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

Case No. ADJ6663169
Regular
Jan 27, 2010

RICHARD SHILTS (Deceased), KAAREN GUEST (Widow) vs. BRUNTON ENTERPRISES, INC., SEABRIGHT INSURANCE CO.

This case concerns whether a union's "carve-out" agreement, allowing for alternative dispute resolution under Labor Code § 3201.5, applies to dependent death benefits. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, reversing a prior finding. The WCAB held that "carve-out" agreements, by their plain language, apply only to "employees" and not to dependents' death benefit claims. Because dependents' rights to death benefits are independent of the deceased employee's claim and constitutionally mandated, the WCAB found these claims fall under its exclusive jurisdiction.

carve-out agreementLabor Code section 3201.5death benefitsdependents' claimalternative dispute resolutionWCAB jurisdictioncollective bargaining agreementindustrial injurywidowinsurer
References
Case No. ADJ8408754
Regular
Sep 01, 2017

DAVID WILSON (Deceased) vs. SECURITAS SECURITY SERVICES USA, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a decision regarding deceased applicant David Wilson's permanent disability benefits. The Board found the record inadequate to determine if applicant's right hand tremors stemmed from his industrial injury. Therefore, the case is returned to the trial level for further medical development of this specific issue by Dr. Horner. The Board did not address other contentions concerning benefit termination after death or constitutional challenges at this time.

Securitas Security ServicesSedgwick Claims Management ServicesDavid Wilson (Deceased)Michele WilsonAnthony WilsonTia CarringtonPetition for ReconsiderationFindings and Award and Orderworkers' compensation administrative law judgeWCJ
References
Case No. ADJ1780566 (FRE 0246374) ADJ428063 (FRE 0246373) ADJ3588105 (FRE 0246375) ADJ2219910 (FRE 0247600)
Regular
Dec 01, 2014

ERIC GORDON vs. FRITO-LAY, INC.

This case involves applicant Eric Gordon's appeal of a denied Independent Medical Review (IMR) determination regarding prescribed medications. The Workers' Compensation Appeals Board (WCAB) denied his petition for reconsideration because the applicant failed to present clear and convincing evidence of specific statutory grounds for overturning the IMR decision. The WCAB also affirmed that it lacks jurisdiction to decide constitutional challenges to the IMR process itself. Consequently, the applicant's attempt to have the IMR decision overturned based on alleged excess of power or constitutional grounds was unsuccessful.

Workers' Compensation Appeals BoardIndependent Medical Review (IMR)Petition for ReconsiderationAdministrative Director's powersLabor Code section 4610.6(h)constitutional issuesArticle XIV Section 4cross-examinationmedically necessaryMaximus Federal Services
References
Case No. GOL 0099213
Regular
Oct 24, 2007

DEREK VELASQUEZ vs. JOSE VELASQUEZ, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought reconsideration of a decision barring his temporary disability claim under Labor Code Section 4656(c)(1). The applicant conceded the claim was barred but argued the statute was unconstitutional, violating equal protection. The Workers' Compensation Appeals Board denied reconsideration, adopting the Administrative Law Judge's report which stated the Board lacks jurisdiction to determine the constitutionality of statutes.

Workers' Compensation Appeals BoardDerek VelasquezJose VelasquezState Compensation Insurance FundGOL 0099213ReconsiderationAdministrative Law JudgeGreener v. Workers' Comp. Appeals Bd.Industrial InjuryCervical Spine
References
Case No. ADJ1225282 (VNO 0377064) ADJ3069813 (VNO 0377062)
Regular
May 05, 2015

CHERYL CASTRILLO vs. CATHOLIC HEALTH CENTER WEST dba. MARIAN MEDICAL CENTER

The Workers' Compensation Appeals Board affirmed a prior decision finding that the defendant properly completed and communicated utilization review decisions, and that the applicant failed to prove the Independent Medical Review (IMR) process was biased. The Board held that delays in IMR decisions do not invalidate them, citing a relevant appellate court opinion. Furthermore, the Board lacks the authority to rule on the constitutionality of the relevant Labor Code sections. Therefore, the original decision was upheld.

