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

Case No. ADJ15513907
Regular
Apr 12, 2023

MARICELA LEON vs. ADVANCE BUILDING MAINTENANCE INC., SECURITY NATIONAL INSURANCE COMPANY, AMTRUST CONCORD

The applicant sought reconsideration of a WCJ's finding that the Appeals Board lacked jurisdiction over medical treatment reasonableness due to a timely utilization review (UR) determination. The applicant argued the UR decision was untimely because it was not served on counsel within two days. The Appeals Board granted reconsideration, finding that a UR decision, even if timely made, is invalid if not timely communicated. Therefore, the matter was returned for a new decision, requiring the WCJ to determine if the UR decision was timely communicated and to adjudicate medical necessity if it was not.

Workers' Compensation Appeals BoardUtilization ReviewTimelinessMedical TreatmentPetition for ReconsiderationFindings of FactLabor CodeDubon IIBodamIndependent Medical Review
References
5
Case No. ADJ3968322
Regular
Apr 29, 2011

GABRIEL CORTEZ vs. THOMAS WYNN & MIA WYNN, UNINSURED EMPLOYERS BENEFITS TRUST FUND

The Workers' Compensation Appeals Board granted reconsideration of a prior decision finding applicant Gabriel Cortez was an employee of defendants Thomas and Mia Wynn. The Board rescinded the decision due to an incomplete record, specifically the absence of the WCJ's actual decision. The matter is remanded for further proceedings and a new decision, allowing parties to address a newly raised Labor Code section 3715(b) issue. The defendants' arguments regarding employment status under Labor Code sections 2750.5, 3351(d), and 3352(h) remain to be fully adjudicated.

Labor Code section 2750.5Labor Code section 3351(d)Labor Code section 3352(h)unlicensed drywall installeremployment relationshipPetition for ReconsiderationReport and RecommendationSupplemental Petition for ReconsiderationLabor Code section 3715(d)WCJ decision
References
3
Case No. ADJ2302824 (LBO 0318405) ADJ4306138 (LBO 0318432)
Regular
Jun 17, 2009

MICHAEL BLACKWELDER vs. INDUSTRIAL DISTRIBUTION GROUP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, RELIANCE INDEMNITY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision that disallowed a lien claimant's claim for over $2,000,000. The Board found the original decision lacked sufficient reasoning and did not adequately address the reasonableness and necessity of the claimant's billing. Due process requires further development of the record to allow for a complete adjudication of the issues. Therefore, the case is returned to the trial level for further proceedings and a new decision.

Workers' Compensation Appeals BoardLien claimantReconsiderationJoint Findings and OrderCompromise and ReleaseLien trialSubstantial evidenceMedical evidenceBill reviewAbuse of discretion
References
5
Case No. MISSING
Regular Panel Decision

Claim of Buchanon v. Adirondack Steel Casting Co.

The Workers' Compensation Board's decision and amended decision, which found that the claimant did not have a total industrial disability, were affirmed on appeal. The employer's argument regarding the untimeliness of the claimant's supplemental notice of appeal was rejected due to lack of proof of service for the amended decision. The Board's plenary authority to modify previous decisions was upheld, as no facts indicated arbitrary or capricious action in amending its prior decision. The court concluded that the Board's finding of no total industrial disability was supported by substantial evidence, noting that the case involved a conflict of medical opinion, which is a factual matter for the Board to resolve. All remaining arguments by the claimant were considered and dismissed.

Workers' Compensation Law § 23Industrial DisabilityAppellate ReviewBoard Decision AffirmationMedical Opinion ConflictSubstantial EvidenceTimeliness of AppealArbitrary and Capricious StandardFactual DisputeClaimant's Appeal
References
4
Case No. MISSING
Regular Panel Decision
Dec 21, 1992

Claim of Stokes v. Permanente

The Workers' Compensation Board initially ruled that the claimant sustained a compensable injury after being struck by a car while crossing a street from a parking lot to her workplace. This decision and an amended decision were subsequently appealed. The appellate court found substantial evidence to support the Board's finding that the injury occurred while the claimant was entering the employment premises, thus arising out of and in the course of her employment. Consequently, the court affirmed the Board's decision and amended decision.

Workers' CompensationEmployment InjuryCompensable InjuryGoing and Coming Rule ExceptionParking Lot InjuryAppellate ReviewBoard Decision Affirmed
References
0
Case No. GOL 0097694
Regular
Nov 09, 2007

SANDRA M. WAYNE vs. GHITTERMAN & GHITTERMAN, STATE COMPENSATION INSURANCE FUND

This Workers' Compensation Appeals Board decision admits deposition testimony of a Qualified Medical Evaluator (QME) over applicant's objection, finding the evidence newly discovered and probative. The Board affirms the judge's finding of temporary total disability based on the QME's unchanged opinion, clarifying it applies only to the admitted cumulative trauma injury claim. The decision limits the award to the admitted claim, deferring adjudication on the denied claim.

