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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8481999
Regular
Jan 21, 2020

Benjamin Claxton vs. Arizona Cardinals, Great Divide Insurance Company, administered by Berkley Specialty Underwriting Managers, Oakland Raiders, Ace American Insurance, administered by ESIS

The Workers' Compensation Appeals Board (WCAB) has granted reconsideration for Benjamin Claxton's case against the Arizona Cardinals and Oakland Raiders. This decision was made after an initial review of the record and is intended to allow for further study of the factual and legal issues. The WCAB aims to issue a just and reasoned decision after this thorough examination. Pending the decision after reconsideration, all related communications must be filed directly with the WCAB Commissioners, not with any district office or through EAMS.

Petition for ReconsiderationWorkers' Compensation Appeals BoardArizona CardinalsGreat Divide Insurance CompanyBerkley Specialty Underwriting ManagersOakland RaidersAce American InsuranceESISOpinion and OrderGranting Petition
References
Case No. ADJ6943108
Regular
Dec 28, 2015

LARRY TRIPPLET vs. SEATTLE SEAHAWKS, INDIANAPOLIS COLTS, INC., A Corporation of the STATE OF DELAWARE, dba INDIANA COLTS, insured by GREAT DIVIDE INSURANCE CO., c/o BERKLEY SPECIALTY UNDERWRITING MANAGERS

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of a prior decision. This action was taken to allow the Board further time to thoroughly review the factual and legal issues of the case. The Board seeks to ensure a comprehensive understanding of the record before issuing a just and reasoned decision. All future correspondence regarding the petition must be filed directly with the Board's Commissioners, not district offices.

Petition for ReconsiderationWorkers' Compensation Appeals BoardADJ6943108Seattle SeahawksIndianapolis ColtsGreat Divide Insurance Co.Berkley Specialty Underwriting ManagersOpinion and OrderGranting PetitionStatutory Time Constraints
References
Case No. ADJ6814425
Regular
Apr 23, 2012

JIMMY WILLIAMS vs. SAN FRANCISCO 49ers; TIG INSURANCE COMPANY Administered By RISK ENTERPRISE MANAGEMENT LIMITED; SUCCESSOR IN INTEREST BY MERGER TO GULF INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY; BERKELEY SPECIALTY UNDERWRITING MANAGERS, LLC; NEW ORLEANS SAINTS; LOUISIANA WORKERS' COMPENSATION CORPORATION; SEATTLE SEAHAWKS; PSI; HOUSTON TEXANS; BERKELEY SPECIALTY UNDERWRITING MANAGERS, LLC.

In this Workers' Compensation Appeals Board case, applicant Jimmy Williams' Petition for Removal has been denied. The order signifies the Board's decision not to further review or remove the case from its current proceedings. The specific grounds for denial are not detailed in this excerpt. The decision was issued by the Workers' Compensation Appeals Board on April 23, 2012.

Petition for RemovalWorkers' Compensation Appeals BoardSan Francisco 49ersTIG Insurance CompanyRisk Enterprise Management LimitedGulf Insurance CompanyThe Travelers Indemnity CompanyBerkeley Specialty Underwriting Managers LLCNew Orleans SaintsLouisiana Workers' Compensation Corporation
References
Case No. ADJ7233546
Regular
Apr 12, 2013

REGINALD SWINTON vs. ARIZONA CARDINALS, GREAT DIVIDE INSURANCE COMPANY, BERKLEY SPECIALTY UNDERWRITING MANAGERS, LLC, DALLAS COWBOYS, TRAVELERS, SEATTLE SEAHAWKS, PSI

This Workers' Compensation Appeals Board decision affirms a prior administrative law judge's finding in the case of Reginald Swinton. The Board adopted the judge's report and recommendation without further elaboration. Therefore, the original May 31, 2012, Findings and Order remain in effect. The specific details of the claim against the Arizona Cardinals, Dallas Cowboys, and Seattle Seahawks were not detailed in this excerpt.

Reginald SwintonArizona CardinalsGreat Divide Insurance CompanyBerkley Specialty Underwriting ManagersDallas CowboysTravelersSeattle SeahawksPSIADJ7233546Anaheim District Office
References
Case No. ADJ7225815
Regular
Jun 27, 2012

MICHAEL BARROW vs. WASHINGTON REDSKINS, DALLAS COWBOYS FOOTBALL CLUB, NEW YORK GIANTS, TENNESSEE TITANS, CAROLINA PANTHERS, GREAT DIVIDE INSURANCE administered by BERKLEY SPECIALTY UNDERWRITING MANAGERS, LLC, LEGION INSURANCE in liquidation by CIGA, TRAVELERS

The Workers' Compensation Appeals Board (WCAB) rescinded a prior finding that it had jurisdiction over the Dallas Cowboys for applicant Michael Barrow's injury claim. The WCAB determined that while applicant's agent, a California resident, negotiated the contract and communicated acceptance from Los Angeles, this action alone did not establish a "contract of hire" made in California. Crucially, the applicant himself was not in California at the time of acceptance, and the contract required his personal signature to be fully binding. Therefore, the WCAB lacked jurisdiction over this extraterritorial claim against the Dallas Cowboys.

