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

Case No. ADJ9888475 ADJ10049451
Regular
Apr 08, 2019

CHRISTOPHER PINEGAR vs. VERIZON COMMUNICATIONS, NATIONAL UNION FIRE INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT, INC.

This case involves a Petition to Reopen filed by the applicant alleging new and further disability. The Appeals Board found that the claim related to a specific injury from May 10, 2012, is time-barred as the petition was filed over five years after the injury date. However, the Board agreed with the trial judge that the record needs further development regarding the applicant's cumulative trauma claim. Therefore, the decision was rescinded, the specific injury claim was dismissed as untimely, and the matter was returned to the trial level for further proceedings on the cumulative trauma claim.

Petition to ReopenNew and Further DisabilityStipulated AwardSpecific InjuryCumulative TraumaStatute of LimitationsJurisdictionLabor Code Section 5804Labor Code Section 5410Workers' Compensation Appeals Board
References
9
Case No. claim No. 1, claim No. 2
Regular Panel Decision

Colley v. Endicott Johnson Corp.

The case involves an appeal from a Workers' Compensation Board decision concerning two claims. The claimant suffered a back injury in 1985, and that claim was closed in 1986. In 2004, while working in Ohio for MCS Carriers, the claimant sustained another back injury. The Workers' Compensation Law Judge ruled that the 1985 claim was barred from reopening by Workers’ Compensation Law § 123 and that New York lacked subject matter jurisdiction over the 2004 claim. The Workers' Compensation Board affirmed these rulings, leading to this appeal. The appellate court affirmed the Board's decision, confirming the applicability of § 123 to the 1985 claim due to lapsed statutory limits and concluding that insufficient significant contacts existed to confer New York jurisdiction over the 2004 out-of-state injury.

Workers' CompensationJurisdictionStatute of LimitationsReopening ClaimOut-of-state InjurySignificant ContactsAppellate ReviewBack InjuryTruck DriverNew York Law
References
6
Case No. ADJ8680977
Regular
Apr 28, 2014

Albert Johnson vs. Southwest Airlines, ACE USA Insurance

The Workers' Compensation Appeals Board reversed a judge's decision that barred Albert Johnson's cumulative trauma claim due to the statute of limitations. The Board found that the employer's continued provision of medical treatment for Johnson's injuries tolled the one-year statute of limitations under Labor Code section 5405(c). This treatment, provided after an initial specific injury but before the cumulative trauma claim was filed, was deemed to have also addressed the cumulative trauma elements. Therefore, Johnson's claim for cumulative trauma injury ending August 17, 2009, was found to be timely filed.

Cumulative traumaStatute of LimitationsLabor Code section 5405TollingMedical treatmentSpecific injuryRamp agentSouthwest AirlinesWorkers' Compensation Appeals BoardReconsideration
References
1
Case No. ADJ10537232, ADJ10537109, ADJ10058212
Regular
Jan 25, 2018

CHARLES CONLEY vs. STATE OF CALIFORNIA DEPARTMENT OF HEALTHCARE SERVICES

The Appeals Board granted reconsideration to further study the applicant's psychiatric and heart injury claims arising from his employment. The WCJ found the claims barred by the statute of limitations and denied a cumulative trauma claim due to lack of medical evidence. The Board rescinded the Findings and Orders, returning the case for further proceedings to address the WCJ's mischaracterization of specific injuries as cumulative trauma and the potential tolling of the statute of limitations. The Board also noted a need for further development of medical evidence on causation for the cumulative trauma claim.

Petition for ReconsiderationFindings and OrdersQualified Medical EvaluatorStatute of LimitationsCumulative TraumaSpecific InjuryIndustrial CausationEstoppelMyocardial InfarctionCoronary Artery Bypass Surgery
References
9
Case No. ADJ 10459549, ADJ 10459544
Regular
Jul 07, 2017

SAUL MEJIA VALLADARES vs. SERVICON SYSTEMS, INCORPORATED

In this case, the Appeals Board affirmed the Arbitrator's denial of the applicant's specific injury claim from March 7, 2016, due to credibility issues and lack of substantial evidence. However, the Board rescinded the denial of the cumulative trauma claim from April 2011 to April 2016. The Board found that medical records indicated prior orthopedic complaints within the cumulative trauma period, necessitating further medical evaluation despite the applicant's credibility issues on other claims. Therefore, the cumulative trauma claim is returned to the Arbitrator for further development of the medical record.

