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Case Law Database

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

Case No. ADJ10195617
Regular
Jan 10, 2018

JAVIER ORDAZ MARCIAL vs. NORCAL HARVESTING, LLC, INTERCARE HOLDINGS INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Removal because the WCJ's orders regarding injury AOE/COE and temporary disability were final and subject to reconsideration, not removal. The Board also denied the Petition for Reconsideration, adopting the WCJ's reasoning that resolving AOE/COE on disputed body parts was necessary to determine temporary disability. Furthermore, the Board noted that the issue of credit was not properly before them as it was deferred in prior proceedings. Therefore, the defendant's petitions were rejected.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationAOE/COEDeclaration of Readiness to ProceedExpedited HearingPre-trial conference statementMinutes of Hearing and Summary of EvidenceCreditFinal Order
References
5
Case No. ADJ7392610
Regular
Apr 21, 2014

SAYED SHAH vs. AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA, THE HARTFORD, administered by SEDGWICK CMS

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the finding that the applicant did not sustain an injury arising out of and in the course of employment (AOE/COE) to his back, internal system, psyche, or sleep disorder. The Board affirmed the administrative law judge's (WCJ) determination that the applicant's trial testimony was not credible, and that the medical reports relied upon by the applicant were based on an inaccurate history. The Board also found that the issue of AOE/COE injury was properly raised for trial, as the applicant had placed benefits contingent on an industrial injury in dispute.

Workers' Compensation Appeals BoardAOE/COEFindings and OrderPetition for ReconsiderationWCJCredibility DeterminationDr. Daniel CapenDr. Satish KadabaQualified Medical ExaminerPretrial Conference Statement
References
1
Case No. ADJ444109
Regular
Sep 17, 2013

MICAELA HERRERA vs. EL TORO TORTILLERIA, ENDURANCE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, affirming the judge's order that the lien claimant receive nothing. The Board found the lien claimant failed to prove the applicant sustained an industrial injury AOE/COE, as a Compromise and Release does not automatically stipulate to this. Even if injury AOE/COE were proven, the Board noted the treatment provided, including narcotics and "medical foods," was inconsistent with the QME's recommendation for non-narcotic pain medication. The lien claimant also failed to provide evidence of requested authorization for the disputed treatment.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantFindings of Fact and Orderreasonably necessary treatmentindustrial injuryAOE/COEpreponderance of the evidenceCompromise and ReleaseQualified Medical Examiner (QME)
References
5
Case No. ADJ1966949 (GOL 0095232)
Regular
Mar 19, 2012

ARMANDO OROZCO (ARMANDO OROZCO JUAREZ) vs. PACIFIC VINEYARD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant employer's petition for reconsideration of a finding that the applicant sustained an injury arising out of and in the course of employment (AOE/COE). The employer contended the AOE/COE finding lacked substantial evidence, particularly questioning the applicant's account of falling off a tractor and being run over. The Workers' Compensation Appeals Board (WCAB) denied the petition, adopting the WCJ's report which found the applicant's testimony persuasive, supported by employer witnesses attesting to his trustworthiness, and contradicted by unreliable defense expert testimony. The WCJ also noted a prior employer letter disputing the *nature* of the injury, not its occurrence, and the fact the applicant showed scarring.

AOE/COEPetition for ReconsiderationFinding of FactCompromise and Releasesubstantial evidenceWCJdefendant employerapplicantState Compensation Insurance Fundinjury
References
1
Case No. ADJ12582828
Regular
Jan 03, 2023

TERRY KELLY vs. SAFEWAY

This case involves a workers' compensation claim where the defendant sought reconsideration of an award finding injury AOE/COE to multiple body parts. The primary dispute centers on the applicant's occupational group number, with the applicant claiming "butcher" (420) and the defendant arguing "meat cutter" (322), impacting permanent disability ratings. The Board granted reconsideration, finding insufficient evidence to determine the occupational group number and therefore deferring permanent disability for all affected body parts pending further development of the record. The finding of injury AOE/COE to the applicant's cervical spine, thoracic spine, lumbar spine, bilateral knees, bilateral elbows, and bilateral wrists was upheld.

