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

Case No. ADJ9743291
Regular
Nov 06, 2018

CDWARD DE LA ROSA vs. ALL AREA PLUMBING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) dismissed applicant Edward De La Rosa's removal petition, finding the WCAB lacks jurisdiction over his claim. De La Rosa failed to timely dispute his claim denial through the mandatory Alternative Dispute Resolution (ADR) process, as required by his union's agreement. Specifically, he did not request a Qualified Medical Evaluator within the prescribed 30-day period after receiving notice of denial. This failure to follow the ADR procedures, including timely dispute resolution steps, bars the WCAB from adjudicating the merits of his injury claim.

RemovalLabor Code section 5301Petition for RemovalDue ProcessJurisdictionADR ProgramCertified RecordApplication for AdjudicationPetition to DismissQualified Medical Evaluator
References
Case No. ADJ1403472
Regular
Dec 29, 2008

ALEKSANDER YAMNITSKIY vs. MORROW-MEADOWS CORP., ST. PAUL TRAVELERS

The Workers' Compensation Appeals Board denied the defendant's petition for removal, which sought dismissal of the applicant's claim based on a collective bargaining agreement's alternative dispute resolution (ADR) provisions. The Board found insufficient evidence regarding the operative eligibility letter for the ADR plan at the time of the applicant's injury. The case is returned to the trial level to determine if the defendant can provide the necessary documentation to establish the ADR plan's applicability and warrant dismissal.

ADRLabor Code Section 3201.5collective bargaining agreementpetition for removalworkers' compensationapplication for adjudicationeligibility letterAdministrative DirectorWCJdismissal
References
Case No. ADJ7188251 ADJ7188272
Regular
Jan 29, 2010

Raymond Mark vs. City of Los Angeles

The Workers' Compensation Appeals Board granted reconsideration of an Arbitrator's award of temporary partial disability for a sleep disorder. The defendant argued that the case fell under an ADR "carve-out" provision and that the chosen Qualified Medical Evaluator found the sleep disorder non-industrial. The Board rescinded the Arbitrator's decision because the record lacked a proper Minutes of Hearing and Summary of Evidence, which is crucial for meaningful review of ADR cases. The matter was returned to the Arbitrator for further proceedings and a new decision.

ADRCarve-out caseQualified Medical EvaluatorAgreed Medical EvaluatorSleep disorderTemporary partial disabilityArbitrator's DecisionReconsiderationMinutes of Hearing and Summary of EvidenceDue process
References
Case No. ADJ6634260
Regular
Aug 02, 2010

MELCHOR ELIZARRARAS vs. MIKE BUBALO CONSTRUCTION COMPANY, SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior finding that the parties were not subject to an Alternative Dispute Resolution (ADR) process. The Board found the original decision was based on unclear issues and the record may support a valid ADR process applicable to the applicant's injury. The case is returned to the trial level for further proceedings and a new decision on whether the applicant's injury is covered by a valid ADR system under Labor Code §3201.5.

Labor Code §3201.5Alternative Dispute ResolutionADR systemcollective bargaining agreementSouthern California District Council of LaborersMike Bubalo Construction CompanySeabright Insurance Companyindustrial injurylow back injuryright shoulder injury
References
Case No. ADJ8098049
Regular
Oct 01, 2013

SEZETTE DUBAY, as conservator for CARI PILLO on behalf of JOHN PILLO (deceased) vs. CONTRA COSTA ELECTRIC, INC., insured by AMERICAN CASUALTY COMPANY OF REDDING, PENNSYLVANIA, Adjusted by SEDGWICK CMS, et al.

This case concerns whether a deceased employee's death benefit claim falls under an Alternative Dispute Resolution (ADR) carve-out agreement. The defendant argued that arbitration agreements bind non-signatories and should apply to death benefits, likening them to derivative wrongful death claims. However, the Appeals Board affirmed the WCJ's decision, finding Labor Code section 3201.5 clearly limits ADR to disputes "between employees and employers." The Board reasoned that a dependent's claim for death benefits is an independent statutory right, not a dispute between an employee and employer, thus outside the scope of the ADR carve-out.

