition for reconsideration filed by the defendant, Chevron U.S.A., Inc. The Board has granted this petition, not based on a final determination, but to allow further study of the factual and legal issues presented. This grants Chevron the opportunity for a more thorough review and potentially further proceedings to ensure a just decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting PetitionDecision After ReconsiderationStatutory Time ConstraintsFactual and Legal IssuesReconsideration UnitSelf-Insured DefendantEdwin D. ReesChevron U.S.A.
References
Case No. ADJ6461309
Regular
Jul 19, 2012

JOSEPH MARTIN vs. City of Ukiah, Permissibly Self-Insured, administered by REDWOOD EMPIRE MUNICIPAL FUND

The Workers' Compensation Appeals Board denied reconsideration, upholding the WCJ's decision regarding air ambulance service fees. The board found that California Administrative Rule 9789.70, which dictates reasonable fees for ambulance services, is preempted by the federal Airline Deregulation Act. This preemption applies because the rule attempts to regulate the prices and services of air carriers, which is exclusively within federal purview. Therefore, the board concluded that the specific fee limitations in Rule 9789.70 do not apply to air ambulance services.

Workers Compensation Appeals BoardAD Rule 9789.70Air Ambulance ServicesAirline Deregulation ActADA Preemption49 U.S.C. § 41713(b)(1)Morales v. Trans World AirlinesState Regulation of Air CarriersWCABPetition for Reconsideration
References
Case No. ADJ1143788 (VNO 0517331) ADJ2670708 (VNO 0517332)
Regular
Jul 01, 2011

SANTIAGO SOTO vs. AUTOZONE, INC., U.S. F& G, Administered By GALLAGHER BASSETT

In this workers' compensation case, the applicant sustained two industrial injuries: one on December 22, 2003 (cervical spine, lumbar spine, left shoulder) and another on September 2, 2004 (right and left knees). The defendant sought reconsideration of the original award, arguing that temporary disability benefits for the earlier injury should be limited by Labor Code section 4656(c)(1). However, the Appeals Board affirmed the WCJ's decision, holding that the 104-week limitation under section 4656(c)(1) applies only to injuries occurring after its effective date of April 19, 2004. Since the applicant's first injury predates this date, the limitation does not apply to it, and benefits are awarded accordingly.

Workers' Compensation Appeals BoardAutoZone Inc.U.S. F& GGallagher BassettSantiago SotoAmended Joint Findings and AwardTemporary DisabilityPermanent DisabilityLabor Code section 4656Foster v. Workers' Comp. Appeals Bd.
References
Case No. SAU2262762
Regular
Sep 17, 2019

KEVIN TUCKER vs. E.L. YEAGER CONSTRUCTION CO., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRISTAR RISK MANAGEMENT

This case concerns whether the California Insurance Guarantee Association (CIGA) must pay a medical lien assigned to EDS Financial Services. The Workers' Compensation Appeals Board denied EDS's petition for reconsideration, upholding a prior ruling that issue preclusion bars EDS from relitigating the lien's status as a "covered claim." The Board found that the identical issues of whether the assigned lien constituted a covered claim under Insurance Code section 1063.1 were actually litigated and decided in a previous case, *Wanda Fullylove*. EDS's arguments regarding separate statutory provisions and the nature of assignments were rejected, as prior litigation fully addressed the claim's covered status under CIGA's statutory framework, including the exclusion for assignee claims.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGACovered ClaimIssue PreclusionCollateral EstoppelInsurance Code Section 1063.1(c)(1)(F)Insurance Code Section 1063.1(c)(9)(B)AssigneeLien Claimant
References
Case No. ADJ9349861
Regular
Aug 08, 2014

Ernest Millette vs. 81 Grand Holdings, Inc., dba California Rehabilitation, Illinois Midwest Insurance Agency, LLC on behalf of PROCENTURY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the prior award of medical care. The Board adopted the judge's report which found the defendant's arguments regarding causation and utilization review (UR) to be unsupported by evidence. The judge admonished defendant's counsel for misstating the record and noted that the defendant failed to provide a clear basis for disputing causation or denying injury benefits within the required timeframes.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportSection 9792.9.1(b)(1)(C)Rule 9792.9.1(b)(1)(D)admonish counselmisstating evidencecausationspecific injuryoccupational therapist
References
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