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

Case No. ADJ10569473
Regular
Sep 12, 2017

EDWIN RAQUEDAN (deceased), IMELDA RAQUEDAN vs. VIOLA, INC.; EVEREST NATIONAL INSURANCE COMPANY

This case concerns whether the presumption of compensability under Labor Code section 5402 applies to a deceased accountant's fatal car accident claim. The defendant employer contests the finding that this presumption was triggered because no DWC-1 claim form was ever filed by the applicant. The Appeals Board granted reconsideration, rescinded the trial judge's order, and returned the matter for further proceedings. The Board noted that under *Honeywell*, the 90-day presumption period runs only from the filing of a claim form, not from the employer's general knowledge of an injury.

Labor Code section 5402presumption of compensabilityPetition for ReconsiderationFindings and OrderIndustrial causationMotor vehicle accidentClaim formRebuttable presumptionHoneywell v. Workers' Compensation Appeals BoardOpinion on Decision
References
1
Case No. MISSING
Regular Panel Decision

Flores v. Anjost Corp.

Plaintiffs filed a class action lawsuit against Anjost Corporation and its principals, alleging violations of the Fair Labor Standards Act and the New York Labor Law, including issues with minimum wage, overtime pay, tip withholding, and uniform costs. The court addressed Plaintiffs' motion for class certification, following a prior conditional certification of an FLSA collective action. Evaluating the proposed classes under Rule 23 of the Federal Rules of Civil Procedure, the court found that the requirements for numerosity, commonality, typicality, and adequacy of representation were largely met. Consequently, the court granted the motion for class certification in a modified form, establishing three specific classes: a Tipped Employee Class, a Spread of Hours and Wage Statement Class, and a Uniform Claims Class. The decision also included orders for the defendants to disclose class member information and for both parties to jointly prepare a proposed class notice.

Class ActionFair Labor Standards Act (FLSA)New York Labor Law (NYLL)Wage and Hour ClaimsOvertime WagesMinimum WageTip WithholdingUniform CostsWage StatementsSpread of Hours Premium
References
71
Case No. ADJ7960157 (RDG 0095395) ADJ4276340
Regular
Apr 03, 2013

DAVID SANDROCK vs. INDEPENDENT BUSINESS FORMS, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

This case involves a petition for reconsideration filed by the defendant, Independent Business Forms, Inc. The Workers' Compensation Appeals Board has granted this reconsideration. The Board intends to further study the factual and legal issues to ensure a just and reasoned decision. All future communications regarding this matter must be filed in writing with the Office of the Commissioners.

SandrockIndependent Business FormsPreferred Employers Insurance CompanyADJ7960157ADJ4276340ReconsiderationPetition for ReconsiderationWorkers' Compensation Appeals BoardRedding District OfficeSan Francisco
References
0
Case No. ADJ4276340 RDG 0095395 ADJ7960157
Regular
Aug 15, 2013

David Sandrock vs. Independent Business Forms, Inc., Preferred Employers Insurance Company

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and amended a prior decision regarding David Sandrock's cumulative trauma claim. The WCAB found that Sandrock's cumulative trauma injury ending July 28, 2006, is not presumptively compensable because no claim form was filed with the employer, as required by Labor Code sections 5401 and 5402. The Board determined that the insurer, Preferred Employers, did not violate due process by submitting the case on briefs at a conference. The WCAB deferred the issue of injury arising out of and occurring in the course of employment (AOE/COE) and returned the matter to the trial level for further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderCumulative TraumaPresumptive CompensabilityClaim Form90-Day Investigation PeriodDue ProcessIndustrial InjuryAOE/COE
References
1
Case No. ADJ870019 (SFO 0455266) ADJ3218516 (SFO 0428166) ADJ322513 (SFO 0423213)
Regular
Oct 05, 2015

LINDA LECHNER vs. MARIN GENERAL HOSPITAL, ARROWOOD INDEMNITY COMPANY

The Board granted reconsideration of the award for self-procured medical expenses for a walk-in bathtub. The applicant failed to provide a proper request for authorization (DWC Form RFA) from her treating physician. Therefore, the defendant was not obligated to conduct utilization review for the bathtub. The case is returned to the trial level for the applicant's physician to submit a correct request for retrospective authorization.