Workers' Compensation Appeals BoardUtilization ReviewIndependent Medical ReviewAdministrative DirectorPetition for ReconsiderationFindings of Fact and OrderWCJLabor Codeconstitutionalitytimeliness
References
Case No. OAK 0312539
Regular
Nov 17, 2006

DAN HUNT vs. LEMKE CONSTRUCTION, INC, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of an earlier decision regarding an applicant's temporary disability indemnity. The WCAB affirmed the 104-week limit for temporary disability but clarified that this period begins from the date of the first payment, not the date of injury, per Labor Code section 4656(c)(1). The WCAB also noted it lacks jurisdiction to rule on the constitutionality of the statute and adopted the administrative law judge's reasoning on this point.

Workers' Compensation Appeals BoardTemporary Disability IndemnityLabor Code section 4656(c)(1)Hawkins v. Amberwood Productsdate of commencement of temporary disability paymentindustrial injurycarpenterright leg and ankletemporary total disabilityconstitutionality
References
Case No. STK 0192031
Regular
Aug 10, 2007

JOSE CRUZ vs. TRACY DODGE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board reconsidered an award of continuing temporary disability benefits, finding that payments are limited to 104 weeks from the initial payment date under Labor Code section 4656(c)(1). The Board clarified that an injury to multiple body parts from a single incident still constitutes a "single injury" for purposes of this limitation. Jurisdiction was reserved to determine the exact date of the first temporary disability payment to calculate the 104-week period.

Labor Code section 4656(c)(1)Hawkins v. Amberwood Productstemporary disability indemnity104 compensable weeksdate of first paymentsingle injuryspecific injurysection 3208.1(a)temporary total disabilitytemporary partial disability
References
Case No. ADJ7446809
Regular
Apr 17, 2013

JOE RAMIREZ vs. THE KROEGER COMPANY/RALPHS

The Workers' Compensation Appeals Board denied reconsideration of a decision dismissing Amy Swei's lien claim. The dismissal was based on the lien claimant's failure to pay a mandatory $100 lien activation fee prior to the scheduled lien conference, as required by Labor Code Section 4903.06(a)(4). The administrative law judge found the fee was paid after the 8:30 AM conference commenced, making the payment untimely. The Board adopted the judge's reasoning, emphasizing the clear language of the Labor Code mandating payment before the conference.

WCABADJ7446809Petition for ReconsiderationDWCemergency rule 10208(a)Labor Code section 4903(b)lien activation feeDeclaration of Readiness to Proceedlien conferenceOrders Dismissing Lien Claim
References
Case No. ADJ7054442
Regular
Jan 11, 2013

JARRAD JELSMA vs. WINE GROUP, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Board denied the defendant's petition for reconsideration of the WCJ's award of temporary disability indemnity. The defendant failed to demonstrate due diligence in producing a wage statement discovered after trial, which it claimed would lower the indemnity rate. While denying reconsideration of the retroactive award, the Board allowed the defendant to petition to reopen the award to prospectively adjust the temporary disability indemnity rate based on the disputed wage statement. The Board also denied credit to the defendant for any retroactive overpayment of temporary disability indemnity.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAverage Weekly EarningsTemporary Disability IndemnityWage StatementDue DiligenceNewly Discovered EvidenceReopen AwardRetroactive Overpayment
References
Case No. ADJ6937895
Regular
Jan 29, 2014

OSVALDO CALLEROS vs. EL CHOLO CAFÉ, EVEREST NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded an order dismissing a lien claimant's lien. Although the lien claimant missed a conference and filed an objection late, the Board found that the treatment was authorized by the defendant and that returning the matter to the trial level would achieve substantial justice. The Board emphasized the public policy favoring disposition of cases on their merits, and that returning the case would allow for fair and equitable resolution without substantial prejudice to the defendant.

Lien ClaimantReconsiderationOrder Dismissing LienEquitableUnjust EnrichmentAuthorized TreatmentLien ConferenceNotice of Intention to DismissObjectionSubstantial Justice
References
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