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

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. ADJ7196811
Regular
May 17, 2012

ROBERTO LEDESMA vs. U.C. BERKELY, SEDGWICK CMS

Here's a summary for a lawyer: The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding a discovery order compelling production of non-privileged claims file notes from a specific prior period. The Board found these notes relevant to the time medical reports influencing the current Agreed Medical Evaluator were obtained. While one Commissioner concurred with allowing physician depositions, he dissented on the claims file notes, arguing their relevance and probative value were outweighed by undue consumption of time and questioning their necessity for the present admitted claim.

Petition for RemovalWorkers' Compensation Appeals BoardDiscovery OrderClaims File NotesAgreed Medical EvaluatorApportionmentFraudulent MeansDeposition of PhysiciansWCJ Report and RecommendationEvidence Code Section 352
References
Case No. ADJ1875496
Regular
Oct 30, 2009

KENNETH PATTERSON vs. ROSSCRETE ROOFING, INC., STATE COMPENSATION INSURANCE FUND

The WCAB denied reconsideration of a WCJ's finding that the applicant's injury was not caused by serious and willful misconduct by the employer. A commissioner dissented, arguing that the employer's failure to provide safety equipment constituted serious and willful misconduct.

Workers' Compensation Appeals BoardSerious and Willful MisconductLabor Code section 4553Industrial Accident CommissionEmployer's DutySafety PrecautionsKnown DangerReckless DisregardCal/OSHA CitationRule 3210(c)
References
Case No. ADJ4502386 (ANA 0329574)
Regular
Jul 02, 2012

MARTINA GONZALEZ vs. ST. JOHN KNITS, INC., ARGONAUT INSURANCE COMPANY

The WCAB denied a petition for removal seeking to overturn an order denying a continuance of a lien conference. The defendant's new counsel requested the continuance due to the pending substitution of attorneys, but the WCJ denied it, citing the importance of court-set calendars. While the majority found no significant prejudice given the extended discovery period and flexibility at trial, a dissenting opinion argued the defendant was prejudiced by being denied a meaningful lien conference to resolve issues before trial.

Petition for RemovalSubstitution of AttorneyLien ConferenceContinuanceWCJ OrderFindings and AwardIndustrial InjuryPermanent DisabilityAdelson Testan Brundo JimenezLaughlin Falbo Levy Moresi
References
Case No. ADJ2295331 (ANA 0397551)
En Banc
Jun 18, 2013

Wesley Carroll vs. Cincinnati Bengals, New Orleans Saints, Louisiana Workers' Compensation Corporation, Travelers Insurance

The Appeals Board held that under Labor Code § 3600.5(b), an employee hired outside California is exempt from the state's workers' compensation laws if they are temporarily in the state for work, the employer provides coverage from another state, and that state has reciprocal exemption provisions, leading to the dismissal of the Cincinnati Bengals from the case.

WCABEn BancReconsiderationLabor Code § 3600.5(b)ExemptionExtraterritorial ProvisionsOhio Workers' CompensationSelf-Insured EmployerTemporary EmploymentCumulative Injury
References
Case No. ADJ3482987 (VNO 0361935) ADJ4225713 (VNO 0387387)
Regular
Dec 24, 2012

ELIZABETH ARGUELLES vs. APPLE ONE SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION INSURANCE COMPANY, In Liquidation, COMMUNITY DEVELOPMENT COMMISSION

This Workers' Compensation Appeals Board decision affirmed a finding that the Community Development Commission (CDC) is jointly and severally liable as a special employer for the applicant's injuries. The CDC's self-insurance was deemed "other insurance" under Insurance Code section 1063.1, precluding liability for CIGA. The Board found the CDC waived statute of limitations and procedural joinder defenses due to a four-year delay in raising them. Consequently, the CDC remains responsible for providing workers' compensation benefits.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAApple One ServicesCommunity Development CommissionCDCPermissibly Self-InsuredCumulative TraumaSpecific InjuryOther Insurance
References
Case No. ADJ9163491; ADJ9163494
Regular
Jan 09, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN & COUNTRY

This case concerns an applicant's petition for removal after the WCJ denied his objection to a QME's report. The applicant argued the QME report was untimely and prejudicial because it issued a zero impairment rating. The Appeals Board denied removal, finding the applicant waived his objection by not requesting a replacement QME panel until after receiving the unfavorable report. The Board cited precedent preventing parties from waiting to see if a report is favorable before objecting to its timeliness. Commissioner Zalewski dissented, believing the applicant could object after receipt as long as the objection preceded the replacement panel request.

Petition for RemovalQualified Medical EvaluatorQME reportuntimely filingservice of reportreplacement panelobjectionstatutory timeframesLabor CodeAdministrative Director Rule
References
Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
Case No. ADJ9145724
Regular
Jun 01, 2015

ARZAGA, JOSE vs. CROWN AUTOMOTIVE, INC., AMTRUST NORTH AMERICA

This case involves an applicant seeking to select a pain management specialist outside his employer's Medical Provider Network (MPN). The applicant argued the MPN failed to provide a qualifying specialist within the required 15-mile/30-minute access standard for a primary treating physician. The Board denied the employer's petition for reconsideration, affirming the applicant's right to choose an out-of-network physician and reimbursement for investigative costs. The majority reasoned that the MPN must meet the closer access standard for a primary treating physician, even if that physician is a specialist. A dissenting opinion argued that a specialist, when chosen as a primary treating physician, should fall under the 30-mile/60-minute access standard for specialists.

Medical Provider NetworkMPNprimary treating physicianpain management specialistaccess standardAdministrative Director's Rule 9767.5investigative costsLabor Code section 5703Lescallett v. Wal-MartMartinez v. New French Bakery
References
Case No. ADJ638016 (VNO 0518817)
Regular
Mar 22, 2011

Roger Schleifstein vs. Leslie's Pool Supply, ST. PAUL'S TRAVELERS INSURANCE

This case concerns a lien claim by Grossman Medical Group for $188,310.89 in unpaid medical treatment expenses following an industrial injury. The WCAB affirmed the WCJ's decision disallowing the lien, finding Grossman Medical failed to prove its charges exceeded the Official Medical Fee Schedule (OMFS) due to extraordinary circumstances. Applicant's private health insurer, CIGNA, had already paid a significant portion of the bill, and the Appeals Board held that the statutory changes eliminating the exception for billing above OMFS in disputed claims applied. The dissenting opinion argued that Grossman Medical met its burden by demonstrating reasonable and customary fees supported by comparable cases, particularly where treatment was extensive.

Lien claimantGrossman Medical GroupOfficial Medical Fee ScheduleOMFSusual and customary feesextraordinary circumstancesreasonablenesslabor codeappeals boardcompromise and release
References
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