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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Mangum v. National Union Fire Insurance

A claimant was injured in July 2000 and filed for workers' compensation after her disability claim was denied. The Workers' Compensation Board initially indexed the claim against Career Horizons, Inc., with AIG Claims Services, Inc. as its administrator. AIG failed to appear at multiple hearings, leading to the claim's establishment and penalties. After an initial appeal by AIG, the Board affirmed the establishment but remitted the case to identify the proper carrier. CNA Insurance Company was subsequently identified as the employer's true workers' compensation carrier. The WCLJ and the Board ruled that AIG was estopped by laches from denying coverage. This court, however, reversed the Board's finding of estoppel, concluding that the Board abused its discretion by not addressing evidence suggesting CNA had timely notice of the claim and basing its decision on incorrect employer/carrier identification. The matter was remitted for further proceedings.

Workers' CompensationEstoppelLachesInsurance CoverageCarrier LiabilityThird-Party AdministratorAppellate ReviewRemittalProcedural Due ProcessTimely Notice
References
9
Case No. ADJ3591939 (LAO 07459514)
Regular
Jan 09, 2009

JUANA VENEGAS vs. X-CHANGE PERSONNEL SERVICES, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE, in liquidation, by BROADSPIRE, MERLE NORMAN COSMETICS, AIG CLAIMS SERVICES, INC.

AIG Claims Services, Inc. (AIG) appeals the WCJ's October 20, 2008 determination that the issue of applicant's alleged special employment by Merle Norman Cosmetics must be submitted to arbitration. The Appeals Board dismisses the petition for reconsideration, grants the petition for removal, and rescinds the submission to arbitration.

Special employmentCIGAcovered claimsarbitrationremovalreconsiderationinterim orderfinal orderprejudiceLabor Code section 5275(a)
References
11
Case No. ADJ4662216 (MON 0235398) ADJ1137113 (MON 0264731)
Regular
Jul 17, 2017

REBECCA WERTZ vs. HERBALIFE, AIG CLAIMS SERVICES

This case concerns Dr. Silver's lien claim for fees exceeding the Official Medical Fee Schedule (OMFS). The Appeals Board affirmed the WCJ's decision denying the lien claim, finding no statutory or regulatory basis for an "extraordinary circumstances" exception to the OMFS for services rendered after January 1, 2004. The Board also rejected due process claims regarding the exclusion of evidence and the inability to cross-examine the defendant's bill review expert. The Board concluded that lien claimant failed to prove the services were extraordinary or to demonstrate entitlement to equitable relief.

Workers' Compensation Appeals BoardLien ClaimantOfficial Medical Fee ScheduleOMFSExtraordinary CircumstancesAdministrative Director RuleSB 228Labor Code Section 5307.1Equitable ReliefDue Process
References
13
Case No. MISSING
Regular Panel Decision

Claim of Engler v. United Parcel Service

Claimant, a delivery driver for United Parcel Service, filed a workers' compensation claim in 2001, alleging interstitial pulmonary fibrosis due to exposure to dust and irritants. Initially, a Workers' Compensation Law Judge found he suffered an occupational disease and permanent partial disability. The Workers' Compensation Board affirmed, but the Court reversed in 2003, remitting the case to consider accidental injury. In an amended decision, the Board ruled claimant sustained an accidental injury from airborne irritants. The employer and carrier appealed again. The Court affirmed the Board's decision, finding substantial evidence that the claimant's condition arose from unusual environmental factors within his delivery vehicle, consistent with medical opinions linking his lung disease to mixed dust exposure at work.

Interstitial Pulmonary FibrosisOccupational ExposureWorkers' Compensation BenefitsCausally Related InjuryDelivery Vehicle EnvironmentAirborne IrritantsMedical TestimonyBiopsy FindingsSubstantial EvidenceAppellate Review
References
9
Case No. ADJ590815 (RIV 0081064) ADJ6520585
Regular
Feb 22, 2012

CARMEN MARQUEZ vs. RYLAND HOMES, AIG CLAIMS SERVICES

This Workers' Compensation Appeals Board order denies a Petition for Removal in the case of *Marquez v. Ryland Homes, AIG Claims Services*. The Board adopted and incorporated the reasoning of the workers' compensation administrative law judge's report. Therefore, the Petition for Removal is DENIED.

Workers' Compensation Appeals BoardPetition for RemovalWCJ reportdeny removalRyland HomesAIG Claims ServicesADJ590815RIV 0081064Frank M. BrassNeil P. Sullivan
References
0
Case No. ADJ4669093 (POM 0259861)
Regular
May 06, 2014

JAMES C. RIALS, III vs. SWIFT TRANSPORTATION COMPANY, INC.; AIG CLAIM SERVICES

The Workers' Compensation Appeals Board dismissed James C. Rials, III's Petition for Reconsideration against Swift Transportation Company, Inc. and AIG Claim Services because the petition was untimely filed. The Board adopted the administrative law judge's report and recommendation, finding the petition lacked merit due to its late submission. Furthermore, the applicant was warned that future filings could result in being declared a vexatious litigant.

