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

Case No. ADJ3623428 (MON 0334798) ADJ1196230 (MON 0334799)
Regular
Feb 08, 2010

FREDERICK DOMINGUE vs. CEDAR SINAI MEDICAL CENTER

Defendant Cedar Sinai Medical Center sought reconsideration of an approved Compromise and Release (C&R) for $99,000, settling applicant Frederick Domingue's claims for various injuries, including psyche, respiratory, and cancer. Defendant argued CMS approval was a condition precedent, applicant failed to disclose terminal brain cancer, and the WCJ abused discretion due to applicant's death post-execution but pre-approval. The Appeals Board denied reconsideration, finding no evidence CMS approval was required given the C&R's terms and CMS guidelines, and that the WCAB has discretion to approve a C&R even after an applicant's death. Furthermore, the Board found no sufficient evidence of nondisclosure of a separate terminal brain cancer condition.

Compromise and ReleasePetition for ReconsiderationOrder Approving Compromise and ReleaseMedicare Set AsideCMS approvalcondition precedentindustrial injurypsycherespiratory systemspine
References
Case No. ADJ8873556
Regular
Jun 03, 2016

LUIS ALVARENGA vs. SCOPE INDUSTRIES, COMMERCE & INDUSTRY INSURANCE, AIG CLAIMS

The Workers' Compensation Appeals Board granted reconsideration and rescinded an order approving a Compromise and Release (C&R). The defendant argued for rescission based on a mutual mistake regarding the necessity of CMS approval for the Medicare Set Aside (MSA) amount. While CMS approval is not mandatory, the Board found the C&R inadequate as written. Specifically, the settlement did not adequately account for the MSA amount in relation to the applicant's net recovery, and the applicant was not fully advised of potential Medicare benefit denials if CMS review was bypassed. The case is returned for further proceedings to address these adequacy issues.

Compromise and ReleaseMutual MistakeMedicare Set AsideCMS ApprovalPetition for ReconsiderationOrder Approving Compromise and ReleaseRescindGood CauseFuture Medical TreatmentAdequate Consideration
References
Case No. ADJ8239362
Regular
Aug 01, 2019

ADAUCO LOPEZ (DECEASED), EDUVIGES LOPEZ vs. DESERT FALLS PROPERTY & MANAGEMENT, ULLICO CASUALTY COMPANY in liquidation, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involved a dependency claim for the deceased worker, Adauco Lopez, with Eduviges Lopez as the applicant. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the facts and law. Following a settlement conference, the parties submitted a Compromise and Release (C&R) agreement for approval. The WCAB approved the C&R, awarding $55,000 to the applicant, but reduced the attorneys' fees from $11,000 to $9,900, finding that amount to be reasonable and in the applicant's best interest.

Compromise and ReleaseUllico Casualty Company in liquidationCalifornia Insurance Guarantee Associationdependency claimappeals board approvalLabor Code section 5001WCAB Rule 10882Labor Code section 5002settlement adequacyattorneys' fees
References
Case No. ADJ2244538 (LAO 0883304)
Regular
Jul 29, 2011

MELVIN ISAAC vs. PARAMOUNT PICTURES

This case involves the Workers' Compensation Appeals Board (WCAB) removing a matter on its own motion to review a Compromise and Release (C&R) order. The WCAB issued a Notice of Intention to approve the C&R with addenda, allowing parties 20 days to object. As no objections were received, the WCAB rescinded the WCJ's prior approval and entered a new order approving the C&R with the addenda. The cases are now returned to the trial level for further proceedings.

Workers' Compensation Appeals BoardRemovalCompromise and ReleaseAddendaWCJ OrderRescindedApprovedTrial LevelParamount PicturesMelvin Isaac
References
Case No. ADJ8308192 ADJ11314956
Regular
Sep 12, 2019

LILY LOPEZ vs. ST PASCHAL BAYLON CATHOLIC CHURCH, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board rescinded the trial judge's decision finding mutual mistake regarding a Medicare Set Aside (MSA) and CMS approval. The Board determined that CMS does not mandate MSA review, negating the finding of mutual mistake. However, due to concerns about the applicant being adequately advised of potential future Medicare benefit impacts without CMS review, the case is returned to the trial level for further proceedings. The applicant's petition for penalties was denied.

