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

Case No. ADJ7860847 & ADJ7860626
Regular
Nov 09, 2011

FERNANDO SARMIENTO vs. BLUE CHIP RECYCLING, WAUSAU UNDERWRITERS INSURANCE CO., LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board has granted reconsideration in the case of Fernando Sarmiento versus Blue Chip Recycling and its insurers. This decision was made due to a petition filed by defendant Wausau Underwriters Insurance Company, necessitating further review of the factual and legal issues. The Board requires additional study of the record to ensure a just and reasoned decision. All future communications in this matter should be directed to the Board's Office of the Commissioners in San Francisco.

Petition for ReconsiderationWorkers' Compensation Appeals BoardWausau UnderwritersLiberty MutualFernando SarmientoBlue Chip RecyclingStatutory time constraintsFactual and legal issuesDecision After ReconsiderationOffice of the Commissioners
References
Case No. ADJ7857239
Regular
May 27, 2016

DENNIS ARNOLD vs. WASTE MANAGEMENT COLLECTION AND RECYCLING; ACE AMERICAN INSURANCE, adjusted by GALLAGHER BASSETT SERVICES

This Workers' Compensation Appeals Board case, ADJ7857239, concerning Dennis Arnold vs. Waste Management Collection and Recycling, has been dismissed. The dismissal is due to the petitioner's withdrawal of their Petition for Reconsideration of the April 11, 2016 decision. The Board formally ordered the dismissal based on this withdrawal.

Petition for ReconsiderationWithdrawn PetitionDismissed PetitionWorkers' Compensation Appeals BoardWaste Management Collection and RecyclingACE American InsuranceGallagher Bassett ServicesADJ7857239Oakland District OfficeKatherine Zalewski
References
Case No. ADJ8501790
Regular
Jul 29, 2015

Kelly Chase vs. St. Louis Blues Hockey Club, Federal Insurance Company

The Workers' Compensation Appeals Board (WCAB) reversed a prior finding of industrial injury for a professional hockey player against the St. Louis Blues. The WCAB found insufficient connection to California for jurisdiction, citing the player's limited games in the state compared to his overall career. This decision followed the precedent set in *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*, which requires a legitimate and substantial connection to the state for jurisdiction. The WCAB concluded that 21 games out of 485 did not meet this standard for a cumulative injury claim.

WCABSt. Louis Blues Hockey ClubFederal Insurance CompanyADJ8501790Opinion and Decision After Reconsiderationcumulative industrial injuryprofessional hockey playersubject matter jurisdictionstatute of limitationssubstantial medical evidence
References
Case No. ADJ7722691
Regular
Apr 21, 2014

Tania Bello vs. Barrett Business Services, Inc.

This case involves Blue Shield of California's petition for reconsideration of a WCJ's order dismissing its lien. The lien was dismissed because Blue Shield failed to appear at a Lien Conference, and the WCJ found proper service of the notice. Blue Shield claimed non-receipt of the hearing notice but the WCAB dismissed their petition as untimely. The petition was filed 27 days after the order, exceeding the 25-day jurisdictional limit for filing a petition for reconsideration.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationDismissalLien ConferenceNotice of HearingServiceEAMSUntimely PetitionLabor Code § 5900(a)
References
Case No. ADJ7860847, ADJ7860626
Regular
May 14, 2012

FERNANDO SARMIENTO vs. PAYROLL MANAGEMENT GROUP, INC, BLUE CHIP RECYCLING, WAUSAU UNDERWRITERS INSURANCE COMPANY, LIBERTY MUTUAL

The Appeals Board vacated its prior grant of reconsideration and dismissed the defendant's petition as untimely and based on non-final orders. The Board granted removal on its own motion to consolidate two cases and affirmed the WCJs' denial of the defendant's petitions to compel the applicant to transfer care to a Medical Provider Network (MPN). While the defendant is generally not liable for treatment outside an MPN per *Valdez*, the Board found that MPN validity and notice issues, and the applicant's right to self-procure treatment at their own expense, were not yet determined. The Board clarified that the defendant can request an expedited hearing to determine entitlement to medical treatment, rather than compel MPN transfer.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNPetition to CompelReconsiderationRemovalVenueConsolidationFinal OrderLabor Code
References
Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
Case No. ADJ8292814, ADJ8859836, ADJ8292825
Regular
Oct 29, 2019

JO MARIE JENNINGS vs. PASADENA CITY COLLEGE, KEENAN & ASSOCIATES

In this workers' compensation case, the Appeals Board granted reconsideration to address the statute of limitations defense raised by the defendant, Pasadena City College. The Board found that the defendant failed to prove that Anthem Blue Cross, as a lien claimant, had sufficient knowledge of the claim to trigger the statute of limitations. Consequently, the Board affirmed the original decision, but amended the findings of fact to explicitly state that Anthem Blue Cross's lien is not barred by the statute of limitations.

Workers' Compensation Appeals BoardPasadena City CollegeKeenan & AssociatesPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeStatute of LimitationsAffirmative DefenseBurden of ProofLabor Code § 5705Jack Morgan M.D.
References
Case No. ADJ745778 (SRO 0132381)
Regular
Mar 13, 2009

CYNTHIA GORDON vs. CALISTOGA SPA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, reversing a prior decision. The WCAB found that it lacks jurisdiction over medical treatment payment disputes when an express agreement exists between the parties, as stipulated by Labor Code section 5304. In this case, a chain of contracts, including one between the hospital and Blue Cross Life and Health, and another between Blue Cross and the defendant insurer, created an express agreement. This contractual arrangement precluded the WCAB from determining the payment due to the medical provider.

WCAB jurisdictionLabor Code section 5304medical treatment disputeexpress agreementarbitration clauseequitable estoppellacheschain of contractsmedical provider contractinsurer contract
References
Case No. ADJ792862 (GRO 0034136)
Regular
Nov 16, 2009

DEMISE GUTH vs. BLUE CROSS OF CALIFORNIA, ZURICH LOS ANGELES

Reconsideration granted; affirmed except for amending temporary disability period to April 19, 2006 to July 18, 2007 and correcting clerical error in award.

GuthBlue CrossZurichtemporary disabilitycumulative injuryupper extremitiesshoulderneckEmployment Development DepartmentState Disability Insurance
References
Case No. ADJ4469041 (SDO 0329027)
Regular
Aug 15, 2008

DANIEL STREETER vs. NORTH COUNTY FORD, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and reversed a prior finding, holding it lacks jurisdiction over Tri-City Medical Center's lien claim for applicant's treatment. The Board found that a chain of contracts between Tri-City, Blue Cross, and SCIF constituted an "express agreement" as contemplated by Labor Code Section 5304. This agreement fixed the payment amounts for medical treatment, thereby divesting the Appeals Board of jurisdiction to determine the lien claim's value. Consequently, Tri-City Medical Center's lien claim was denied due to lack of jurisdiction.

Workers' Compensation Appeals BoardLabor Code section 5304jurisdictionexpress agreementlien claimTri-City Medical CenterState Compensation Insurance FundBlue Crossmedical treatmentnegotiated rates
References
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