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

Case No. ADJ6903811
Regular
Apr 21, 2014

Thomas Puentes vs. American Tire Distributors, Inc., XL Specialty Lines Insurance, Inc., adjusted by Broadspire

The Workers' Compensation Appeals Board denied the petition for reconsideration in Thomas Puentes' case against American Tire Distributors. The denial affirmed the judge's finding that the applicant's testimony regarding his prior medical treatment was not credible. This decision was based on extensive medical records showing ongoing treatment and limitations for back pain just days before the admitted industrial injury. The Board applied significant weight to the judge's credibility determination and found the apportionment of disability to be correct and supported by the evidence.

Petition for ReconsiderationWorkers' Compensation Appeals BoardAmerican Tire DistributorsInc.XL Specialty Lines InsuranceInc.BroadsPIREADJ6903811Fresno District OfficeGarza v. Workmen's Comp. Appeals Bd.
References
Case No. ADJ6939425
Regular
Oct 01, 2016

Rene Garcia vs. American Tire Distributors, Broadspire

This case concerns a worker, Rene Garcia, seeking reconsideration of a Workers' Compensation Appeals Board decision. The applicant argued that a stipulation for an Agreed Medical Examiner (AME) should bind the defendant to their recommended bi-level neck surgery. The Board denied reconsideration, affirming the judge's finding that the AME stipulation did not override the statutory requirement to resolve medical treatment disputes through the Utilization Review/Independent Medical Review process. The Board also upheld the denial of attorney fees, as no benefits were awarded under the specific 2011 stipulation.

Workers' Compensation Appeals BoardRene GarciaAmerican Tire DistributorsBroadspirePetition for ReconsiderationFindings and OrderAdministrative Law Judgeunreasonable delaypayment of compensationtemporary disability
References
Case No. ADJ10204001
Regular
Oct 06, 2017

ANIBAL ALVAREZ vs. AMERICAN TIRE DISTRIBUTORS, XL INSURANCE OF AMERICA, BROADSPIRE

The Workers' Compensation Appeals Board denied American Tire Distributors' petition for reconsideration. The defendant sought to overturn a finding that applicant Anibal Alvarez sustained an industrial injury to his low back and cervical/thoracic spine. The Board affirmed the original judge's decision, relying on the applicant's credible testimony and the treating physician's opinion, which it found to be consistent with substantial medical evidence. The Board emphasized the judge's authority to weigh conflicting medical opinions and assess witness credibility.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Orderindustrial injurylow backcervical spinethoracic spinelumbar spineforklift driverpanel Qualified Medical Evaluator
References
Case No. ADJ10125079
Regular
Feb 22, 2017

BIRGIT GALINDO vs. AMERICAN MEDICAL RESPONSE, ACE AMERICAN INSURANCE COMPANY

This case involves a petition for removal filed by the defendants, American Medical Response and its insurer. The Workers' Compensation Appeals Board (WCAB) denied the petition, citing that removal is an extraordinary remedy only granted in cases of substantial prejudice or irreparable harm. The WCAB found that the defendants failed to demonstrate such harm and that reconsideration would be an adequate remedy if an adverse decision is eventually issued. Therefore, the defendants' contentions can be raised with the trial judge.

Petition for RemovalWorkers' Compensation Appeals BoardSubstantial PrejudiceIrreparable HarmReconsiderationWCJ AnalysisAdministrative Law JudgeExtraordinary RemedyFinal DecisionTrial Judge
References
Case No. ADJ169636 (ANA 0384077)
Regular
Nov 01, 2013

SIGRID GOSSERAND vs. KAISER PERMANENTE, KAISER WORKERS COMPENSATION

The Workers' Compensation Appeals Board granted reconsideration, rescinded an order dismissing a lien claim for failure to pay an activation fee, and returned the matter for further proceedings. The dismissed lien claimant, Rehab Solutions, argued their lien should not be dismissed because a lien filing fee was paid in 2005 under a former Labor Code section. The Board found evidence suggesting this prior fee payment and noted that a lien activation fee was not required at that time. The trial judge will now determine if Rehab Solutions paid the prior filing fee on behalf of the official lien claimant, North American Distributors.

Workers' Compensation Appeals BoardLien ClaimActivation FeeFiling FeeLabor Code section 4903.06Labor Code section 4903.05Petition for ReconsiderationWCJRehab SolutionsNorth American Distributors
References
Case No. SRO 0110490
Regular
Jan 14, 2008

DIANE INGRAM vs. DENNY'S RESTAURANTS, CIGA For HIH INSURANCE, In Liquidation, INTERCARE INSURANCE SERVICES, American Casualty Company

This case involves a dispute over reimbursement between the California Insurance Guarantee Association (CIGA) and American Casualty Company (American). CIGA, having paid benefits for an applicant's cumulative trauma injury, sought reimbursement from American, the solvent insurer during a portion of that injury period. The Workers' Compensation Appeals Board affirmed an award of $29,988.31 to CIGA, finding that American's delay in assuming responsibility and existing case law required American to cover CIGA's interim payments, despite American's res judicata arguments.

