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

Case No. ADJ7775170
Regular
Jul 16, 2012

JUANA NEGRETE vs. SHURFLO, HAMPSHIRE INSURANCE COMPANY

This case involves an applicant's workers' compensation claim filed after layoff, triggering Labor Code Section 3600(a)(10). The Appeals Board granted reconsideration, finding the applicant met her burden of proof that she notified her employer of her injury prior to her layoff. The applicant's unrebutted testimony and supporting medical evidence demonstrated employer notice, thus overcoming the statutory bar to compensation. The case was remanded for further proceedings on the merits of the applicant's claim.

Workers' Compensation Appeals BoardJuana NegreteShurfloHampshire Insurance CompanyADJ7775170Opinion and Order Granting ReconsiderationDecision After Reconsiderationbilateral armsbilateral elbowssleep problems
References
Case No. ADJ7331781
Regular
Dec 10, 2012

GARY TERRELL vs. COUNTY OF SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration of a prior decision regarding Gary Terrell's workers' compensation claim against the County of San Diego. The Board affirmed the original decision but amended Finding of Fact No. 3. This amendment clarifies that the date of injury, for the purposes of Labor Code section 5412, spans from August 21, 1971, to May 1, 2010. The Board adopted and incorporated the administrative law judge's report into its opinion.

Workers' Compensation Appeals BoardGary TerrellCounty of San DiegoPermissibly Self-InsuredADJ7331781Opinion and Order Granting ReconsiderationDecision After ReconsiderationReport of Workers' Compensation Administrative Law JudgeLabor Code section 5412Date of Injury
References
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
Case No. ADJ9271600
Regular
Oct 02, 2017

JESUS BARRERA vs. UMAMI RESTAURANT, LLC, BERKSHIRE HATHAWAY, HARTFORD

The Workers' Compensation Appeals Board (WCAB) dismissed Jesus Barrera's petition for reconsideration because it was filed untimely. The WCJ's decision was personally served, triggering a strict 20-day filing deadline for reconsideration, not subject to mail service extensions. Barrera's representative had until August 8, 2017, to file, but the petition was received on August 9, 2017. As the deadline is jurisdictional, the WCAB lacked authority to consider the untimely petition.

Petition for ReconsiderationUntimely FilingPersonal Service20-Day LimitJurisdictionalWCABWCJLabor Code SectionsCalifornia Code of RegulationsOrder Dismissing Lien
References
Case No. ADJ4134943 (LAO 0800933), ADJ2639030 (LAO 0847979)
Regular
Jan 14, 2016

ARTURO GUILLEN vs. PRO AMERICA PREMIUM TOOLS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE INSURANCE SERVICES, PACIFIC NATIONAL INSURANCE COMPANY, HIGHLANDS INSURANCE COMPANY

This case involves a petition for reconsideration by Highlands Insurance Company regarding a prior decision that found the applicant sustained two cumulative trauma injuries. The Workers' Compensation Appeals Board affirmed its prior decision, finding one injury occurred when Pacific National Insurance Company was the insurer and the second injury occurred when Highlands was the insurer. Highlands argued the applicant sustained only one cumulative trauma injury or a single specific injury. The Board denied Highlands' petition, upholding the determination of two distinct cumulative trauma injuries.

Cumulative trauma injuryCalifornia Insurance Guarantee AssociationCIGAPacific National Insurance CompanyHighlands Insurance CompanyPro America Premium ToolsPetition for ReconsiderationDecision After Reconsiderationinsurer in liquidationservicing facility
References
Case No. ADJ4408007 (STK 0205209)
Regular
Sep 20, 2013

CLIAS MONTES vs. TRUEGREEN LANDCARE, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board dismissed the petition for reconsideration in case ADJ4408007. This dismissal was based on the fact that the Workers' Compensation Judge had already vacated the original Findings and Award on August 1, 2013. Therefore, the petition for reconsideration of the July 26, 2013 decision was rendered moot.

Petition for ReconsiderationMootVacatedFindings and AwardWorkers' Compensation Appeals BoardDismissedJuly 262013August 12013
References
Case No. ADJ4151507 (SFO 0487197)
Regular
Feb 02, 2020

Tracy Sullivan vs. Café Amsterdam, State Compensation Insurance Fund

The Appeals Board granted reconsideration and amended the previous award, finding the applicant's burn injury did not qualify for the "severe burns" exception to the temporary disability indemnity limit under Labor Code section 4656(c)(3)(D). Consequently, temporary disability indemnity is limited to 104 weeks from the commencement of payments on August 10, 2004. The Board affirmed the WCJ's finding that the applicant's psychiatric injury was compensable, meeting the "sudden and extraordinary" employment condition exception. Clerical errors in the original findings were also corrected.

ADJ4151507SFO 0487197Tracy SullivanCafé AmsterdamState Compensation Insurance FundPetition for ReconsiderationFindings Award and OrderWCJindustrial injurycervical spine
References
Case No. ADJ352088 (MON 0360366)
Regular
Apr 12, 2011

NANCY MONTOYA vs. AUGUST CONSTRUCTION, INC., SEABRIGHT INSURANCE

This case concerns a clerical error in a workers' compensation award where the weekly temporary disability indemnity rate was inconsistently stated. The applicant, Nancy Montoya, incurred an industrial injury while employed by August Construction, Inc. The defendant petitioned for reconsideration to correct the typographical error in the Findings and Award, specifically regarding the stipulated temporary disability indemnity rate. The Workers' Compensation Appeals Board granted reconsideration, amended the award to reflect the agreed-upon rate of $833.33 per week, and returned the case for further proceedings.

Workers' Compensation Appeals BoardAugust ConstructionSeabright InsuranceFindings and AwardPetition for ReconsiderationTypographical ErrorTemporary Disability Indemnity RatePermanent Disability Indemnity RateStipulationReport and Recommendation
References
Case No. ADJ7500638
Regular
Nov 10, 2015

FREDDY PAREDES vs. ANTONIO COLOCHO MARTINEZ, UNINSURED EMPLOYERS BENEFITS TRUST FUND

The Workers' Compensation Appeals Board dismissed Freddy Paredes' petition for reconsideration because it was untimely. The petition was filed on September 21, 2015, which was more than the jurisdictional 25-day deadline from the WCJ's August 24, 2015 decision. Proof of mailing is insufficient; the petition must be received by the Board within the statutory period. Since the petition was untimely, the Board had no authority to consider its merits.

Petition for ReconsiderationUntimely FilingDismissedWorkers' Compensation Appeals BoardWCJ ReportLabor CodeCalifornia Code of RegulationsJurisdictional Time LimitMaranian v. Workers' Comp. Appeals Bd.Rymer v. Hagler
References
Case No. ADJ1284568 (BAK 0142029)
Regular
Nov 09, 2015

SHEILA WINBURN vs. STATE OF CALIFORNIA, CDCR - NORTH KERN STATE PRISON, Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

This order corrects a clerical error in a prior Workers' Compensation Appeals Board decision issued August 21, 2015. The original decision failed to include an attorney fee in the total temporary disability award, which was present in the WCJ's initial ruling. The Appeals Board is correcting this omission to ensure clarity and a complete understanding of the award. The corrected decision now includes the attorney fee payable to Leviton, Diaz & Ginocchio, with other aspects of the August 21, 2015 decision affirmed.

Clerical ErrorAttorney FeeTemporary DisabilityPetition for ReconsiderationDecision After ReconsiderationWorkers' Compensation Appeals BoardCDCRNorth Kern State PrisonLegally UninsuredAdjusting Agency
References
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