Utilization ReviewDWC Form RFAPrimary Treating PhysicianWalk-in BathtubSelf-Procured Medical ExpensesPetition for ReconsiderationSupplemental Findings and AwardRetrospective ReviewMedical NecessityIndustrial Injury
References
1
Case No. ADJ8079708
Regular
May 06, 2013

JAMES AZBILL vs. FATORS MOTORCYCLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to amend a prior finding, affirming the claim is not barred by the statute of limitations. However, the Board reversed the finding that the applicant was entitled to the presumption of compensability under Labor Code section 5402(b). This presumption requires the filing of a DWC-1 claim form, which was absent in this case. The Board will return the matter to the trial level for further proceedings on deferred issues.

Workers' Compensation Appeals BoardFators MotorcyclesState Compensation Insurance FundJames AzbillADJ8079708Opinion and OrderReconsiderationFindings and OrderWCJStatute of Limitations
References
0
Case No. ADJ10962119; ADJ11023301
Regular
Jul 10, 2018

OSCAR RENDEROS vs. SEA BREEZE CONSTRUCTION, WESCO INSURANCE, AMTRUST FINANCIAL SERVICES

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant's claim was not barred by the statute of limitations. The Board deferred to the Administrative Law Judge's (WCJ) credibility determination, finding no substantial evidence to reject it. The employer's letter stating they would "administratively close" the file was not deemed a denial of the claim, thus not triggering the statute of limitations. The WCJ found the employer failed to adequately inform the applicant of his rights after receiving the DWC-1 form.

WCABPetition for ReconsiderationStatute of LimitationsDWC-1 Claim FormAOE/COECredibility DeterminationLabor Code §5405Notice of RightsIndustrial InjuryClaims Administrator
References
4
Case No. ADJ10426328
Regular
Oct 11, 2018

Fernando Marquez vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

This case involves a teacher who claims a cumulative trauma injury from toxic chemical exposure near his school, leading to 100% permanent disability. The Workers' Compensation Appeals Board (WCAB) affirmed the finding of industrial injury and permanent total disability. However, they rescinded the presumption of compensability due to the lack of a filed DWC-1 claim form. The WCAB also clarified the injured body parts to include trachea and prediabetes, and confirmed the decision to not apportion the disability.

Workers' Compensation Appeals BoardCumulative trauma injuryThyroid cancerMetastatic lung cancerIndustrial exposureToxic chemicalsCarcinogensPermanent disabilityApportionmentDue process
References
2
Case No. ADJ10049659
Regular
May 29, 2018

JOSE PINA DIAZ vs. SUNBURST CHURCH OF SELF REALIZATION, ILLINOIS MIDWEST INSURANCE AGENCY on behalf of STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration for both the applicant and the defendant regarding the initial Findings of Fact and Award. The Board rescinded the prior award and returned the case to the trial level for further proceedings. Key issues included the applicant's alleged injury to his nervous system and psyche, and whether the statute of limitations tolled due to the employer's failure to provide a DWC-1 claim form. The Board found the WCJ's original decision lacked clarity and sufficient basis on these points.

WCABPetition for ReconsiderationFindings of Fact and AwardDate of InjuryLast Injurious ExposureStatute of LimitationsTolledDWC-1 Claim FormNervous System and PsycheCumulative Trauma Injury
References
3
Case No. STK 182176
Regular
Mar 07, 2008

ShAENA SOUTHARD vs. HALLMARK CARDS/ROYAL SUNALLIANCE, SARA LEE/BROADSPIRE

The Workers' Compensation Appeals Board denied Sara Lee's petition for reconsideration, affirming the WCJ's finding of cumulative injury sustained while working for Sara Lee. The Board relied on the Labor Code § 5402(b) presumption of compensability due to Sara Lee's failure to deny the claim within 90 days of receiving the DWC-1 form. Additionally, the Board found the medical opinion of Dr. Feinberg, which attributed a portion of the injury to Sara Lee's employment, to be credible and substantial evidence.

WCABPetition for ReconsiderationCumulative InjurySara LeeHallmark CardsLabor Code § 5402(b)Presumption of CompensabilityAgreed Medical EvaluatorQualified Medical EvaluatorDr. Steven D. Feinberg
References
10
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