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

Case No. ADJ1457992 (AHM 0084718)
Regular
Dec 26, 2014

DARLENE HELLER vs. COWELL BAKER'S STRIPPING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS, FREMONT INSURANCE COMPANY

This case concerns a dispute over the correct procedure for obtaining medical reevaluations for a worker's injury with a date prior to January 1, 2005. The Appeals Board denied the applicant's petition for reconsideration, reversing an earlier decision that had directed the parties to use the panel QME process. The Board clarified that for pre-2005 injuries, the pre-Senate Bill 899 AME/QME procedures apply, not the current section 4062.2 QME process. One Commissioner dissented, arguing the prior award should be reinstated.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order DenyingFindings and AwardLabor Code section 4062.2panel qualified medical examinationQMEdisputed body partsadmitted liabilitydate of injury
References
3
Case No. 01-42217-REG
Regular Panel Decision

Ames Department Stores, Inc. v. Lumbermens Mutual Casualty Co. (In re Ames Department Stores, Inc.)

This document is a report and recommendation from Judge Robert E. Gerber concerning Ames Department Stores, Inc.'s motion to confirm exclusive jurisdiction in an adversary proceeding against Lumbermens Mutual Casualty Company. The proceeding, occurring under Ames' Chapter 11 bankruptcy, addresses the ownership of an $8 million trust account and alleged interference with the debtor's property. Judge Gerber recommends that the court possesses subject matter jurisdiction over all claims, asserting exclusive jurisdiction over specific claims involving automatic stay violations, marshaling, and equitable subordination. Furthermore, he advises that the McCarran-Ferguson Act does not mandate deferral to an Illinois state court for these issues, and the First Assuming Jurisdiction Doctrine is applicable to certain in rem claims.

Bankruptcy LawJurisdictional DisputeExclusive JurisdictionAutomatic Stay ViolationMcCarran-Ferguson ActIn Rem JurisdictionAdversary ProceedingChapter 11 BankruptcySurety BondsCash Collateral
References
65
Case No. MISSING
Regular Panel Decision

In re Paragon Process Service, Inc.

Paragon Process Service, Inc. appealed a decision by the Unemployment Insurance Appeal Board, which held the company responsible for unemployment insurance contributions for its process servers from 1978 to 1980. Paragon contended that these process servers were independent contractors, not employees, over whom it exercised no control beyond legal requirements. The court, referencing precedents like *Matter of 12 Cornelia St. (Ross)*, determined that the Board lacked a rational basis for classifying the process servers as employees. Consequently, the court reversed the Board's decision. The matter was then remitted to the Unemployment Insurance Appeal Board for further proceedings consistent with this new finding.

Unemployment insuranceIndependent contractorProcess serversEmployer liabilityEmployee classificationAppellate reviewAdministrative decisionRational basis reviewLabor lawNew York law
References
2
Case No. ADJ351684 (LAO 0887175)
Regular
May 03, 2011

JOHNNY STEWART vs. PRAXAIR, INC./OLD REPUBLIC INSURANCE COMPANY; As Administered By BROADSPIRE

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration as the WCJ's order was not final. The Board granted removal, rescinded the WCJ's order, and returned the case for further proceedings. The Board found that the parties had already participated in the AME/QME process, citing the applicant's failure to attend multiple scheduled appointments. Therefore, the WCJ's order compelling further AME/QME participation was premature and prejudicial.

Workers' Compensation Appeals BoardPraxair Inc.Old Republic Insurance CompanyBroadsplireJohnny StewartAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code Section 4062.2Findings of Fact and OrderPetition for Reconsideration
References
0
Case No. ADJ8509489, ADJ8509492, ADJ8509493, ADJ8834631
Regular
Sep 17, 2019

Barbara Stewart vs. State of California, Department of Corrections & Rehabilitation

The Workers' Compensation Appeals Board granted reconsideration, reversing the WCJ's finding that the Agreed Medical Evaluator (AME) was not appropriately replaced. The Board found that due to the AME's impending retirement and unavailability for further discovery regarding the applicant's hypertension and sleep issues, a replacement Qualified Medical Evaluator (QME) panel was validly obtained. Consequently, the parties are ordered to utilize the new QME panel for further evaluation. This decision ensures the applicant's due process rights for discovery on internal medicine claims are protected.