Workers Compensation Appeals BoardCIGAHIH InsuranceAmerican Casualty CompanyReconsiderationFindings and AwardArbitratorLien ClaimRes JudicataCumulative Trauma
References
Case No. ADJ1607898 (LAO 0879867) ADJ2804252 (LAO 0879869) ADJ4136955 (LAO 0879868)
Regular
Sep 20, 2016

JON VERDOULIS vs. INK SYSTEMS, INC., AMERICAN INSURANCE/FIREMANS FUND INSURANCE COMPANY

This case involves a worker's cumulative trauma claims against Ink Systems, Inc. and American Insurance. The Administrative Law Judge (ALJ) initially found American Insurance liable for certain periods and allowed the applicant to elect against them. American Insurance sought reconsideration, arguing a prior settlement barred claims and their liability was limited by Labor Code section 5500.5. The Appeals Board granted reconsideration, adopting the ALJ's recommendation to amend the decision. The Board ultimately affirmed the original decision except for finding that the applicant *cannot* elect against American Insurance for these cumulative trauma claims.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactCompromise and ReleaseRes JudicataLabor Code section 5500.5cumulative traumaelection against insurerWCJadministrative law judge
References
Case No. POM 283452
Regular
Aug 07, 2007

GUADALUPE OLAGE vs. STAFFMARK, AMERICAN HOME INSURANCE, Adjusted By AIG/AMERICAN INTERNATIONAL CLAIMS

The Workers' Compensation Appeals Board granted reconsideration of a prior award, rescinding it due to insufficient evidence regarding the applicant's average weekly earnings. The Board found the applicant's irregular work hours necessitated a calculation based on earning capacity, but the record lacked evidence to accurately predict this capacity. The case is remanded to the trial level for further proceedings to determine the applicant's average weekly earnings.

Workers' Compensation Appeals BoardGuadalupe OlageStaffmarkAmerican Home InsuranceAIG/American International ClaimsCase No. POM 283452Opinion and Order Granting ReconsiderationDecision after ReconsiderationFindings and AwardIndustrial Injury
References
Case No. ADJ4484214, ADJ1095231, ADJ1532047, ADJ7900801
Regular
May 17, 2017

CANA SWARTOUT vs. ENTERTAINMENT PARTNERS, AMERICAN HOME ASSURANCE, AIG CLAIMS SERVICES, CAST & CREW ENTERTAINMENT, ZURICH NORTH AMERICA, ENTERTAINMENT PARTNERS, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, CNA CLAIMS PLUS

This case involved multiple employers and insurance carriers for Dana Swartout's various work-related injuries sustained between 2002 and 2007. The Workers' Compensation Appeals Board (WCAB) initially issued findings but granted reconsideration to study the issues, including contentions about permanent total disability and statute of limitations. Following settlement conferences, the parties entered into a Compromise and Release agreement, which the WCAB has now approved. The WCAB rescinded its prior order and approved the settlement, finding it adequate and in the applicant's best interest.

Workers Compensation Appeals BoardDana SwartoutEntertainment PartnersAmerican Home AssuranceAIG Claims ServicesCast & Crew EntertainmentZurich North AmericaAmerican Casualty CompanyCNA Claims PlusPermanent Total Disability
References
Case No. ADJ2239874 (STK 0170112) ADJ472994 (STK 0198041) ADJ3391005 (STK0208641)
Regular
Dec 15, 2008

MITCHELL PACHECO vs. INNOVATIVE STEEL SYSTEMS and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT COMPENSATION INSURANCE COMPANY, in liquidation, LENNAR CORPORATION and OLD REPUBLIC INSURANCE COMPANY, RICHMOND AMERICAN HOMES and AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to the trial level. The Board found that the WCJ erred by applying the wrong disability rating schedule and by issuing a combined award for three separate successive injuries. The matter is remanded for separate determinations of permanent disability for each injury, with the 2005 and 2006 injuries to be rated under the 2005 Schedule.

CIGAFremont Compensation Insurance CompanyliquidationInnovative Steel SystemsLennar CorporationOld Republic Insurance CompanyRichmond American HomesAmerican Home Assurance Companyindustrial injuriesneck
References
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