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

Case No. ADJ4435696 [ANA 0406876] ADJ1243268 [ANA 0406877]
Regular
Sep 02, 2008

ANN JOHNSON vs. SANTA ANA UNIFIED SCHOOL DISTRICT

The School District failed to provide proper notice of its Medical Provider Network (MPN) to the applicant at the time of injury. The District is liable for reasonable medical treatment self-procured by the applicant.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Santa Ana Unified School Districtnotice requirementsAdministrative Director Rule 9767.12(a)Knight v. United Parcel Serviceburden of proofself-procured treatmentliabilityreconsideration
References
1
Case No. ADJ1609885 (ANA 0410274)
Regular
Jun 14, 2010

JUAN MEDINA vs. SANTA ANA PLATING, STATE COMPENSATION INSURANCE FUND SANTA ANA

This case involves a lien claimant, Main Street Specialty Surgery Center, seeking reimbursement for medical services provided to applicant Juan Medina for an industrial injury on December 13, 2002. The lien claimant filed its application for adjudication on May 29, 2008, over five years after the date of injury and the provision of medical services. The Workers' Compensation Appeals Board reversed the finding of the administrative law judge, holding that the lien claimant's claim is barred by Labor Code section 5405. The Board clarified that lien claimants initiating proceedings must adhere to the same statutes of limitations as the injured worker, and without a timely filed application, recovery is precluded.

Workers' Compensation Appeals BoardReconsiderationOpinion and DecisionFindings and AwardLien ClaimantStatute of LimitationsLachesLabor Code section 4903.5Labor Code section 5405Application for Adjudication
References
3
Case No. ADJ6710001 (ANA) MF ADJ7803228 (ANA) ADJ8017966 (ANA) ADJ8064588 (ANA) ADJ8262934 (ANA) ADJ9093396 (ANA) ADJ9076943 (ANA) ADJ9083545 (SDO) ADJ6925792 (ANA) ADJ8907815 (ANA) ADJ8819925 (ANA) ADJ9087879 (ANA) ADJ9093460 (ANA) ADJ8443963 (ANA) ADJ6829099 (ANA) ADJ6843222 (ANA)
Regular
May 07, 2015

LARRY WATKINS, GORDON BELL, DANIEL BUGGS, JAMES STIENKE, WILLIAM BRYANT, RONALD JOHNSON, ROBERT HYLAND, WALKER GILLETTE, REGGIE RUCKER, ANDREW SELFRIDGE, DOUG VAN HORN, ANANIAS CARSON, JACK GREGORY, THOMAS MULLEN, WILLIE YOUNG, JOHN HICKS vs. NEW YORK GIANTS, NEW YORK STATE INSURANCE FUND, et al.

The Workers' Compensation Appeals Board affirmed an Arbitrator's decision finding the New York State Insurance Fund (NYSIF) liable for workers' compensation claims against the New York Giants. Despite NYSIF's claims of sovereign immunity and limitations to New York coverage, the Board found that the policy's Coverage B provided indemnity for injuries sustained by employees "wherever such injuries may be sustained." The Board emphasized that insurance policy exclusions must be clear, and NYSIF failed to demonstrate any such limitations for injuries occurring outside New York, especially given the team's extensive operations outside the state. The Board also noted that NYSIF's contentions regarding California jurisdiction would be determined on a claim-by-claim basis.

Workers' Compensation Appeals BoardNew York State Insurance FundNew York GiantsSovereign ImmunityComityCalifornia JurisdictionCoverage BOut-of-State InjuriesInsurance Policy LimitationsIndemnify
References
2
Case No. ADJ6710001 (ANA) MF ADJ7803228 (ANA) ADJ8017966 (ANA) ADJ8064588 (ANA) ADJ8262934 (ANA) ADJ9093396 (ANA) ADJ9076943 (ANA) ADJ9083545 (SDO) ADJ6925792 (ANA) ADJ8907815 (ANA) ADJ8819925 (ANA) ADJ9087879 (ANA) ADJ9093460 (ANA) ADJ8443963 (ANA) ADJ6829099 (ANA) ADJ6843222 (ANA)
Regular
May 07, 2015

LARRY WATKINS, GORDON BELL, DANIEL BUGGS, JAMES STIENKE, WILLIAM BRYANT, RONALD JOHNSON, ROBERT HYLAND, WALKER GILLETTE, REGGIE RUCKER, ANDREW SELFRIDGE, DOUG VAN HORN, ANANIAS CARSON, JACK GREGORY, THOMAS MULLEN, WILLIE YOUNG, JOHN HICKS vs. NEW YORK GIANTS, NEW YORK STATE INSURANCE FUND

This case concerns the New York State Insurance Fund's (NYSIF) liability for workers' compensation claims filed by former New York Giants employees. NYSIF argued it was not liable due to sovereign immunity and limitations in its New York-centric insurance policies. The Workers' Compensation Appeals Board affirmed the Arbitrator's decision, finding that Coverage B of the policy broadly indemnified the Giants for employee injuries sustained "wherever such injuries may be sustained," without clear exclusionary language. This coverage extended despite NYSIF's arguments about its New York origin and lack of authorization to write insurance in California. The Board also deferred the jurisdictional question for individual claims to the Workers' Compensation Judge.

Workers' Compensation Appeals BoardNew York State Insurance FundNew York Giantssovereign immunitycomitycoverageextraterritorial injuriesinsurance policy interpretationCoverage Bbusiness operations
References
2
Case No. ANA 0398839, ANA 0398840, ANA 0399440, ANA 0399441
Regular
Jan 07, 2008

Catalina Castellon vs. Harte Hanks, Inc., Ace USA, Adjusted by ESIS

The Workers' Compensation Appeals Board granted reconsideration, reversing the finding that the applicant's October 6, 2004 injury claim was time-barred. The Board held that Labor Code section 5410 permits claims for new and further disability within five years of the injury, provided the employer voluntarily furnished medical treatment, which was established here. The case is remanded to the trial level to consider the applicant's claim for new and further disability related to the elbow injury.

