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Case Law Database

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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ3872960
Regular
May 06, 2013

ALONZO WATKINS vs. LONG BEACH UNIFIED SCHOOL DISTRICT

This case concerns applicant Alonzo Watkins' petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying his claim for unpaid benefits totaling $14,269.10. The WCAB denied reconsideration, finding that Watkins failed to provide substantial evidence of non-payment, as the employer presented proof of payment via checks issued over 16 years prior. The WCAB also ruled that Watkins raised the issue of the employer's failure to produce payment records for the first time on appeal, which is impermissible. Furthermore, the WCAB clarified that the record retention requirements for adjusting agencies do not mandate indefinite maintenance of claim files.

Petition for ReconsiderationFindings and OrderIndustrial InjuryBack InjuryLower ExtremitiesTeacherCompromise and ReleasePayment RecordsProof of PaymentNon-Payment
References
Case No. ADJ10977396
Regular
Apr 09, 2019

PEDRO OSORIO vs. BUENAVENTURA RANCH, LLC, BERKSHIRE HATHAWAY HOMESTATE COMPANIES

This case concerns an applicant's claim for Labor Code section 5814 penalties due to the defendant's alleged unreasonable refusal to pay temporary and permanent disability benefits. The Workers' Compensation Appeals Board granted reconsideration, finding that the issue of penalties was properly before the trial judge despite the lack of a formal penalty petition. The Board determined that the original decision lacked sufficient explanation for denying penalties, given evidence suggesting delayed payments and the opinion of a doctor regarding the industrial nature of the applicant's disability. Consequently, the matter is returned to the trial level for further development of the record and determination on the merits of the section 5814 penalty claim.

Labor Code Section 5814Petition for ReconsiderationFindings and AwardTemporary Disability BenefitsPermanent Disability BenefitsUnreasonable Refusal to PayWCJ Report and RecommendationDeposition of Dr. PearsonBenefits PrintoutNotice of Permanent Disability Payments
References
Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
Case No. ADJ9100288
Regular
May 17, 2018

GILBERT CORTEZ (Deceased), NOHEMA CORTEZ (Surviving Spouse & Guardian Ad Litem), et al. vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, Legally Uninsured, CALIFORNIA PUBLIC EMPLOYEES RETIREMENT SYSTEM, STATE COMPENSATION INSURANCE FUND (Claims Administrator)

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision concerning death benefits for the deceased employee's children, Andres and Marisa Cortez. The WCAB remanded the case to the administrative law judge to properly join the California Public Employees' Retirement System (CalPERS) and determine the entitlement to and coordination of workers' compensation death benefits with CalPERS special death benefits. The WCAB clarified that the "good cause" standard under *Antrim* applies and that CalPERS benefits may offset workers' compensation benefits to avoid duplicate payments. Further proceedings are required to consider the specific claims of dependency and the impact of CalPERS payments.

Workers' Compensation Appeals BoardCDCRSCIFCalPERSdeath benefitsdependent childrenspecial death benefitsoffsetAntrim standardLabor Code section 4707
References
Case No. ADJ1298520
Regular
Dec 24, 2010

CLUSEGUN AFOLAYAN (DECEASED), OLUWASEUN AFOLAYAN, et al vs. STATE OF CALIFORNIA CDCR, CALIFORNIA REHABILITATION CENTER, Legally Uninsured, SCIF/STATE CONTRACTS

In this workers' compensation case, the Appeals Board reconsidered a WCJ's award of dependency benefits to three adult children of a deceased worker. The WCJ had awarded $192,000 total, based on the children being total dependents despite the widow electing CalPERS benefits which typically bar other death benefits. The Board agreed that the adult children are entitled to benefits under Labor Code section 4702, as the widow's CalPERS election does not necessarily exclude other dependents with good cause. However, the Board disagreed with the WCJ's calculation method and remanded the case for a new decision, directing the adult children to divide the difference between the maximum benefit for a widow with dependents and the benefit for a widow without dependents.

Workers' Compensation Appeals BoardDependency benefitsLabor Code Section 4702Adult childrenDeath benefitsLabor Code Section 4707CalPERS special death benefitGood causeTotal dependentsWidow's benefits
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ36 55308 (SDO 0361476)
Regular
Mar 15, 2016

VERONICA GONZALEZ LEON vs. CENTINELA STATE PRISON, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, CCPOA Benefit Trust Fund, seeking reimbursement for living expenses paid to an applicant. The Workers' Compensation Appeals Board denied CCPOA's petition for reconsideration, affirming the judge's prior ruling. The Board found that CCPOA's lien was invalid because temporary disability payments had been fully discharged before the lien was filed. Furthermore, the Board clarified that under Labor Code section 4903.1(a)(3)(A), such liens for living expenses are only permissible against available temporary disability indemnity and not against permanent disability benefits.

Workers' Compensation Appeals BoardLien claimantPetition for reconsiderationFindings and OrderLiving expense paymentsSelf-funded employee welfare benefit planLabor Code section 4903.1Temporary disabilityIndustrial causationPermanent disability payments
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
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