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

Case No. ADJ3393930 (AHM 0089017) ADJ2735537 (AHM 0094395)
Regular
May 06, 2013

DAVID CARMONA vs. BMW OF NORTH AMERICA, ZURICH NORTH AMERICA, FIREMAN'S FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration in *Carmona v. BMW of North America*, finding the Workers' Compensation Judge's (WCJ) report insufficient. The WCAB rescinded the WCJ's prior decision and returned the case for further proceedings and a new decision. While the WCJ intended to correct a clerical error regarding cumulative trauma dates, the WCAB felt further development of the record was needed on temporary total disability, but not apportionment related to Dr. Stewart. This is not a final decision on the merits.

DAVID CARMONABMW OF NORTH AMERICAZURICH NORTH AMERICAFIREMAN'S FUNDWORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONADMINISTRATIVE LAW JUDGECLERICAL ERRORCUMULATIVE TRAUMATEMPORARY TOTAL DISABILITY
References
Case No. ADJ7110663
Regular
May 09, 2016

WILLIAM BO MATTHEWS vs. SAN DIEGO CHARGERS, ZENITH INSURANCE COMPANY, NEW YORK GIANTS, INSURANCE COMPANY OF NORTH AMERICA/ACE USA, DENVER GOLD, THE NORTH RIVER INSURANCE COMPANY

This case involves a petition for reconsideration of an arbitrator's decision regarding workers' compensation liability for a professional football player's cumulative trauma injuries. The Workers' Compensation Appeals Board (WCAB) granted reconsideration and modified the arbitrator's award, finding the applicant sustained two separate cumulative trauma injuries due to distinct periods of employment exposure. Consequently, the WCAB ruled that the petitioner, Insurance Company of North America/ACE USA (ESIS), is not liable for contribution to another insurer, The North River Insurance Company (NRIC), which had mistakenly paid a portion of a settlement. The Board affirmed the finding of two injuries, citing a significant break in employment as creating separate compensable periods, but rescinded the award to NRIC, holding NRIC should recover nothing from ESIS.

WCABPetition for ReconsiderationArbitration DecisionContributionCumulative InjuryProfessional Football PlayerInsurance Company of North America/ACE USAZenith Insurance CompanyThe North River Insurance CompanyLabor Code Section 5500.5
References
Case No. ADJ8423237
Regular
Nov 09, 2016

RUBEN SALINAS vs. MAGALY CORPORATION, AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board denied reconsideration, affirming that the lien claimant received due process despite the absence of a formal Notice of Intention to Impose Sanctions. The Board found that the lien claimant had multiple opportunities to respond to the defendant's detailed petitions for sanctions and costs, including a hearing and subsequent amended filings. Therefore, the lien claimant had adequate notice and the opportunity to be heard, satisfying due process requirements.

WCABPetition for Reconsideration DeniedLien ClaimantDue ProcessNotice and Opportunity to be HeardPetition for SanctionsLabor Code § 5813WCJ Report AdoptedSanctions IssueAmended Petition for Sanctions
References
Case No. ADJ8059380
Regular
May 11, 2016

ALVARO ABARCA vs. REIMER FARMS, AMTRUST NORTH AMERICA

This case concerns a dispute over attorney's fees where applicant's attorney, Giron, failed to appear at a lien conference. The WCJ ordered Giron to forfeit his share of the fees to the applicant's former attorneys due to non-appearance. The Appeals Board rescinded this order, finding a potential due process violation due to unclear notice and a lack of opportunity for Giron to be heard on the fee division. The matter was returned to the WCJ to determine reasonable attorney's fees and consider potential sanctions for Giron's conduct.