Occupational Group NumberMeat CutterButcherCumulative TraumaPermanent DisabilityQualified Medical EvaluatorSubstantial EvidenceFurther DevelopmentBody PartsWPI Ratings
References
11
Case No. ADJ9163440
Regular
Oct 05, 2015

INOCENCIO PEDROSA vs. KAISER FOUNDATION HEALTH PLAN

This case concerns a workers' compensation claim where the applicant alleged injury to his right ankle and cervical spine from operating a pallet jack. The defendant disputed the injury AOE/COE, primarily citing surveillance footage and alleged inconsistencies in applicant's testimony. The WCJ found injury AOE/COE based on Dr. Sadler's report, which interpreted the surveillance video as confirming applicant's head hitting a wall, despite the WCJ finding Dr. Sadler's report not substantial due to his failure to consider prior injuries. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the matter for further development of the record, finding no substantial evidence to support the injury finding. Additionally, defense counsel was admonished for improperly submitting extraneous documents with the Petition for Reconsideration.

AOE/COEPetition for ReconsiderationWCJsubstantial evidencecredible witnesssurveillance footagedeposition testimonyprimary treating physicianpanel qualified medical examinersupplemental report
References
7
Case No. MISSING
Regular Panel Decision

L&L Painting Co. v. Contract Dispute Resolution Board

L&L and Odyssey, contractors for lead-based paint removal on the Queensboro Bridge, disputed a contract drawing's interpretation with the Department of Transportation (DOT) concerning scaffolding clearance. Petitioners sought additional compensation after DOT rejected their proposed platform design, claiming a latent ambiguity in the contract. The Contract Dispute Resolution Board (CDRB) denied their claim, finding a patent ambiguity requiring pre-bid clarification. The Supreme Court upheld CDRB's decision, and this appellate court affirmed, concluding that the ambiguity was indeed patent, contrasting 'all roadways' in the note with the drawing's specific references. A dissenting opinion argued against this, stating an engineer would find no ambiguity.

Contract DisputePublic Works ContractQueensboro BridgeConstruction LawContract InterpretationAmbiguityPatent AmbiguityLatent AmbiguityCPLR Article 78Administrative Law
References
0
Case No. ADJ398757 (LBO 0393631)
Regular
Dec 24, 2010

GARY E. MORGAN vs. REYNOLDS BUICK, GMC & PONTIAC, ICW GROUP

The applicant sought removal, arguing that proceeding to trial on injury arising out of and occurring in the course of employment (AOE/COE) without a Qualified Medical Evaluator (QME) opinion would be prejudicial. The defendants asserted factual defenses and their due process rights. The Appeals Board granted removal, finding that the applicant carries the burden of proof for AOE/COE. Therefore, the Board amended the trial order to exclude AOE/COE, allowing only the issue of travel expenses for a QME evaluation to be tried.

Petition for RemovalAOE/COEQualified Medical EvaluatorPQMECompensabilityTravel ExpensesLabor Code Section 4060Burden of ProofIndustrial InjuryMedical-Legal Evaluation
References
0
Case No. ADJ6751788
Regular
Aug 16, 2010

MOISES ROBLES GARCIA vs. ABLE BUILDING MAINTENANCE, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration of a finding of industrial injury for applicant Moises Robles Garcia. Defendant Able Building Maintenance argued the applicant failed to prove injury arising out of and occurring in the course of employment (AOE/COE) and raised affirmative defenses of intoxication and material deviation. The Board rescinded the original decision and returned the case to the trial level for further proceedings, specifically to determine AOE/COE and consider the applicant's credibility and deposition transcripts. The WCJ must now make a determination on AOE/COE and potentially other defenses.

AOE/COEintoxication defensematerial deviationexcluded evidencedeposition transcriptswitness demeanorcredibilitypreponderance of the evidencecausal connectionrational incident of work
References
6
Case No. ADJ6875445
Regular
Aug 02, 2010

JOSE RIVAS vs. NNC MANAGEMENT, LLC/ADP TOTAL SOURCE, SPECIALTY RISK SERVICES

Defendant NNC Management, LLC/ADP Total Source sought removal of a WCJ's order to proceed to trial on both AOE/COE and temporary disability. The applicant claimed an injury in January 2009, and the employer denied it based on a post-termination defense. The defendant argues they were denied due process by being forced to litigate temporary disability without prior notice, as the initial proceedings focused solely on AOE/COE. The Appeals Board granted the petition for removal, amending the order to limit the August 4, 2010 trial to the AOE/COE issue only.

Petition for RemovalPost-termination defenseAOE/COETemporary DisabilityDue ProcessDeclaration of Readiness to ProceedPriority ConferenceMandatory Settlement ConferenceDiscoverySubstitution of Attorneys
References
0
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