ADR carve-outnon-signatorywrongful death claimdependentsemployee definitionLabor Code 3201.5collective bargaining agreementinter vivos benefitsarbitrationWCJ
References
Case No. ADJ11364300
Regular
May 24, 2019

JOHN MANNING vs. ORANGE COUNTY FIRE AUTHORITY

This case involves a dispute over an applicant's entitlement to an Independent Medical Examiner (IME) under an Alternative Dispute Resolution (ADR) agreement governing workers' compensation claims. The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration, finding the original order was not a final decision. However, the WCAB granted the petition for removal, rescinded the administrative law judge's finding that no IME was warranted, and returned the case for further proceedings. The WCAB determined it was unclear whether it had jurisdiction to rule on the medical-legal discovery dispute, as parties cannot confer jurisdiction by stipulation, and ordered the trial judge to determine if the ADR program or the WCAB has jurisdiction.

ADR agreementCalifornia Labor Code §3201.7Independent Medical Examiner (IME)removalreconsiderationWorkers' Compensation Appeals Board (WCAB)specific injurycumulative traumafire captainskin cancer
References
Case No. ADJ14547470
Regular
Apr 17, 2025

RICHARD LYNN vs. CONTRA COSTA ELECTRIC, AMERICAN CASUALTY COMPANY OF READING, PA

The Workers' Compensation Appeals Board granted reconsideration to applicant Richard Lynn, who challenged a Workers' Compensation Arbitrator's (WCA) denial of his right to a Qualified Medical Evaluator (QME) examination. The WCA had found that Lynn forfeited this right by not attending a scheduled QME exam, citing an Alternate Dispute Resolution (ADR) agreement. The Board determined that the ADR section did not mandate forfeiture and that the WCA, like a WCJ, possessed discretion to appoint a medical examiner to ensure due process and fully adjudicate issues, especially given the lack of medical-legal reporting on industrial causation. Consequently, the Board rescinded the WCA's Findings and Order and returned the matter for further proceedings consistent with its decision.

ADR ProgramQMELabor Code Section 3600(a)(10)NECA/IBEWsubstantial justicedue processmedical-legal evaluationrescindedreturnedarbitraton
References
Case No. ADJ7188251; ADJ7188272
Regular
Mar 08, 2013

Raymond Mark vs. City of Los Angeles

This case involves a petition by applicant Raymond Mark to resubmit or remove two workers' compensation cases, alleging the City of Los Angeles refused to fund an arbitrator. The Appeals Board dismissed the petition for three reasons: no arbitrator decision existed for review, the underlying claims were previously dismissed giving the Board no jurisdiction, and the Board lacks jurisdiction over disputes concerning the administration of the Alternative Dispute Resolution Agreement itself. The Board concluded that the applicant's recourse for funding disputes lies in collective bargaining, arbitration, or petitioning the Administrative Director to decertify the agreement.

Petition for ResubmissionADR CasesL.C. § 3201.7ADR ARB IVCity of Los AngelesFunding ArbitratorOpinion and Order Granting ReconsiderationDecision After ReconsiderationOrder of DismissalJurisdiction
References
Case No. ADJ7188251; ADJ7188272
Regular
Dec 30, 2013

RAYMOND MARK vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's "Petition for Re-Submission of ADR Cases" for being identical to a previously dismissed petition. The WCAB cited the same reasons as the prior dismissal in their Opinion and Order. The Board warned that further attempts to obtain action in violation of Labor Code section 3201.7 may be construed as a bad faith action, potentially leading to sanctions. Therefore, the applicant's petition was dismissed.

Petition for ResubmissionRemovalLC § 3201.7ADR ARB IVBad Faith ActionSanctionsLabor Code Section 5813Workers' Compensation Appeals BoardCity of Los AngelesPermissibly Self-Insured
References
Case No. ADJ7160971
Regular
Jan 12, 2015

JACINTO CATILLO vs. SANTA CLARITA INTERIORS, ZURICH AMERICAN INSURANCE CO

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of the defendant's petition to review an arbitrator's award finding the applicant sustained a lumbar spine injury. The defendant's petition for reconsideration was potentially untimely and filed with the incorrect district office for this ADR carve-out case. The WCAB will issue a notice of intention to dismiss unless the defendant provides proof of timely filing with the correct office. The defendant has 15 days to submit documentation demonstrating the petition was timely filed.

Petition for ReconsiderationArbitrator's Findings and AwardJourneyman CarpenterLumbar SpinePermanent DisabilityApportionmentTemporary Total Disability IndemnityArbitrator's Report and RecommendationElectronic Adjudication Management SystemADR carve-out case
References
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