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

Case No. ADJ11629744
Regular
Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

The applicant sought reconsideration after the WCJ denied injury claims to the brain, internal system, psyche, and sexual dysfunction, as well as the issuance of additional QME panels. The Appeals Board granted reconsideration, finding good cause existed for additional QME panels in internal medicine and psychiatry. The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred. The Board concluded that additional QME evaluations were necessary for a full adjudication of the claimed injuries outside of the admitted orthopedic injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche
References
3
Case No. ADJ10917207
Regular
Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute
References
9
Case No. WCB No. G0699039
Regular Panel Decision
Sep 23, 2011

HARRIS, JEFFREY T. v. SCHMIDT, ASHLEY E.

Leo P. DiLuzio sustained work-related injuries to his neck, back, and left knee on July 19, 2005. He was classified with a permanent partial disability and received an additional 25 weeks of Schedule Loss of Use (SLU) for his left knee, making it a 50% SLU. The self-insured employer argued that the 525-week cap on indemnity benefits for concurrent SLU and PPD awards under Workers' Compensation Law § 15(3)(w) should apply, despite the pre-July 26, 2010 accident date. The Workers' Compensation Law Judge (WCLJ) ruled that the claimant was entitled to both SLU and PPD awards without the 525-week cap. The Board Panel affirmed the WCLJ's decision, referencing Matter of Sanchez and clarifying that the 525-week cap in § 15(3)(w) is applicable only to accidents occurring on or after July 26, 2010.

Workers' CompensationPermanent Partial DisabilitySchedule Loss of UseIndemnity BenefitsConcurrent AwardsStatutory InterpretationAccident DateLegislative AmendmentSection 15(3)(w)Section 15(3)(v)
References
1
Case No. MISSING
Regular Panel Decision

Winthrop Baking Co. v. Raimist

The court denied a motion seeking to incorporate additional terms into an existing injunction order. The decision was rendered by a panel of judges including Young, Kapper, Lazansky, Hagarty, and Carswell.

InjunctionMotionOrder DenialCourt DecisionLegal Procedure
References
0
Case No. G107 435
Regular Panel Decision
Jun 02, 2023

Matter of Marku v. ABM Industries

This case concerns the claim of Denise Perry under the Workers' Compensation Law. The Workers' Compensation Law Judge (WCLJ) previously found that the employer, Adventist Home Care, established a violation of Workers' Compensation Law § 114-a by the claimant for willfully making false statements to obtain benefits. Consequently, the WCLJ disallowed indemnity benefits and imposed both mandatory and discretionary penalties. A Board Panel decision filed on February 17, 2022, affirmed the WCLJ's findings. The claimant subsequently filed an application for reconsideration on March 18, 2022, which the Board Panel reviewed. After considering the claimant’s arguments, the Board Panel determined that the application did not raise new issues or present new material evidence, nor did it demonstrate an erroneous statement of material fact or law in the prior decision. Therefore, the Board Panel, by a majority vote, affirmed its prior decision.

Workers' Compensation FraudFalse RepresentationIndemnity Benefits DisallowanceWCL § 114-a PenaltyApplication for Reconsideration DeniedBoard Panel AffirmationWillful MisrepresentationWorkers' Compensation Law Judge DecisionEmployer Established Violation
References
0
Case No. ADJ9453193
Regular
Feb 27, 2018

CRAIG OLIVER vs. ALLEGIS GROUP, ESIS

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinding a prior order for additional QME panels. The WCAB found that the WCJ's interlocutory order was issued without evidence supporting good cause for additional QME panels. Consequently, the matter was returned to the trial level for further proceedings to allow for the proper development of the record.

Petition for RemovalQualified Medical EvaluatorQME panelinternal medicinepain medicinesubstantial prejudiceDeclaration of Readiness to ProceedDORexpedited hearingmandatory settlement conference
References
5
Case No. ADJ9298433
Regular
Mar 28, 2017

ERNEST ALEXANDER vs. LOWE'S HOME CENTERS, LLC; LOWES; SEDGWICK

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal of an order for additional QME panels. Removal is an extraordinary remedy, requiring a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. The Board adopted the WCJ's report, noting the petition was unverified and reconsideration would be an adequate remedy. The WCJ found good cause existed for the additional panels due to disputed body parts and the limitations of the initial podiatrist's specialty.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportsubstantial prejudiceirreparable harmreconsiderationunverified petitionForm 31.7good causeQME panels
References
2
Case No. MISSING
Regular Panel Decision

Trapani v. 10 Arial Way Associates

Cesare Trapani, an employee of P & W Electric, Inc., was injured at a construction site owned by 10 Arial Way Associates and managed by The Marcus Organization, Inc. Both property owner and manager sought defense and indemnification as additional insureds under an insurance policy issued by Assurance Company of America to P & W. A Judicial Hearing Officer initially found them to be additional insureds, a finding upheld by the Supreme Court which denied summary judgment to P & W and Assurance. On appeal, the order was reversed. The appellate court determined that the work contract did not expressly or specifically require additional insured coverage, and a certificate of insurance alone was insufficient. Consequently, the motions by P & W Electric, Inc. and Assurance Company of America were granted, the cross-motions by 10 Arial Way Associates and The Marcus Organization, Inc. were denied, and a judgment was entered declaring that the latter are not entitled to insurance coverage as additional insureds.

Additional InsuredInsurance PolicyContract InterpretationSummary JudgmentDeclaratory JudgmentConstruction Site InjuryThird-Party LiabilityCertificate of Insurance ValidityWork ContractAppellate Procedure
References
11
Case No. ADJ7194315
Regular
Nov 15, 2013

ROSALINDA RODRIGUEZ vs. MERCURY INSURANCE SERVICES, LLC, TRAVELERS PROPERTY & CASUALTY COMPANY OF AMERICA

The Appeals Board granted the defendant's Petition for Removal, rescinding the WCJ's order that removed the case from calendar due to lack of jurisdiction. The WCJ erred in finding he could not rule on the defendant's petition to strike the applicant's request for additional QME panels. The Board determined that Labor Code section 133 and WCAB Rule 10348 grant the WCJ jurisdiction to determine the reasonableness and necessity of such requests. The case is returned to the WCJ to decide whether additional QME panels are warranted.

Petition for RemovalQualified Medical EvaluatorPanel RequestJurisdictionAdministrative Director RuleGood CauseMedical DirectorOff CalendarOrder RescindedReturn to Trial Level
References
0
Case No. ADJ9683216
Regular
Sep 30, 2016

DUNIA DE LA CRUZ vs. SOOD ENTERPRISES, INC. dba JACK IN THE BOX, SECURITY NATIONAL INSURANCE COMPANY ADMINISTERED BY AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) denied defendant's petition for reconsideration and dismissed its petition for removal. The WCAB found that an additional Qualified Medical Examiner (QME) panel in rheumatology was appropriate to further develop the medical record on causation, as recommended by the initial orthopedic QME. Defendant argued the WCJ erred by ordering this without first determining applicant's credibility and AOE/COE, but the Board deemed the need for a rheumatological evaluation a critical issue justifying reconsideration. Therefore, the WCAB upheld the WCJ's order for an additional QME panel.

QME panelrheumatologyAOE/COEcredibilitymedical causationdepositionsupplemental evaluationgood causethreshold issuesreconsideration
References
17
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