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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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. ADJ3525697 (LAO 0534774) ADJ2342373 (LAO 0512482) ADJ1310306 (LAO 0568035) ADJ2645702 (LAO 0519888) ADJ1384751 (LAO 0568036) ADJ2871875 (ANA 0235799)
Regular
Feb 03, 2017

ALICE BRYANT vs. REGENTS OF THE UNIVERITY OF CALIFORNIA, permissibly self-insured, UCLA MEDICAL CENTER; SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves applicant Alice Bryant's petition for reconsideration of prior dismissed workers' compensation claims and a Labor Code section 132a retaliation claim. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, upholding the administrative law judge's findings. The WCAB concluded that Bryant's claims were previously dismissed, with some dismissed by her own request and others for failure to prosecute. Furthermore, the WCAB found that Bryant failed to demonstrate extrinsic fraud and lacked the required diligence to reopen these final dismissals, even with newly discovered evidence.

Workers' Compensation Appeals BoardRegents of the University of CaliforniaSedgwick Claims Management ServicesPetition for ReconsiderationFindings and OrdersWorkers' Compensation Administrative Law JudgeLabor Code section 132aRetaliation claimExtrinsic fraudDismissed claims
References
Case No. ADJ1282419 (LAO 0846452) ADJ915214 (LAO 0854736)
Regular
Feb 01, 2010

VALERIE VANCE DILLON vs. TJ MAXX, CNA CLAIMS PLUS

This case involves a Compromise and Release agreement between the applicant and defendants. The Board granted reconsideration, rescinded the prior decision, and returned the matter to the trial level. This action is contingent on the workers' compensation administrative law judge approving the settlement. If not approved, the original decision could be reinstated, with the right to seek reconsideration.

Compromise and ReleasePetition for ReconsiderationGrant ReconsiderationRescind DecisionTrial LevelWorkers' Compensation Appeals BoardAdministrative Law JudgeSalvage and ClaimsSalvage and ClaimsSalvage and Claims
References
Case No. ADJ967988 (VNO 0449090)
Regular
Jul 01, 2009

MARIA G. MAYA vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying her claim for cumulative trauma injury to various body parts, arguing the employer failed to deny her claim within 90 days, thus triggering a presumption of compensability under Labor Code section 5402. The WCAB denied reconsideration, affirming the trial judge's finding that section 5402's 90-day period does not commence until a claim form is properly filed. The Board noted that the applicant did not provide proof of when the relevant claim form was received by the employer, and an earlier claim form pertained to a different, specific injury. Therefore, the applicant failed to establish the basis for the presumption of compensability.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationAdministrative Law JudgeIndustrial InjuryPermanent DisabilityFurther Medical TreatmentLabor Code Section 5402Presumed CompensableCumulative Trauma
References
Case No. ADJ8396129
Regular
Mar 05, 2014

RENE HERNANDEZ vs. LBH HOTEL CORP., dba MR. C HOTEL, AMTRUST NORTH AMERICA

The Appeals Board granted reconsideration, rescinded the WCJ's finding that the applicant's claim was barred, and found the injury presumptively compensable. This was because the employer failed to deny the claim within the 90-day period required by Labor Code section 5402. The defendant did not present evidence to rebut this presumption or demonstrate they formed the intent to deny the claim within the statutory timeframe. The matter was returned to the WCJ for further proceedings regarding the nature and extent of the injury.

Labor Code § 5402ReconsiderationPresumption of CompensabilityNinety-Day RuleDenial of ClaimPost-Termination ClaimRebuttal of PresumptionPetition for ReconsiderationFindings and OrderWorkers' Compensation Appeals Board
References
Case No. ADJ11254123
Regular
Oct 28, 2019

SAMANTHA HANSEN vs. ALERE HEALTH SYSTEMS, INC., THE HARTFORD INSURANCE GROUP

This case concerns a workers' compensation claim for a neck and spine injury. The applicant's attorney provided proof of service for the claim form on the defendant employer on March 16, 2018, and later sent a copy to the defendant insurance carrier. The defendant denied the claim on April 29, 2019, and argued that the claim should not be presumed compensable as the applicant did not prove receipt of the claim form. The Board upheld the WCJ's decision, finding that the proof of service created a presumption of receipt that the defendant failed to rebut. Therefore, the applicant's claim is presumed compensable under Labor Code Section 5402 as the defendant did not reject liability within 90 days.

Workers' Compensation Appeals BoardLabor Code Section 5402Presumption of CompensabilityReconsiderationFindings of Fact and OrdersPetition for ReconsiderationRN Case ManagerCumulative InjuryProof of ServiceClaim Form
References
Case No. ADJ9860385 ADJ9860124
Regular
Mar 27, 2017

JANICE HASLEY vs. FRITO-LAY, INC., ACE AMERICAN INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case concerns applicant Janice Hasley's request for a second Qualified Medical Evaluator (QME) panel for a cumulative trauma injury claim. The Board granted reconsideration, treating Hasley's petition as one for removal. The original findings denied the request for a second QME panel, which the Board rescinded due to an unclear record regarding claim forms and injury specifics. The case is returned to the trial level for further development of facts to determine if a second QME panel is warranted under *Navarro v. City of Montebello*.

QME panelNavarro v. City of MontebelloLabor Code sections 4062.3(j)4064cumulative trauma injuryspecific injury claimDeclaration of Readiness to ProceedPetition for Reconsiderationremovalrescinded Findings of Fact
References
Case No. ADJ6905551
Regular
May 24, 2010

Donald Laytham vs. SUTTER CENTER FOR PSYCHIATRY

This case concerns whether an industrial injury claim was barred as post-termination under Labor Code § 3600(a)(10). The applicant faxed a claim form on April 10, 2009, before receiving his termination notice on April 14, 2009, which was dated April 10, 2009, and mailed April 13, 2009. The Board affirmed the finding that the employer had sufficient notice of the injury prior to termination via the faxed claim form. Therefore, the claim was not barred as post-termination.

Workers' Compensation Appeals BoardReconsiderationFindings of FactIndustrial InjuryFacilities and Project CoordinatorClaim FormPost Termination ClaimLabor Code Section 3600(a)(10)Labor Code Section 5401(c)Labor Code Section 5402(a)
References
Case No. ADJ9373269, ADJ9373270
Regular
Dec 12, 2017

SOCORRO SALAZAR vs. MV TRANSPORTATION, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's finding that the applicant failed to prove her injury was presumptively compensable under Labor Code section 5402. The Board clarified that the 90-day presumption period begins when an employee files a claim form, not when the employer receives notice of injury. The Board affirmed that a claim form, not an Application for Adjudication of Claim, is the legally mandated method for initiating a workers' compensation claim. Therefore, the applicant did not meet her burden of proof for presumptive compensability.

WCABPetition for ReconsiderationLabor Code section 5402presumption of compensabilityclaim formdenial of liabilityApplication for Adjudication of Claimrebuttable presumptionfraudulent attemptsstatutory references
References
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