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

Case No. GOL 0088273
Regular
Aug 18, 2008

ROBERT SIEBURG vs. RONALD WOLFE & ASSOCIATES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the original award, and returned the case for further development of the record. The Board found the findings of the administrative law judge regarding $97\%$ permanent disability and apportionment were not supported by substantial medical evidence. Specifically, the opinion of Dr. Kahmann was deemed deficient due to internal inconsistencies, lack of explanation for apportionment, and undefined work restrictions. The Board also found Dr. Basham's report did not meet the standard for substantial medical evidence regarding cognitive dysfunction.

WORKERS' COMPENSATION APPEALS BOARDROBERT SIEBURGRONALD WOLFE & ASSOCIATESSTATE COMPENSATION INSURANCE FUNDGOL 0088273OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONFindings and AwardWCJmaintenance person
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
Case No. ADJ9904638, ADJ7352002
Regular
Jul 25, 2017

Carmen Caez vs. California Department of Social Services (IHSS), administered by YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration, amending the prior decision to defer the statute of limitations issue for the applicant's low back and other injuries sustained on November 1, 2008. The Board found the initial determination barring benefits lacked substantial evidence, particularly regarding the timeliness of the claim under Labor Code section 5405. Further development of the record is required to address potential tolling of the statute of limitations due to the employer's failure to provide proper workers' compensation notification. The case is returned for further proceedings to resolve these issues.

ADJ9904638ADJ7352002IHSS caregiverLabor Code sections 35503551statute of limitations tolledclaim formHoneywell v. Workers' Comp. Appeals Bd.denial letterApplication for Adjudication
References
Case No. ADJ4571860
Regular
Oct 16, 2008

FRANK REID vs. COUNTY OF SAN DIEGO

The Appeals Board reversed the trial judge's decision, finding the applicant's skin cancer was not an insidious, progressive disease and thus jurisdiction over permanent disability could not be reserved. They also disallowed apportionment of the applicant's 37 percent permanent disability, as he had no prior awards and was covered by a statutory exception for peace officer injuries. The Board established July 28, 2003, as the permanent and stationary date and corrected the date of injury to July 28, 2003.

Workers' Compensation Appeals BoardFrank ReidCounty of San DiegoCriminal Investigator IVindustrial injuryskin cancerinsidious disease processpermanent and stationarypermanent disabilityapportionment
References
Case No. SFO 0499272
Regular
Jul 07, 2008

Helen Miller vs. Green Gulch Farm and Zen Center, EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board affirmed the administrative law judge's finding that Helen Miller was an employee of Green Gulch Farm and Zen Center and sustained an industrial injury to her left ankle. The Board found Miller was not a volunteer due to the extensive benefits received and the employer's control, and her jogging injury during a lunch break was a reasonable expectancy of employment, not barred by Labor Code section 3600(a)(9). Therefore, her injury arose out of and occurred in the course of her employment.

Workers' Compensation Appeals BoardHelen MillerGreen Gulch Farm and Zen CenterEverest National InsuranceGallagher BassettSFO 0499272Opinion and Decision After ReconsiderationLabor Code Section 3351Labor Code Section 3352(i)Employee definition
References
Case No. OAK 294681
Regular
Nov 14, 2007

SCOTT SIMPSON vs. GEO OPTIONS, INC., EARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed the WCJ's decision regarding permanent disability apportionment, finding substantial medical evidence supported a 50% apportionment to pre-existing conditions. The Board also upheld the WCJ's finding of unreasonable delay in medical treatment, justifying a penalty against the defendant. A minor clerical error in the award regarding penalty references was corrected.

Workers' Compensation Appeals BoardScott SimpsonGeo Options Inc.Hartford Insurance CompanyOAK 294681Opinion and Decision After Reconsiderationpermanent disabilityapportionmentspondylolisthesisqualified medical examiner
References
Case No. ADJ7264915
Regular
Jul 15, 2013

ANA GONZALES vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

This case involves an applicant who sustained industrial psychiatric injury but whose orthopedic claims were denied due to insufficient medical evidence. The Appeals Board denied the applicant's petition for reconsideration, finding the applicant failed to present substantial medical evidence of industrial causation for her orthopedic complaints. A dissenting commissioner argued that the primary medical evaluator's report was deficient and lacked substantial evidence, warranting further development of the record on orthopedic injuries and other claims. The dissent emphasizes the Board's duty to ensure substantial justice, suggesting it should have ordered further investigation on the denied orthopedic issues.

WCABPetition for ReconsiderationFindings and Orderindustrial injurypsychelow backneckright shoulderright wristright elbow
References
Case No. ADJ11125430
Regular
Sep 30, 2019

Tiffany Merritt vs. CDCR-CALIFORNIA INSTITUTE FOR WOMEN; Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, affirming the WCJ's decision that the applicant did not sustain injury to her psyche arising out of and occurring in the course of employment. The Board found that the applicant's psychological injury was predominantly caused by a lawful, non-discriminatory, good faith personnel action, specifically a transfer to a new department. However, the Board also amended the original order to defer all issues concerning injuries to body parts other than the psyche. These other issues will be returned to the WCJ for further proceedings and decision.

WORKERS' COMPENSATION APPEALS BOARDTIFFANY MERRITTCDCR-CALIFORNIA INSTITUTE FOR WOMENLegally UninsuredSTATE COMPENSATION INSURANCE FUNDADJ11125430Petition for ReconsiderationFindings and OrderWCJHardesty demand
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. 57
Regular
Apr 28, 2011

LAURIE TRINIDAD vs. ALBERTSON'S, PSI, Administered by SPECIALTY RISK SERVICES

This case concerns an applicant's claim for temporary disability benefits beyond five years from the date of injury. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's decision that it lacked jurisdiction to award these benefits. The WCAB determined that while the applicant experienced new periods of disability after the five-year mark, no petition to reopen or for new and further disability was filed within the statutory period following a prior order awarding temporary disability. The Board distinguished this case from prior decisions where jurisdiction extended beyond five years due to the absence of any prior award or a continuing award that was improperly terminated.

Workers Compensation Appeals BoardLaurie TrinidadAlbertson'sSpecialty Risk ServicesOpinion and Decision After Reconsiderationtemporary disability benefitsjurisdictiongrocery checkerlumbar spinebilateral shoulders
References
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