Petition for ReconsiderationDismissedUntimelyVexatious litigantReport and RecommendationAdministrative law judgeWorkers' Compensation Appeals BoardSwift Transportation CompanyAIG Claim ServicesADJ4669093
References
0
Case No. 02-CV-6666L
Regular Panel Decision
Oct 29, 2008

Brown v. NEW YORK STATE DEPT. OF CORREC. SERVICES

Plaintiff, Curtis Brown, a Correction Officer, sued his employer, the New York State Department of Correctional Services (DOCS), and several individuals for racial discrimination and retaliation under Title VII, Sections 1981, 1983, and the New York Human Rights Law. Brown alleged a hostile work environment due to continuous harassment, verbal abuse, and physical violence by white coworkers at Elmira Correctional Facility since 2001, along with retaliatory discipline. Defendants sought summary judgment. The court dismissed claims against individual defendants under Title VII, all claims against Elmira, the State Comptroller, Civil Service, and all constructive discharge claims due to Eleventh Amendment immunity or other legal deficiencies. However, the court denied summary judgment on Brown's Title VII hostile work environment and retaliation claims against DOCS, finding sufficient evidence of fact disputes for these claims to proceed to trial.

Racial DiscriminationHostile Work EnvironmentRetaliationEmployment LawTitle VIICivil Rights ActSection 1981Section 1983Human Rights LawSummary Judgment Motion
References
83
Case No. CV-22-2154
Regular Panel Decision
Mar 21, 2024

In the Matter of the Claim of Naomi Dent

Naomi Dent, an employee of Amazon.com Services, Inc. in Staten Island, sustained injuries to her left foot, ankle, and lower leg while attempting to board a public bus on her second day of work, claiming she was pushed and trampled. She reported the incident approximately two weeks later and filed a claim for workers' compensation benefits. Both a Workers' Compensation Law Judge and the Workers' Compensation Board denied her claim, ruling that her injuries did not arise out of and in the course of her employment, as the incident occurred off-premises and on public transportation. The Appellate Division affirmed the Board's decision, noting the 'special hazard' alleged was a common risk of public transit, unrelated to employment.

Workers' CompensationCourse of EmploymentArise Out Of EmploymentGoing and Coming RulePublic TransportationOff-Premises InjurySpecial HazardAppellate ReviewSubstantial EvidenceBus Accident
References
7
Case No. ADJ1513511
Regular
Sep 21, 2015

RIZALINA DERRO vs. KAISER PERMANENTE, WEST ANAHEIM MEDICAL CENTER, TERRACE VIEW CONVALESCENT HOSPITAL, COVENANT CARE, SOUTH GATE CARE CENTER, BROADSPIRE, SUN HEALTH CARE, AIG CLAIM SERVICES

The Workers' Compensation Appeals Board denied reconsideration of a decision that found Sun Health Care/Regency and CNA Claims Plus liable for the applicant's left wrist injury. The applicant sustained a cumulative trauma injury to her left wrist during the period of 11-1-1995 to 11-1-1996, while employed by both Covenant Care (insured by AIG) and Sun Health Care (insured by CNA). A previous Compromise and Release barred claims against Covenant Care and AIG, leaving Sun Health Care and CNA liable. The Board adopted the WCJ's report, which relied on medical evidence and legal precedent to uphold the finding of industrial injury and liability.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeCumulative TraumaLeft Wrist InjuryCarpal Tunnel SyndromeCompromise and ReleaseApportionmentDate of InjuryMedical Probability
References
0
Case No. claim No. 1, claim No. 2
Regular Panel Decision

Colley v. Endicott Johnson Corp.

The case involves an appeal from a Workers' Compensation Board decision concerning two claims. The claimant suffered a back injury in 1985, and that claim was closed in 1986. In 2004, while working in Ohio for MCS Carriers, the claimant sustained another back injury. The Workers' Compensation Law Judge ruled that the 1985 claim was barred from reopening by Workers’ Compensation Law § 123 and that New York lacked subject matter jurisdiction over the 2004 claim. The Workers' Compensation Board affirmed these rulings, leading to this appeal. The appellate court affirmed the Board's decision, confirming the applicability of § 123 to the 1985 claim due to lapsed statutory limits and concluding that insufficient significant contacts existed to confer New York jurisdiction over the 2004 out-of-state injury.

Workers' CompensationJurisdictionStatute of LimitationsReopening ClaimOut-of-state InjurySignificant ContactsAppellate ReviewBack InjuryTruck DriverNew York Law
References
6
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