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

Case No. ADJ6697300
Regular
Aug 31, 2015

Lorenzo Yanez vs. Universal Label Printers, Sparta Insurance Company, Employers Compensation Insurance Company

This case involves an insurance dispute over contribution liability for a workers' compensation claim. The applicant, Lorenzo Yanez, sustained an injury while employed by Universal Label Printers, with coverage from Sparta Insurance Company and Employers Compensation Insurance Company. A Compromise and Release (C&R) agreement was approved, which included an addendum purportedly allocating liability between Sparta (17%) and Employers (87%). Sparta sought to enforce this addendum for reimbursement, but the trial judge denied their petition, finding a lack of jurisdiction due to no separate petition for contribution being filed within the statutory one-year period. The Appeals Board granted reconsideration, finding continuing jurisdiction to enforce the C&R and its addendum under Labor Code section 5803, and returned the matter to the trial judge to determine the enforceability and terms of the addendum.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderCompromise and ReleaseOrder Approving Compromise and ReleasePetition for ContributionLabor Code Section 5500.5Continuing JurisdictionLabor Code Section 5803Apportionment of Liability
References
Case No. RIV 0027402, RIV 0064770
Regular
Jun 02, 2008

DELIA BEJARANO vs. Riverside Community Hospital, INTERCARE INSURANCE SERVICES, ALLIANZ INSURANCE COMPANY, CONTINENTAL CASUALTY COMPANY C/O BROADSPIRE CLAIMS SERVICES, ZURICH AMERICAN INSURANCE C/O BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinded the trial judge's decision, and remanded the case, finding no final agreement on settlement terms was reached between the parties. The applicant signed a compromise and release, but a subsequent addendum unilaterally introduced by one defendant, altering contribution and lien responsibilities, was not agreed upon by all parties. Therefore, no enforceable settlement existed, and the case was returned for further proceedings.

COMPROMISE AND RELEASEMANDATORY SETTLEMENT CONFERENCEADDENDUM CUNILATERAL MODIFICATIONMEETING OF THE MINDSSETTLEMENT AUTHORITYTENTATIVE AGREEMENTLIABILITY AND CONTRIBUTIONLABOR CODE SECTION 5001FAILURE OF CONSIDERATION
References
Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
Case No. ADJ1644458 (SJO 0259802)
Regular
Apr 29, 2011

KENNY PHAN vs. TOBAR INDUSTRIES

In this workers' compensation case, the applicant sought reconsideration after the WCJ found his Labor Code section 132a claim was waived in a Compromise and Release (C&R) agreement. The applicant argued that paragraph 9 of the C&R form, requiring initials for included issues, did not show a waiver of the 132a claim, despite a conflicting provision in an addendum. The Appeals Board found ambiguity in the C&R documents and resolved it in favor of the applicant, amending the WCJ's finding to state no waiver occurred. The case was returned for further proceedings on the 132a claim.

Workers' Compensation Appeals BoardReconsiderationCompromise and ReleaseLabor Code section 132awaiverAddendumambiguityOffer of Proofhearsayburden of proof
References
Case No. SFO 0492831
Regular
Jan 23, 2008

ELIAS MONTOYA vs. ASTON BARNES, INC., STATE COMPENSATION INSURANCE FUND

The Board granted reconsideration to clarify the application of Labor Code section 4656 regarding temporary disability indemnity limits. The Board held that "new and further" disability does not extend the 104-week limit under section 4656(c)(1), nor do spinal disc excisions and bone grafts qualify as "amputations" under section 4656(c)(2)(C). Consequently, the applicant is entitled to temporary disability indemnity only up to two years from the date of the first payment.

Workers' Compensation Appeals BoardElias MontoyaAston Barnes Inc.State Compensation Insurance FundSFO 0492831Opinion and Decision After ReconsiderationTemporary Disability IndemnityIndustrial InjuryThoracic SpineChest Injury
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. SDO 0354449
Regular
Sep 20, 2007

ADAM PERRY vs. HAMMOND \& MASING CONSTRUCTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed a prior award denying additional temporary disability payments beyond the statutory 104-week limit. The applicant sought to extend payments based on his knee surgeries, arguing they constituted "amputations" under Labor Code section 4656(c)(2)(C). The Board held that the term "amputation" in this context refers to the severance of external body parts, not the surgical removal of internal knee fragments or cartilage.

Workers' Compensation Appeals BoardIndustrial InjuryPsyche InjuryTemporary Total DisabilityLabor Code Section 4656(c)(1)Labor Code Section 4656(c)(2)(C)AmputationsOsteochondral FragmentChondroplastyACL Reconstruction
References
Case No. ADJ9641921, ADJ9640385
Regular
Mar 29, 2016

PAZ CORRALES vs. KIMPTON HOTEL AND RESTAURANT GROUP dba KHRG GOLETA, LLC, FEDERAL INSURANCE COMPANY

The Appeals Board granted reconsideration and rescinded the Order Approving Compromise and Release (OACR) due to a problematic Addendum "A". Applicant contends Addendum "A" incorrectly settled their right to future attorney's fees and contains conflicting, unenforceable provisions regarding future claims and confidentiality. The Board found potential jurisdictional issues and inconsistencies with the law, returning the case for an evidentiary hearing to determine if the C&R should be set aside.

Petition for ReconsiderationCompromise and ReleaseAddendum ALabor Code section 5710attorney's feesrescinded OACRevidentiary hearingmistake inadvertence excusable neglectunenforceable provisionsconfidential provision
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. ADJ7709630
Regular
Feb 21, 2012

CARLOS RUIZ vs. VULCAN MATERIAL COMPANY, OLD REPUBLIC INSURANCE

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration regarding temporary disability benefits, finding no exception applied to the 104-week limit. However, the Board granted the applicant's Petition for Removal, rescinded the Order Compelling a medical examination, and returned the matter for further proceedings. This action was taken due to allegations of defendant's violation of Labor Code section 4062.3(c) and potential prejudice to the applicant.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrderOrder Compelling Medical ExaminationLabor Code section 4656(c)(2)Labor Code section 4656(c)(3)temporary disability benefitsstatutory limitamputation exception
References
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