WCABCatalina CastellonHarte HanksACE USAESISANA 0398839ANA 0398840Opinion and Orders Granting ReconsiderationDecision After ReconsiderationLabor Code Section 5405
References
2
Case No. ADJ473373 (ANA 0406381)
Regular
Feb 10, 2012

FERNANDO GUTIERREZ vs. SOCAL FRAMING aka BMHC; ACE AMERICAN INSURANCE, administered by ESIS, INC.

This case concerns applicant's claim for extended temporary disability (TD) benefits beyond 104 weeks due to a left eye injury. The Appeals Board affirmed the WCJ's denial of the "amputation" exception, ruling that the surgical removal of an eye does not fit the statutory definition. However, the Board remanded the case for further development of the record on the "high-velocity eye injury" exception, as the velocity and force of the object that struck the applicant's eye were unclear. The applicant's Petition for Removal was dismissed as reconsideration was the appropriate remedy.

Workers' Compensation Appeals BoardFernando GutierrezSoCal FramingBMHCACE American InsuranceESISInc.ADJ473373ANA 0406381Opinion and Decision
References
1
Case No. ADJ1938415 (ANA 0320426) ADJ463183 (ANA 0320427) ADJ3293437 (ANA 0389203) ADJ2850300 (ANA 0389204) ADJ3164388 (ANA 0389205) ADJ3932115 (ANA 0389206) ADJ686732 (ANA 0389207) ADJ4516220 (ANA 0400646)
Regular
Apr 11, 2014

JOHN SMITH vs. CALIFORNIA STATE UNIVERSITY LONG BEACH, Permissibly Self-Insured, Adjusted by SEDGWICK CMS, BELLFLOWER UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted by YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board granted reconsideration to clarify the Arbitrator's award between two employers for a concurrent cumulative trauma injury. The Board affirmed the finding of a single injury and the apportionment of liability for orthopedic injuries at 50% and respiratory injuries at 63% to CSULB and 37% to Bellflower USD. However, the Board amended the award to explicitly grant Bellflower USD the right to contest the specific amounts paid by CSULB for benefits before the contribution payment is finalized. This amendment addresses Bellflower USD's due process concerns regarding the calculation of contribution.

Cumulative traumaContributionApportionmentPermissibly self-insuredVocational rehabilitationMedical treatment expensesPermanent disability indemnityRespiratory injuryOrthopedic injuryPetition for reconsideration
References
0
Case No. ANA 0369239 ANA 0369240 ANA 0369241
Regular
Oct 03, 2007

STEVEN A. BANKS vs. COCO'S RESTAURANT, CNA

The Workers' Compensation Appeals Board granted reconsideration because the administrative law judge's finding of 100% total disability was based on a legally deficient medical record and an improper application of the *LeBoeuf* doctrine. The Board found the Agreed Medical Examiner's report failed to properly address apportionment and accurate medical history, necessitating further medical development. Consequently, the prior decision was rescinded and the case returned to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardIndustrial InjuryLow BackPsycheTotal DisabilityVocational RehabilitationCommutationAttorney's Fees
References
2
Case No. ADJ3685689 (ANA 0335527) ADJ1125665 (ANA 0345901) ADJ1288486 (ANA 0345902) ADJ3581550 (ANA 0345904) ADJ2369046 (ANA 0335528) MF ADJ2208312 (ANA 0349503)
Regular
Nov 16, 2012

MARIA WENCES vs. JC RESORTS, INC., dba SAND & SURF HOTEL, et. al.; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION; by BROADSPIRE, for CALIFORNIA COMPENSATION and HIH, in liquidation, EBIC, administered by ARROWWOOD INDEMNITY COMPANY

The Appeals Board granted reconsideration of a WCJ's decision, amending the date of cumulative injury to the applicant's lower extremities to September 21, 1998, through February 18, 2000. The Board affirmed the finding that EBIC, as a solvent carrier, must administer the claim and reimburse CIGA for payments made. This reimbursement amount is to be adjusted by the parties. The Board found the Agreed Medical Examiner's opinions constituted substantial evidence supporting the cumulative trauma finding.

Workers' Compensation Appeals BoardMaria WencesJC ResortsSand and Surf HotelCalifornia Insurance Guarantee AssociationCIGABroadspireHIHEBICArrowpoint Capital
References
9
Case No. ADJ1437076 (ANA 0355949), ADJ2064657 (ANA 0355947), ADJ3681784 (ANA 0355948), ADJ495794 (ANA 0355945), ADJ1053460 (ANA 0355946)
Regular
Sep 12, 2019

Ernest Martinez vs. THE HARTFORD, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and affirmed the Workers' Compensation Judge's findings with minor amendments. The Board clarified the award for temporary disability in one claim and corrected clerical errors in another. The applicant, an attorney, raised multiple contentions regarding various injuries, including disputes over permanent disability awards, apportionment of psychiatric disability, and defendant's alleged non-compliance with prior orders. The Board largely adopted the Judge's reasoning, finding Dr. Cohen's apportionment of psychiatric disability to be substantial evidence and rejecting arguments for a single combined permanent disability award.

ADJ1437076ADJ2064657ADJ3681784ADJ495794ADJ1053460Petition for ReconsiderationJoint Findings Awards and OrdersWCJCumulative TraumaHeart Injury
References
3
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