Workers' Compensation Appeals BoardAgreed Medical EvaluatorQualified Medical EvaluatorPetition for ReconsiderationFindings and OrderDue ProcessDiscoveryInternal MedicineHypertensionCirculatory System
References
0
Case No. MISSING
Regular Panel Decision

Ames v. Norstar Building Corp.

This dissenting opinion concerns the Labor Law § 240 (1) claim brought by plaintiff Leigh Ames, a construction worker who suffered injuries from a fall at an elevated work site. Justices Gorski and Lawton argue against the majority's decision to grant defendants' motion for summary judgment, asserting that defendants failed to demonstrate a prima facie showing for dismissal. The dissent contends that Ames's accident, involving a fall while attempting to access an elevated work area, falls under the protections of Labor Law § 240 (1), challenging the majority's conclusion that a doorway threshold is not an elevated work site. Citing numerous precedents, the dissenting justices maintain that the lack of appropriate safety devices for elevated access constitutes a violation of the Labor Law. Therefore, they advocate for denying summary judgment to the defendants and modifying the existing order.

Construction accidentElevated work siteSummary judgmentLabor Law violationDissenting opinionLadder safetyAccess to work sitePrima facie caseWorker protectionPersonal injury
References
15
Case No. ADJ3851886 (LBO 0381289)
Regular
Feb 07, 2011

MARY WEISSMAN vs. LONG BEACH UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted By TRISTAR RISK MANAGEMENT

The Appeals Board granted removal and dismissed the employer's petition for reconsideration. They found the employer was prejudiced by the late admission of the applicant's QME report, violating due process. The Board affirmed the WCJ's order for further medical development by the AME, instructing him to base his opinion on the applicant's deposition testimony. Finally, the May 14, 2010 QME report was struck from the record.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationAgreed Medical EvaluatorQualified Medical EvaluatorIndustrial InjuryCumulative InjuryViral CardiomyopathySubstantial EvidenceDue Process
References
15
Case No. VNO 0549032
Regular
Mar 07, 2008

RANDY MICHAEL MASSEY vs. RADIO EXPRESS, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to trial. The Board found the trial judge erred by ordering spinal surgery without allowing the defendant to properly challenge industrial causation, violating due process and relevant Labor Code sections. The defendant was entitled to pursue the AME/QME process to determine if the need for surgery was industrially caused, not just medically indicated.

Workers' Compensation Appeals BoardRandy Michael MasseyRadio ExpressEmployers Compensation Insurance CompanyChief Information Officerindustrial injuryspinal surgeryPetition for Reconsiderationexpedited trialLabor Code sections 4062
References
1
Case No. ADJ8173186
Regular
Jun 07, 2013

NATHAN LITTLE vs. DIVERSIFIED UTILITY SERVICES, OLD REPUBLIC GENERAL INSURANCE CORPORATION

The Workers' Compensation Appeals Board denied Nathan Little's Petition for Removal concerning a Qualified Medical Examiner (QME) panel. The Board adopted the WCJ's report, which found the QME process was initiated correctly under Labor Code section 4062.2 while the applicant was represented. Although the applicant later became unrepresented, the Board stated the original procedure should be followed for this QME panel. The denial means the applicant must proceed with the designated QME process.

Petition for RemovalQME PanelLabor Code section 4062.1Labor Code section 4062.2unrepresented applicantrepresented applicantsubstantial prejudiceirreparable harmpanel QMEdermatology
References
0
Case No. ADJ10642863
Regular
Feb 25, 2020

LORI SOLA vs. TEMECULA VALLEY UNIFIED SCHOOL DISTRICT

The Appeals Board amended the WCJ's findings, rescinding the conclusions that the QME exhibited bias and failed to comply with time guidelines. However, the Board affirmed the WCJ's disallowance of the defendant's CHP and personnel records as irrelevant to the sole issue of injury arising out of and in the course of employment. The Board also affirmed the finding that neither treating physician's nor the QME's reports constituted substantial evidence, necessitating further development of the medical record, with parties to attempt to agree on an AME or the WCJ to appoint a physician. Commissioner Razo dissented, arguing the excluded exhibits should have been admitted for potential relevance to credibility and due process.

WCABRemovalReconsiderationFindings of FactQualified Medical EvaluatorAgreed Medical EvaluatorPrimary Treating PhysicianSubstantial EvidenceCausationAOE/COE
References
19
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