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

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. 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
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 The Board rescinded the original decision and returned the case to the trial level for further proceedings, specifically to determine AOE/COE and consider the applicant's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. ADJ7104046
Regular
May 17, 2011

TOMMIE WRIGHT vs. SUPREME COURT OF CALIFORNIA, CORVEL CORPORATION, INC.

In this workers' compensation case, the defendant petitioned for removal, arguing the trial should not proceed due to issues with the Agreed Medical Evaluator's (AME) review and deposition scheduling, as well as the applicant's failure to raise the injury AOE/COE in her declaration of readiness. The Appeals Board granted the petition, finding the applicant's omission of AOE/COE from her DOR problematic. Consequently, the Board redesignated the scheduled trial as a mandatory settlement conference to allow for further resolution, especially after the AME provided a supplemental report.

Petition for RemovalAgreed Medical Evaluator (AME)Declaration of Readiness to Proceed (DOR)Mandatory Settlement Conference (MSC)Injury Arising Out of and Occurring in the Course of Employment (AOE/COE)Supplemental ReportDepositionPretrial Conference StatementWorkers' Compensation Administrative Law Judge (WCJ)Workers' Compensation Appeals Board (WCAB)
References
0
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. ADJ10887940
Regular
May 30, 2019

ONISSA DAVIS vs. KAISER FOUNDATION HEALTH PLAN, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to amend a previous decision. The Board found that the "going and coming rule" does not bar the applicant's claim. However, the issue of whether the injury arose out of and occurred in the course of employment (AOE/COE) was not litigated at trial. Therefore, the Board deferred the AOE/COE issue, allowing parties to proceed with it later if ready.

Petition for ReconsiderationGoing and Coming RuleInjury AOE/COEWorkers' Compensation Appeals BoardWCJFindings and OrderMinutes of Hearing and Summary of EvidenceIndustrial InjuryCompensabilitySubstantial Evidence
References
0
Case No. ADJ12304192
Regular
Mar 27, 2023

JOANNA ELLIOTT vs. PEPPERDINE UNIVERSITY, ADMINISTERED BY GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration and amended the WCJ's decision. While the applicant is presumed to have sustained injury AOE/COE for asthma and digestive issues, the issue of lung disease and nose/throat injury AOE/COE was not properly framed for trial. Therefore, this specific issue has been deferred, pending further proceedings. The WCAB affirmed the WCJ's other findings based on the existing record.

AOE/COEPetition for ReconsiderationWorkers' Compensation Appeals BoardLung DiseaseAsthmaUpper Digestive SystemNose and Throat InjuryDeferred IssueFindings and OrderMedical Evidence
References
0
Case No. ADJ7336122
Regular
Sep 19, 2011

MAXIMINO ULTRERAS vs. COTTAGE HEALTH SYSTEMS

The defendant sought reconsideration and removal of an order vacating submission and appointing a physician due to inadequate medical evidence. The Appeals Board denied removal, finding no irreparable harm. However, it granted reconsideration to rescind the finding of injury arising out of and in the course of employment (AOE/COE). The Board determined that substantial medical evidence was lacking to support the AOE/COE finding and returned the matter to the trial level for further proceedings.

WCABRemovalReconsiderationVacating SubmissionAppointing Regular PhysicianL.C. § 5701AOE/COECumulative InjuryMedical EvidenceSubstantial Evidence
References
12
Case No. ADJ8041070
Regular
Aug 20, 2014

JUANA MONROY vs. GATE GOURMET INC., TRAVELERS, XL SPECIALTY INSURANCE COMPANY

The Appeals Board denied Travelers' Petition for Removal, which sought to reverse an order taking the case off calendar. The Board found that placing the matter off calendar would not cause substantial prejudice to Travelers. However, due to a genuine issue regarding injury arising out of and occurring in the course of employment (AOE/COE), the Board ordered bifurcation of that issue. The case will be reset for a priority conference, and if the AOE/COE issue is not resolved, it will proceed to trial on that specific matter.

Petition for RemovalOff Calendar OrderAOE-COEBifurcationAgreed Medical EvaluatorWCJ Report and RecommendationSubstantial PrejudiceIrreparable HarmPriority Conference CalendarPretrial Conference Statement
References
0
Case No. ADJ9876617
Regular
Nov 09, 2016

JANET MAUS-SCHAD vs. LAW OFFICES OF JAVIER A. ALABART, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to review a prior decision finding applicant sustained injury AOE/COE and rejecting defendants' statute of limitations and other defenses. The Board rescinded the prior decision and returned the matter to the WCJ for further development of the record. Specifically, the Board found that while the defendants' argument that a prior settlement barred the current claim was legally unsupported, the medical evidence on causation was insufficient and inconsistent, requiring further development. The Board also noted that the issue of injury AOE/COE was not explicitly submitted for decision at trial, despite the WCJ's finding.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings of Fact Order OpinionInjury AOE/COEStatute of LimitationsCumulative Trauma InjuryCompromise and ReleaseLabor Code Section 5005Res JudicataSubstantial Evidence
References
4
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