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

Case No. ADJ2161557 (VNO 0502907) ADJ2140125 (VNO 0539282)

Regular

Apr 06, 2009

Robert O'Hare vs. OVERNITE TRANSPORTATION, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration to set aside an approved Compromise and Release (OAC&R) due to a discrepancy in reported permanent disability indemnity advances. The defendant claimed the applicant received $\$7,655$ in advances, not the $\$1,000$ stated in the OAC&R. The Board found potential mutual mistake of fact and rescinded the OAC&R, returning the case for either a new settlement or further litigation. The Board's authority to review timely reconsideration petitions allows for rescission even without a showing of traditional "good cause" like fraud.

Compromise and ReleaseOrder Approving Compromise and ReleasePetition for ReconsiderationRescindMutual Mistake of FactPermanent Disability Indemnity AdvancesIndustrial InjuryTruck DriverWorkers' Compensation Appeals BoardAdministrative Law Judge

References

Case No. ADJ11148584, ADJ11607816

Regular

Dec 31, 2018

BRIDGETT LE BOY vs. KAISER PERMANENTE

The applicant sought reconsideration of an Order Approving Compromise and Release (OACR) for $\$28,000.00$ related to back and lower extremity injuries. She argued she would not have settled if she had known her functional capacity test, crucial for her return to work, was approved on the same day as the settlement. The Appeals Board granted reconsideration due to the applicant's allegations and the Board's broad discretion. The OACR was rescinded, and the case was returned to the trial level for further proceedings to determine if the stipulations should be set aside.

Order Approving Compromise and ReleasePetition for ReconsiderationIndustrial InjuryPharmacy TechnicianFunctional Capacity TestMandatory Settlement ConferenceAppeals BoardWorkers' Compensation JudgeGood CauseFraud

References

Case No. ADJ460837 (VNO 0490198)

Regular

Nov 17, 2008

ROSARIO TRUJILLO, vs. ADECCO STAFFING; CSSC,

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of an Order Approving Compromise and Release, which settled applicant Rosario Trujillo's claims for $\$30,000$. The defendant sought to set aside the settlement, arguing a Medicare set-aside analysis used for the settlement was no longer valid at the time of approval. The Board found the defendant made an insufficient showing to set aside the settlement, noting no changed condition had been demonstrated to invalidate the analysis, and that the defendant failed to establish fraud, mutual mistake, duress, or undue influence.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationCompromise and ReleaseOrder Approving Compromise and ReleaseWCJMedicare Set-Aside AnalysisCoventry Workers' Compensation Servicesgood causefraudmutual mistake of fact

References

Case No. ADJ3544094 (SAC 0351694) ADJ2331078 (SAC 0354152)

Regular

May 11, 2009

NORMA HODGES vs. CLARCOR, INC., ST. PAUL TRAVELERS

Defendant seeks reconsideration of an approved Compromise and Release (C&R) for alleged knee and back injuries due to a dispute over the applicant's Medicare eligibility. The C&R contained a provision stating the applicant was not Medicare eligible, but the defendant later learned she was listed as an active beneficiary. The Board granted reconsideration, rescinded the C&R, and returned the case to the trial level. This action allows for further proceedings to resolve the factual conflict regarding Medicare status and address any necessary Medicare set-asides.

Order Approving Compromise and ReleasePetition for ReconsiderationMedicare Secondary Payer lawsQualified Medical EvaluatorGood CauseFraudMutual Mistake of FactDuressUndue InfluenceRescind

References

Case No. ADJ282433 (LAO 0880367)

Regular

Jun 08, 2015

MICHAEL DUFFEY vs. CMH RECORDS, STATE FARM INSURANCE COMPANY

The Appeals Board granted reconsideration to admit previously excluded defendant exhibits, specifically the depositions and report of Drs. Miller and Saint Martin. Despite ruling the exhibits admissible, the Board affirmed the original finding that defendant failed to present substantial evidence to terminate applicant's continuing home health care. Dr. Miller's change of opinion was deemed unsubstantiated, and Dr. Saint Martin's opinion was deemed irrelevant to the specific terms of the prior stipulation. The Board emphasized that admitting the evidence ensures due process and reinforces the integrity of its decision.

Petition for ReconsiderationFindings and AwardHome Health CareSubstantial EvidenceAdmissible ExhibitsDepositionMedical ReportAgreed Medical EvaluatorPrimary Treating PhysicianDue Process

References

Case No. LAO 829404, LAO 815773

Regular

Jul 20, 2007

LOLONDRA McCOY vs. AVIATION SAFEGUARDS aka COMMAND SECURITY, KEMPER GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded a previous award of vocational rehabilitation benefits. The Board found no substantial evidence to support the applicant's claim that her diabetes, left leg amputation, or right toe amputation were industrially caused, despite the treating physician's opinion. The case was remanded to the trial level for further proceedings to clarify industrial causation for the specific body parts claimed as injured.

Vocational RehabilitationIndustrial CausationDiabetesAmputationQMETreating DoctorCompromise and ReleaseThomas FindingContinuous TraumaLabor Code section 5908.5

References

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Robert O'Hare vs. OVERNITE TRANSPORTATION, GALLAGHER BASSETT SERVICES, INC.

BRIDGETT LE BOY vs. KAISER PERMANENTE

ROSARIO TRUJILLO, vs. ADECCO STAFFING; CSSC,

NORMA HODGES vs. CLARCOR, INC., ST. PAUL TRAVELERS

Order Approving Compromise and ReleasePetition for ReconsiderationMedicare Secondary Payer lawsQualified Medical EvaluatorGood CauseFraudMutual Mistake of FactDuressUndue InfluenceRescind

MICHAEL DUFFEY vs. CMH RECORDS, STATE FARM INSURANCE COMPANY

Petition for ReconsiderationFindings and AwardHome Health CareSubstantial EvidenceAdmissible ExhibitsDepositionMedical ReportAgreed Medical EvaluatorPrimary Treating PhysicianDue Process

LOLONDRA McCOY vs. AVIATION SAFEGUARDS aka COMMAND SECURITY, KEMPER GROUP

Vocational RehabilitationIndustrial CausationDiabetesAmputationQMETreating DoctorCompromise and ReleaseThomas FindingContinuous TraumaLabor Code section 5908.5