WCABjurisdictioncontract of hireextraterritorial claimLabor Code 3600.5(a)Labor Code 5305out-of-state injuryprofessional football playeragent authorityoral acceptance
References
Case No. ADJ9178558 ADJ9178559
Regular
Feb 05, 2015

JAVIER RIVERA vs. JACO ENVIRONMENTAL, INC., ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a Petition for Removal filed by Zurich American Insurance Company concerning a dispute over Qualified Medical Evaluator (QME) panel selection. The administrative law judge had found both parties requested QME panels timely, but ruled the defendant's request invalid for seeking a different specialty without justification. The Board agreed that removal was not warranted and upheld the decision to assign a QME in pain management, the same specialty as the primary treating physician. The Board also clarified the interpretation of Rule 31.1(b), emphasizing the requirement for supporting documentation when requesting a QME in a different specialty.

Petition for RemovalQualified Medical Evaluator (QME) panelprimary treating physicianspecialtypain managementMedical Directortimely requestjustificationRule 31.1(b)extraordinary remedy
References
Case No. ADJ2186877 (VNO 0533117)
Regular
Jun 29, 2010

JODY LATOUF vs. STUMBAUGH & ASSOCIATES, INC., TIG SPECIALTY INSURANCE COMPANY as Administered by RISK ENTERPRISE MANAGEMENT, LTD., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an arbitrator's findings due to an incomplete record, specifically the absence of a Minutes of Hearing and Summary of Evidence. TIG Specialty Insurance Company sought reconsideration, arguing the arbitrator erred in asserting WCAB jurisdiction over a mandatory "carve out" program for carpenters. The WCAB remanded the case for the arbitrator to create a proper record and issue a new decision on the coverage dispute. Additionally, the Van Nuys District Office will consider the submitted Compromise and Release Agreement.

Workers' Compensation Appeals BoardIndustrial InjuryStumbaugh & AssociatesInc.TIG Specialty Insurance CompanyRisk Enterprise ManagementState Compensation Insurance FundLabor Code § 3201.5Carve Out ProgramAlternate Dispute Resolution
References
Case No. ADJ4153143, ADJ1964837 and ADJ1933860
Regular
Nov 05, 2010

JACK L. MARCUM vs. OUTSOURCE MANAGEMENT, INC. dba THE MANAGEMENT CONNECTION, SUPERIOR NATIONAL INSURANCE CO., now liquidation, administered by CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, KLEEGE INDUSTRIES, INC. dba HANDS-ON EVENT LABOR SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant who sustained shoulder injuries in 1999 and 2000, with a compensation judge awarding 4% permanent disability. The California Insurance Guarantee Association (CIGA) is appealing a decision holding it liable, arguing the applicant was not employed by a company insured by Legion Insurance (now handled by CIGA) but rather by Kleege Industries, insured by SCIF. CIGA contended there was a general/special employment relationship and that SCIF's policy should cover the applicant. The Appeals Board granted reconsideration, affirmed the previous awards, and corrected a clerical error to accurately reflect Legion Insurance as the insurer for Outsource Management, Inc. during the relevant period.

California Insurance Guarantee AssociationLegion Insurance CompanyOutsource Management Inc.The Management ConnectionKleege Industries Inc.Hands-On Event Labor ServicesState Compensation Insurance Fundcumulative traumaright shoulder injurypermanent disability
References
Case No. ADJ81 88564
Regular
May 02, 2016

JESUSITO CELARIO vs. L.A. SPECIALTY PRODUCE, INC., SAFETY NATIONAL CASUALTY COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration of a February 23, 2016 decision. This action was taken due to statutory time constraints and an initial review indicating the need for further study of the factual and legal issues. The Board requires additional time to fully understand the record and issue a just decision. All further correspondence related to the petition must now be filed directly with the Office of the Commissioners of the Appeals Board, not district offices or electronically.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting ReconsiderationOpinion and OrderL.A. Specialty ProduceInc.Safety National Casualty CompanyMatrix Absence ManagementInc.Jesusito Celario
References
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