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

Case No. ADJ10452586
Regular
Sep 24, 2018

CONSTANTINO MARTINEZ vs. BLUEWATER GRILL, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION, AMERICAN CLAIMS MANAGEMENT, INC.

Here's a summary of the case for a lawyer in four sentences: The Workers' Compensation Appeals Board denied reconsideration of a decision finding injury AOE/COE. The Board affirmed the Administrative Law Judge's reliance on the Agreed Medical Evaluator's (AME) opinion, finding no persuasive reason to deviate. Defendants' arguments that the AME's opinion was based on an inadequate history or was conclusory were rejected. The Board also refused to consider a neurologic report procured after trial, as discovery had closed.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical EvaluatorWCJ reportsubstantial medical evidencePetition for RemovalPetition for Change VenueApplication for Adjudication of ClaimFindings and AwardInjury AOE/COE
References
4
Case No. ADJ8266811 ADJ8710466
Regular
Jan 12, 2017

LILIANA RUIZ vs. MCDONALD'S, ZENITH INSURANCE COMPANY, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION

This case involves Liliana Ruiz filing eleven workers' compensation claims against McDonald's, six of which were consolidated. One defendant, Zenith Insurance Company, settled two of these consolidated cases with Ruiz via a Compromise and Release for $20,000. Another defendant, California Restaurant Mutual Benefit Corporation (administered by American Claims Management), petitioned for reconsideration, arguing the settlement contravened consolidation purposes. The Board denied reconsideration, adopting the WCJ's report which found American Claims failed to demonstrate prejudice or good cause to set aside the settlement. The Board clarified that Zenith's settlement resolved only its potential liability and did not affect American Claims' right to seek contribution.

Petition for ReconsiderationCompromise and ReleaseContributionConsolidationCumulative TraumaAOE/COEApportionmentInsurance CoverageWCJWorkers' Compensation Appeals Board
References
2
Case No. ADJ11114421
Regular
Jun 05, 2025

FELIX CABRERA vs. OAA INVESTMENTS, INC.; CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

Defendant California Restaurant Mutual Benefit Corporation (CRMBC) sought reconsideration of a February 19, 2021 Findings and Order (F&O) which found CRMBC liable for coverage of applicant Felix Cabrera's injury, ruling that CRMBC's policy cancellation was premature. CRMBC contended it had no coverage obligations as the applicant was employed by OAA Investments, Inc., not insured by CRMBC, and argued against the applicability of Insurance Code section 676.8. The Appeals Board affirmed the WCA's F&O, treating the petition as one for reconsideration, and found that under Insurance Code section 676.8 and equitable principles, CRMBC was liable for coverage. The Board reasoned that due to a material change in ownership, CRMBC's cancellation notice required 30 days' notice, making January 27, 2018, the earliest effective cancellation date, which was after the November 22, 2017 injury date.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPolicy CancellationInsurance Code Section 676.8Material Change in OwnershipEquitable EstoppelAffiliate Certificate of Consent to Self-InsureGroup Self-InsurerAD Rule 15480
References
15
Case No. ADJ17068636
Regular
May 19, 2025

KATHLEEN ZEPEDA vs. CALIFORNIA BAPTIST UNIVERSITY, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION

Applicant Kathleen Zepeda claimed injury to her abdomen, back, and lower extremities while employed by California Baptist University. Lien claimant Medland Medical Group and defendant California Baptist University both sought reconsideration of a February 19, 2025 Findings and Award (F&A). The F&A entitled Medland Medical Group to payment for medical-legal costs related to an April 26, 2023 report but did not find an injury arising out of and in the course of employment (AOE/COE). The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration, granted the lien claimant's petition for reconsideration, and affirmed the F&A with an amendment to explicitly state that the lien claimant failed to meet its burden of establishing injury AOE/COE.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and AwardMedical-Legal ReportPrimary Treating PhysicianInjury AOE/COESubstantial EvidenceContested ClaimMedical Treatment Costs
References
5
Case No. ADJ7762389
Regular
Jan 22, 2014

ANA RAMIREZ vs. HENROSE CORPORATION, dba MCDONALDS RESTAURANT, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION, AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board denied Henrose Corporation's Petition for Removal. Petitioner sought to have the applicant re-evaluated by Agreed Medical Examiners (AMEs) to potentially extend temporary disability beyond the statutory limit, arguing their initial reports were insufficient. The Board found that Petitioner failed to demonstrate significant prejudice or irreparable harm to justify removal. The denial was based on the judge's report, which concluded the matter was set for trial appropriately and the requested re-evaluations were not warranted under the circumstances.

Petition for RemovalWorkers' Compensation Appeals BoardPermanent and Stationary DateTemporary DisabilityMedical ReportsOrthopedic InjuryPsychiatric InjuryAdministrative Law JudgeLabor Code Section 4656(c)(1)Agreed Medical Examiner
References
0
Case No. MISSING
Regular Panel Decision
Jan 15, 1988

Pension Benefit Guaranty Corp. v. LTV Corp.