ADJ8059380Alvaro AbarcaReimer FarmsAmtrust North AmericaLaw Offices of Lionel GironQuinlan Kershawattorney feeslien conferencereconsiderationWorkers' Compensation Appeals Board
References
Case No. ADJ7756309
Regular
Jan 09, 2012

Miguel Robles vs. Evolution Fresh, Inc., Amtrust North America

In **Robles v. Evolution Fresh, Inc.**, the applicant sought reconsideration of a prior decision. The Workers' Compensation Appeals Board granted the petition for reconsideration. This action was taken to allow further study of the factual and legal issues presented in the case. The Board aims to issue a just and reasoned decision after thorough review and potential further proceedings.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationFindings and Decisionstatutory time constraintsfactual and legal issuesjust and reasoned decisionDecision After ReconsiderationOffice of the CommissionersRonnie G. CaplaneDejdra E. Lowe
References
Case No. ADJ178491 (FRE 0247775)
Regular
Aug 15, 2014

FRANCISCO DE LA TORRE vs. QUIRING GENERAL, AMTRUST NORTH AMERICA

This case concerns Francisco De La Torre's workers' compensation claim for a back injury, for which he was later convicted of insurance fraud. The defendant sought to deny permanent disability and medical treatment benefits, arguing the fraud rendered him ineligible. However, the Workers' Compensation Appeals Board affirmed the original award, finding that the permanent disability was based on objective radiological evidence, not the applicant's misrepresentations. The Board also noted that any future contested medical treatment could be addressed individually. Therefore, the defendant's petition for reconsideration was denied.

Workers' Compensation Appeals BoardFrancisco De La TorreQuiring GeneralAmtrust North AmericaPetition for ReconsiderationPermanent DisabilityFurther Medical TreatmentInsurance FraudConvictionIneligibility
References
Case No. ADJ7770118
Regular
Jan 20, 2016

Martha Escobar vs. Vista Cove Care Center, Amtrust North America

This order dismisses a Petition for Removal filed by the applicant, Martha Escobar, in relation to a Workers' Compensation Appeals Board decision. The petitioner formally withdrew their removal petition. Consequently, the Board has dismissed the petition as requested.

Petition for RemovalWithdrawn PetitionWorkers' Compensation Appeals BoardDismissed PetitionVista Cove Care CenterAmtrust North AmericaADJ7770118Anaheim District OfficeDeidra E. LoweRonnie G. Caplane
References
Case No. ADJ8602126
Regular
Nov 09, 2016

SERGIO QUINTERO vs. THE GROWING COMPANY, TOWER INSURANCE AND AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration in the case of Quintero v. The Growing Company. The WCAB adopted and incorporated the reasoning from the workers' compensation administrative law judge's report. The order specifies that the petition for reconsideration is dismissed. Commissioner Caplane, involved in a prior decision, was unavailable.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissedWCJ reportAdministrative Law JudgeSergio QuinteroThe Growing CompanyTower InsuranceAmtrust North AmericaADJ8602126
References
Case No. ADJ10483272
Regular
Mar 08, 2018

ADRIAN FRIAS vs. AVANTI CAFE, TECHNOLOGY INSURANCE COMPANY, AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) denied defendant Avanti Cafe's petitions for reconsideration. The WCAB reviewed the defendant's amended petitions, but found no substantial new grounds for appeal. While the WCAB adopted the workers' compensation judge's report, they specifically excluded the portion addressing the unsigned proof of service, while cautioning the defendant about future compliance. Therefore, the WCAB affirmed the prior decision and denied reconsideration.

Petitions for ReconsiderationAmended PetitionsProof of ServiceAppeals Board Rule 10505Workers' Compensation Administrative Law JudgeDenying ReconsiderationIncorporated ReportComplianceEndorsed StatementSigned Proof of Service
References
Case No. ADJ8396129
Regular
Mar 05, 2014

RENE HERNANDEZ vs. LBH HOTEL CORP., dba MR. C HOTEL, AMTRUST NORTH AMERICA

The Appeals Board granted reconsideration, rescinded the WCJ's finding that the applicant's claim was barred, and found the injury presumptively compensable. This was because the employer failed to deny the claim within the 90-day period required by Labor Code section 5402. The defendant did not present evidence to rebut this presumption or demonstrate they formed the intent to deny the claim within the statutory timeframe. The matter was returned to the WCJ for further proceedings regarding the nature and extent of the injury.

Labor Code § 5402ReconsiderationPresumption of CompensabilityNinety-Day RuleDenial of ClaimPost-Termination ClaimRebuttal of PresumptionPetition for ReconsiderationFindings and OrderWorkers' Compensation Appeals Board
References
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