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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. 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
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
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. 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. ADJ9066748
Regular
May 23, 2014

RAMATU KABBA vs. DAMERON HOSPITAL ASSOCIATION

Applicant Ramatu Kabba sought reconsideration of a finding that her psychiatric injury claim was not presumed compensable. The applicant argued the 90-day presumption period under Labor Code § 5402(b) began when the employer allegedly failed to provide a claim form promptly after receiving notice of injury. However, the Board denied reconsideration, adhering to the holding in *Honeywell v. Workers' Comp. Appeals Bd.* that the 90-day period runs from the filing of the claim form, not the employer's breach. Absent evidence of the employer misleading the applicant into not filing, the presumption did not arise.

Labor Code section 5402(b)presumption of compensabilitypetition for reconsiderationclaim formdenial of liabilityHoneywell v. Workers' Comp. Appeals Bd. (Wagner)estoppelDWC Form 1industrial injurypsyche
References
Case No. ADJ9175109
Regular
Feb 05, 2016

GABRIEL GALLAND vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration and reversed a previous decision, finding the applicant's claim time-barred. The Board determined that the employer provided the applicant with a claim form and notice of benefits on August 13, 2009, which started the statute of limitations. Despite the applicant reporting the injury, there was uncontradicted evidence that he received the claim form. Consequently, the applicant's failure to file his claim within the statutory period after denial resulted in dismissal.

Workers' Compensation Appeals BoardStatute of LimitationsPetition for ReconsiderationFindings of FactLabor Code Section 5405Date of InjuryDisability IndemnityMedical TreatmentTollingEmployer's Report of Occupational Injury
References
Case No. ADJ7109517
Regular
May 05, 2011

DWAYNE RUDD vs. OAKLAND RAIDERS AND ACE/USA, Administered by ESIS, TAMPA BAY BUCCANEERS, Permissibly Self-Insured, Administered by NOVA PRO RISK SOLUTIONS

The Workers' Compensation Appeals Board granted reconsideration to reverse a prior decision and found applicant Dwayne Rudd's claim barred by the statute of limitations. Despite the WCJ finding defendants estopped to assert the defense due to notice violations, the Board determined Rudd possessed actual knowledge of his workers' compensation rights. This knowledge was evidenced by his signing of a DWC-1 form and retaining multiple law firms to pursue prior, dismissed claims for the same cumulative trauma injury. Therefore, the Board concluded there was no prejudice from the lack of notice, and the claim was untimely.

Workers' Compensation Appeals BoardDwayne RuddOakland RaidersACE/USATampa Bay BuccaneersNova Pro Risk Solutionsindustrial cumulative traumaprofessional football playerstatute of limitationsestoppel
References
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
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