David H. Miller and William W. Shaffer ("Miller and Shaffer") moved to intervene individually and as representatives of participants in the Jones & Laughlin Retirement Plan in an action filed by the Pension Benefit Guaranty Corporation (PBGC) against LTV Corporation and LTV Steel Company ("LTV"). LTV did not object to individual intervention but opposed class action intervention, arguing it would delay the PBGC action. The court granted the motion, allowing Miller and Shaffer to intervene both individually and as class representatives. The decision emphasized that Miller and Shaffer met the minimal burden of showing that PBGC's representation might be inadequate, as their interests, seeking full plan benefits, could diverge from PBGC's role as plan administrator. This opinion allows the class action to proceed under Rule 23(e), preventing dismissal or compromise without court approval.

InterventionERISAPension PlansBankruptcyClass ActionRule 24Rule 23(e)Adequate RepresentationPlan TerminationRestoration
References
6
Case No. ADJ8903041
Regular
Jul 01, 2014

MAGALI MANRIQUE DE ARCHA vs. MCDONALD'S/SANCHEZ FAMILY CORPORATION, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION, AMERICAN CLAIMS MANAGEMENT

This order dismisses Magali Manrique de Archa's Petition for Removal in her workers' compensation case against McDonald's/Sanchez Family Corporation. The Workers' Compensation Appeals Board adopted and incorporated the administrative law judge's report, which recommended dismissal. The Board found no grounds to grant removal, thus dismissing the petition.

Petition for RemovalDismissalReconsiderationWorkers' Compensation Appeals BoardAdministrative Law Judge ReportSan Bernardino District OfficeSanchez Family CorporationCalifornia Restaurant Mutual Benefit CorporationAmerican Claims ManagementAlvandi Law Group
References
0
Case No. MISSING
Regular Panel Decision

Pension Benefit Guaranty Corp. v. Broadway Maintenance Corp.

This case involves the Pension Benefit Guaranty Corporation (PBGC) and the bankrupt Broadway Maintenance Corporation (Broadway) disputing the termination date of Broadway's non-union employee pension plan. PBGC initiated the lawsuit to become the statutory trustee and sought to establish March 26, 1981, as the termination date. Broadway argued for an earlier, retroactive date. The court, guided by ERISA and the interests of the plan participants, rejected both parties' proposed dates. The judge formulated a test for involuntary terminations and ultimately established December 5, 1980, as the official termination date, citing the date PBGC first formalized its intent to terminate the plan.

ERISAPension Plan TerminationEmployee Retirement Income Security ActInvoluntary TerminationTermination Date DisputeBankruptcyPlan Participants' InterestsStatutory TrusteeFiduciary DutyPension Benefit Guaranty Corporation
References
2
Case No. MISSING
Regular Panel Decision
Aug 16, 1982

Hartford Accident & Indemnity Co. v. Michigan Mutual Insurance

Hartford, an excess insurer, initiated a lawsuit against primary insurer Michigan Mutual, D.A.L. Construction, and a law firm, Montfort, Healy, McGuire and Salley, seeking to recover a $400,000 settlement portion it paid in an underlying construction site explosion case. The underlying action involved injured parties (the Gobins) who sued entities L.A.D. Associates and DeFoe Corporation, all of whom, along with D.A.L. (Mr. Gobin's employer), were insured by both Michigan Mutual and Hartford. Hartford's claim was predicated on D.A.L.'s potential Dole v Dow Chem. Co. contribution liability, arguing Michigan Mutual or the attorneys should have impleaded D.A.L. in the original suit. Justice Silverman, in a dissenting opinion, argued that an insurer cannot subrogate against its own insured, thus precluding Hartford's claim against D.A.L. and justifying Michigan Mutual's failure to implead. However, the appellate court's final order modified the appealed decision by denying motions to dismiss and for summary judgment, thereby reinstating Hartford's complaint in its individual capacity against Michigan Mutual and Montfort, Healy.

SubrogationExcess InsurancePrimary InsuranceContributionIndemnificationSummary JudgmentImpleaderWorkers' Compensation ExclusionInsurer vs. InsuredRelated Corporations
References
8
Case No. ADJ7493258, ADJ8597877, ADJ10987183
Regular
Feb 23, 2018

Barbara Nakatani vs. Coco's Restaurant, California Restaurant Mutual Benefit Corporation

The Appeals Board granted reconsideration and rescinded an order for sanctions against applicant's attorney, Ms. Otero, due to insufficient evidence and an appearance of bias by the WCJ. The Board disqualified the WCJ based on her lengthy past employment and personal relationship with Ms. Otero's firm, creating a reasonable doubt about her impartiality. Consequently, the cases are reassigned to a new WCJ for further proceedings.

Workers' Compensation Appeals BoardSanctionsPetition for ReconsiderationDisqualificationWCJ BiasAppearance of BiasDue ProcessFair HearingCode of Civil ProcedureLabor Code
References
3
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