Workers' Compensation Appeals BoardReconsiderationCumulative TraumaSpecific InjuryArbitratorCredibility DeterminationMedical EvaluationLabor Code Section 4060Carve-out CaseLabor Code Sections 3201.5
References
7
Case No. ADJ7050517
Regular
Jun 16, 2010

Gary Tull vs. YOUNGS MARKET, Permissibly Self-Insured Administered By CANNON COCHRAN MANAGEMENT SERVICES

This case concerns an applicant claiming cumulative trauma injury to his right knee. The WCJ denied the claim, finding the Panel QME's report insufficient to establish cumulative trauma. The Appeals Board granted reconsideration, noting the PQME found an injury and work-related causation but incorrectly characterized it as a specific injury on a particular date. The Board remanded the case to develop the medical record, specifically directing a supplemental report from the PQME on the cumulative trauma aspect of the claim.

Cumulative traumaPanel Qualified Medical EvaluatorPQMEIndustrial injuryRight kneeFindings and OrderReconsiderationTake nothing orderSubstantial medical evidenceBurden of proof
References
7
Case No. ADJ4191064 (AHM 0091361) ADJ3063740 (AHM 0095797)
Regular
Jan 11, 2010

JOSE BARRIOS vs. McPEEK CHRYSLER PLYMOUTH, INC., GAB ROBINS, BROADSPIRE, California Insurance Guarantee Association (CIGA), Kemper Insurance, Pacific National Company, Cal Indemnity, CalComp Insurance, Pacific Auto Insurance Company

This case involves a workers' compensation claim for cumulative trauma injury to the applicant's neck, back, shoulders, and wrists. The Appeals Board granted reconsideration to amend the date of injury for this cumulative trauma claim. Based on established law regarding the "date of injury" for cumulative trauma, the Board determined that the period of compensable temporary disability commencing in August 2000 constituted sufficient knowledge and disability to establish the injury date. Consequently, liability for the claim, which involved multiple insurers now adjusted by CIGA, was assigned accordingly with a revised injury end date of August 3, 2000.

CIGAKemper InsurancePacific National Companyliquidationcovered claimscumulative traumadate of injurytemporary total disabilityLabor Code section 5500.5Rodarte
References
2
Case No. ADJ8070183 ADJ9326618
Regular
Feb 17, 2016

CARLOS VASQUEZ vs. TRINET, AMERICAN HOME ASSURANCE

This case involves a defendant seeking reconsideration of a prior Board decision that found applicant sustained new and further disability from a January 7, 2009 injury and allowed further development of the medical record for a cumulative trauma claim. The defendant argued the treating physicians' reports were not substantial evidence for new and further disability and that there was insufficient evidence to reopen the cumulative trauma claim. The Board denied reconsideration, reaffirming its prior decision based on substantial medical evidence, and noting that the absence of an officially designated primary treating physician does not invalidate the relied-upon medical opinions. The Board further clarified that an Agreed Medical Examiner can be used for further evaluation of the cumulative trauma claim.

Workers' Compensation Appeals BoardPetition for ReconsiderationNew and Further DisabilityCumulative Trauma InjuryJoint Findings of Fact and OrderSubstantial EvidenceAgreed Medical ExaminerQualified Medical EvaluatorPrimary Treating PhysicianNon-Substantial Evidence
References
2
Case No. ADJ12672803, ADJ12979844, ADJ12673709
Regular
Apr 24, 2023

FREDDIE BANUELOS vs. ROBERT BERCU, STATE FARM FIRE AND CASUALTY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration of three prior decisions, affirming the dismissal of the post-termination defense for a right knee injury (ADJ12979844) and a cumulative trauma psychiatric injury claim (ADJ12673709), finding employer knowledge prior to termination. However, the Board amended the decision for a cumulative orthopedic injury claim (ADJ12672803), deferring the finding of industrial injury pending further development of the record regarding specific body parts and treatment needs. The Board also clarified that no psychiatric injury was found to date in ADJ12673709, and arguments regarding medical evidence for that claim were premature.

Post-termination defenseLabor Code 3600(a)(10)Labor Code 3208.3(e)Employer knowledgeIndustrial injuryOrthopedic injuryPsychiatric injuryCumulative traumaSpecific injuryRight knee injury
References
3
Case No. CLAIM NO. 78
Regular Panel Decision

In Re DDI Corp.

This case concerns the application of excusable neglect to a late class proof of claim filed by Raymond Ferrari and other representatives on behalf of a putative class against DDi Corp., a debtor in a pre-arranged chapter 11 case. The claim was filed approximately six weeks after the bar date. The debtors moved to expunge the claim due to untimeliness and procedural defects, while the representatives cross-moved for leave to file late, arguing lack of actual notice. The court denied the cross-motion, finding that the class was an unknown creditor at the time the bar date notice was mailed, and therefore, excusable neglect was not established. Consequently, the debtors' motion to expunge Claim No. 78 was granted.

excusable neglectlate claimclass actionproof of claimbar datebankruptcysecurities fraudchapter 11actual noticeunknown creditor
References
10
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