Workers' Compensation Appeals BoardQualified Medical EvaluatorTemporary Total DisabilityCumulative TraumaExpedited HearingConsolidationSubstantial EvidenceApportionmentMotor Vehicle AccidentFunctional Restoration Program
References
1
Case No. ADJ2219069 (VNO 0399870)
Regular
Jun 18, 2012

STANLEY VENTUS vs. BFI/ALLIED WASTE INDUSTRIES, AMERICAN HOME ASSURANCE, administered by CHARTIS

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration due to deficiencies in the trial record. The original findings allowed the applicant to pursue additional disability claims beyond the five-year statute of limitations, but the Board found it could not meaningfully review the decision. Crucially, the adjudication file lacked essential documents like the Minutes of Hearing and Summary of Evidence, and no exhibits were formally admitted. Therefore, the case is returned to the trial level for further proceedings and a new decision with a proper record.

Petition to ReopenStatute of LimitationsNew and Further DisabilityStipulations With Request For AwardWCJ FindingsMedical ReportsAdmitted EvidenceAdjudication FileMinutes of HearingSummary of Evidence
References
2
Case No. MISSING
Regular Panel Decision
Apr 08, 2015

Claim of Rosa v. June Electrical Corp.

This case involves appeals from two decisions of the Workers’ Compensation Board concerning a claimant who sustained significant burns and injury in an electrical accident on January 31, 2013, while performing work for June Electrical Corporation (JEC), and subsequently passed away on October 8, 2013. The Workers’ Compensation Law Judge and later the Board determined that an employer-employee relationship existed between the claimant and JEC, established the claim, and awarded compensation, holding the workers’ compensation carrier liable. Subsequently, a federal district court entered a default judgment declaring that the carrier owed no duty to defend or indemnify JEC regarding the accident, prompting the carrier, JEC, and a third-party administrator to appeal the Board's decisions. This court affirmed the Board's amended decision, which clarified that the federal judgment had no collateral estoppel or res judicata effect on the Board's adjudication, primarily because neither the Board nor the claimant were parties to the federal action. The court also found substantial evidence to support the Board's determination of an employer-employee relationship based on the record and corroborated hearsay testimony.

Workers' CompensationEmployer-Employee RelationshipCollateral EstoppelRes JudicataFederal JudgmentState Court JurisdictionAppellate ReviewHearsay CorroborationWorkers' Compensation BoardInsurance Coverage
References
39
Case No. MISSING
Regular Panel Decision

Claim of Farcasin v. PDG, Inc.

Claimant, a director of research and publications, developed neck and shoulder pain radiating to his arms and hands after working for the employer for a month, attributing it to a lack of an ergonomically designed workstation and an outdated computer. A Workers’ Compensation Law Judge initially found he suffered an occupational disease. The Workers’ Compensation Board affirmed this decision, but later amended it, ruling that claimant suffered an accidental injury. The employer appealed both decisions. The Court affirmed the Board's decision, finding no abuse of discretion in amending the prior decision and that substantial evidence supported the finding of an employment-related accidental injury, which can be established by medical evidence of repetitive acts causing debilitating injury, even if symptoms accrued gradually.

Workers' CompensationAccidental InjuryOccupational DiseaseRepetitive Strain InjuryErgonomicsAppellate ReviewBoard DecisionJurisdictionMedical EvidenceGradual Injury
References
7
Case No. ADJ7641549 (MF)
Regular
Dec 19, 2013

JAMES WARDE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS

This case addresses whether an incarcerated individual, awaiting trial due to inability to make bail, is considered "reincarcerated" under Labor Code section 3370(a)(3) for workers' compensation benefit purposes. The applicant argued his custody was not a sentence but a pre-adjudication detention. The Appeals Board affirmed the WCJ's decision, holding that "reincarcerated" broadly includes any confinement in a city or county jail, irrespective of the reason or status of adjudication. The Board found this interpretation aligns with legislative intent to cease benefits when an inmate's basic needs are publicly provided during confinement. Therefore, the applicant is not entitled to temporary disability benefits while in county jail.

Workers' Compensation Appeals BoardLabor Code section 3370ReincarcerationIncarcerationTemporary Disability IndemnityButte County jailPenal or correctional institutionAssigned employmentStipulationsPetition for Reconsideration
References
0
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