Medicare Set AsideMSACMS approvalmutual mistakejudicial errorCompromise and Releasenull and voidPetition to Set Asiderescindedvacated
References
Case No. ADJ10221665
Regular
Dec 10, 2020

STEPHEN OPPLER vs. SUBSEQUENT INJURIES BENEFIT TRUST FUND

This case involves a workers' compensation applicant, Stephen Oppler, and the Subsequent Injuries Benefit Trust Fund (SIBTF). After the applicant petitioned for reconsideration of an administrative law judge's order, a settlement was reached via Compromise and Release. The Workers' Compensation Appeals Board (WCAB) reviewed the agreement, found the settlement adequate and in the applicant's best interest, and approved it. The WCAB also found the requested attorneys' fee reasonable and rescinded the previous findings while approving the settlement.

Subsequent Injuries Benefit Trust FundCompromise and ReleaseWorkers' Compensation Appeals BoardWCJReconsiderationLabor Code section 5001WCAB Rule 10700(b)Labor Code section 5002Attorneys' feeFindings of Fact and Order
References
Case No. ADJ4689210 (VNO 0544832) ADJ6906409 ADJ7469887
Regular
Sep 20, 2019

Donald Yeager vs. CALPORTLAND COMPANY, MITSUI SUMITOMO INSURANCE USA, INC., administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Applicant sought removal and disqualification of the Workers' Compensation Judge after the judge ordered trial and denied reassignment. However, the parties had already entered into and received approval for three Compromise and Release agreements settling all claimed injuries. The Appeals Board found these settlement agreements rendered the Applicant's petitions moot. Therefore, the Board dismissed both the Petition for Disqualification and the Petitions for Removal.

Petitions for RemovalPetition for DisqualificationCompromise and ReleaseOrders Approving Compromise and ReleaseOrder Rescinding Orders Approving Compromise and ReleaseReconsideration UnitJurisdictionMoot IssuesWCJ GlassWCJ Morgan
References
Case No. ADJ9120917, ADJ6899995
Regular
Sep 16, 2016

RICK STEIN vs. CITY OF HUNTINGTON BEACH

The WCAB dismissed the defendant's petition for reconsideration because the WCJ's order vacating a prior order approving a compromise and release was not a final order. The Board granted the defendant's petition for removal to amend the vacating order, specifying the matter should be set for a status conference. This action was taken under WCAB Rule 10859, allowing the WCJ to rescind an order and conduct further proceedings within 30 days. The case is returned to the WCJ to determine if good cause exists to set aside the compromise and release.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalCompromise and ReleaseOrder Approving Compromise and ReleaseOrder Vacating Order Approving Compromise and ReleaseWCJLabor Code Section 132(a)Cumulative Trauma InjuryLeft Knee Injury
References
Case No. LBO 0375915 LBO 0375916 LBO 0375917
Regular
Feb 11, 2008

MARIA C. GOMEZ vs. ANGELICA TEXTILE, ZURICH AMERICAN INSURANCE COMPANY, REPUBLIC MASTER CHEF, ST. PAUL TRAVELERS

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior order approving a \$509 compromise and release for applicant Maria C. Gomez's cumulative trauma injuries. The applicant contended the settlement was based on a civil release signed under duress and that she lacked proper service of the documents. The Board found the applicant's allegations warranted further investigation, remanding the case for proceedings at the trial level.

Propria personaJoint Order Approving Compromise and ReleaseDelegated serviceCumulative trauma injuriesGeneral releaseCivil actionDuressPetition for ReconsiderationReport and RecommendationAbsence of evidence
References
Case No. ADJ10821696
Regular
Apr 17, 2018

PATRICIA MENDOZA vs. WESTERN OILFIELDS SUPPLY CO., INC. dba RAIN FOR RENT

This Workers' Compensation Appeals Board matter is dismissed because the defendant withdrew its Petition for Reconsideration after a settlement agreement was reached. The parties had already submitted a Compromise and Release, and an order approving it was issued prematurely by the District Office while the reconsideration petition was pending. Consequently, the District Office lacked jurisdiction to issue the approval order at that time. The parties can resubmit the settlement agreement for a new approval order once the case returns to the trial level.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalCompromise and ReleaseOrder ApprovingJurisdictionTrial LevelWCJPermissibly Self-insuredESIS
References
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