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

Case No. ADJ10228371 ADJ580886 (VNO 0437854) ADJ2267886 (VNO 0492610) ADJ8376625
Regular
Mar 18, 2019

RICHARD TULL vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION

The California Workers' Compensation Appeals Board granted reconsideration, amending a prior order to correct the date of injury in case ADJ580886. The Board deferred the issues of whether the defendant overpaid permanent disability benefits in ADJ580886 and whether any overpayment could be credited against benefits in other consolidated cases (ADJ2267886, ADJ8376625, ADJ10228371). The Board found the original decision lacked sufficient explanation regarding the overpayment and credit claims. The matter is returned to the trial level for further proceedings on these deferred issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationOverpayment of Permanent Disability BenefitsCredit for OverpaymentDate of Injury CorrectionLabor Code Section 5313Clerical ErrorJudicial ErrorSubstantial EvidenceStipulated Award
References
0
Case No. ADJ1315206 (SDO 0327261)
Regular
Jun 25, 2010

Marvin Nelson vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES

This case concerns Marvin Nelson's workers' compensation claim for an industrial injury to his back. The WCAB granted reconsideration to amend the findings regarding temporary disability overpayment. While upholding the denial of a neck injury claim due to insufficient medical evidence contemporaneous with the injury, the Board found no overpayment of temporary disability between August 16-24, 2004. The determination of permanent disability, apportionment, and further overpayments remains deferred pending further medical development.

Workers Compensation Appeals BoardMarvin NelsonState of California Department of Social ServicesIndustrial InjuryBack InjuryNeck InjuryTemporary DisabilityPermanent DisabilityOverpaymentDr. Carl Maguire
References
4
Case No. AHM 0093986 AHM 0116200
Regular
Jan 15, 2008

Dawn Keep vs. CHINO VALLEY MEDICAL CENTER, BROADSPIRE INSURANCE COMPANIES, STATE COMPENSATION INSURANCE FUND

The applicant sought reconsideration of a workers' compensation award, primarily challenging the permanent disability rating and the employer's credit for temporary disability overpayments. The Board affirmed the permanent disability findings but rescinded the overpayment credit, deferring that issue to allow for determination of the applicant's permanent and stationary date and clarification of overlapping cumulative trauma and temporary disability periods. This action requires the WCJ to first establish these dates before ruling on any potential overpayment credit.

Cumulative traumaPermanent disability ratingApportionmentAgreed Medical Examiner (AME)Escobedo v. Workers' Comp. Appeals Bd.Temporary disability overpaymentPermanent and stationary dateZurich AmericaState Compensation Insurance Fund (SCIF)WCJ Report and Recommendation
References
1
Case No. ADJ12340832
Regular
Sep 14, 2022

JOSE PEREZ vs. VILLA PARK LANDSCAPE, CALIFORNIA INSURANCE COMPANY, APPLIED RISK SERVICES

The applicant sought reconsideration of an award that found industrial injury to his back and entitled him to disability benefits, but also granted the defendant a credit for temporary disability overpayment. The Appeals Board affirmed the award of disability benefits but deferred the issue of the credit for temporary disability overpayment. This deferral is due to the defendant failing to present evidence or provide a clear explanation for the alleged overpayment, and the potential conflict between temporary and permanent disability indemnity purposes. Further proceedings are recommended to determine if the credit should be awarded.

WCABReconsiderationFindings of Fact and AwardIndustrial InjuryTree TrimmerTemporary DisabilityPermanent DisabilityCredit for OverpaymentAgreed Medical Examination (AME)Primary Treating Physician (PTP)
References
12
Case No. MISSING
Regular Panel Decision
Jun 24, 1991

Marziliano v. Sullivan

Plaintiff Josephine Marziliano sought review of a determination by the Secretary of the United States Department of Health and Human Services that denied her request to waive recovery of an overpayment of Supplemental Security Income benefits. The Magistrate Judge recommended that the matter be referred to the Secretary for a new hearing, emphasizing the importance of giving required deference to the treating physician’s opinions in such overpayment waiver proceedings. The defendant objected to the application of the treating physician rule in these proceedings. District Judge Goettel adopted the Magistrate Judge's report and recommendation, affirming that the treating physician rule applies with full force when determining whether a claimant was 'at fault' in accepting an overpayment and ordered the case remanded for a new hearing.

Supplemental Security Income (SSI)Overpayment WaiverTreating Physician RuleMental ImpairmentAdministrative Law Judge (ALJ)RemandSocial Security Administration (SSA)Disability BenefitsResource LimitationsReporting Requirements
References
8
Case No. GRO 0034142
Regular
Jan 25, 2008

JOANNE WILLIAMS vs. DENNY'S CORPORATION, AMERICAN HOME ASSURANCE, GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board granted reconsideration, affirming the applicant's temporary disability indemnity rate based on her anticipated managerial salary. However, the Board deferred issues of credit for overpayments, penalties, and associated attorney's fees due to an undeveloped record regarding actual payments and the specific periods of temporary disability. The case is returned to the trial level for further proceedings on these deferred issues.

WCABReconsiderationTemporary Disability IndemnityPenaltyAttorney's FeesEarnings CalculationEarning CapacityLabor Code 4453GoytiaKyllonen
References
6
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
18
Case No. ADJ2531503 (AHM 0111102), ADJ3636599 (AHM 0111103), ADJ4058229 (AHM 0123911)
Regular
Dec 23, 2010

JIM POTTS vs. CITY OF IRVINE POLICE DEPARTMENT

The Workers' Compensation Appeals Board granted reconsideration to correct the permanent disability rate and defer the attorney's fee calculation for the life pension. The Board affirmed the 86% permanent disability finding, rejecting the defendant's argument that the applicant's post-injury work history should have altered the medical opinions, as the defendant had the opportunity to address this. The Board also clarified that the 1997 Permanent Disability Rating Schedule was correctly applied and deferred the issue of temporary disability overpayment to the trial level.

Cumulative traumaSpineLeft shoulderRight wristBilateral kneesLeft ankleCardiovascular systemHypertensionPermanent disabilityLife pension
References
2
Case No. ADJ614580
Regular
Sep 13, 2011

RUDY FLORES vs. HYATT WEST HOLLYWOOD, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, BROADSPIRE

This case involves a dispute over medical treatment payment for an industrial injury to Rudy Flores. The Workers' Compensation Appeals Board (WCAB) reconsidered a prior award concerning treatment at Cedars-Sinai Medical Center. The WCAB deferred the issue of Cedars-Sinai's entitlement to payment for treatment from September 25, 2003, to October 13, 2003, pending further proceedings. This deferral stems from unresolved questions about Cedars-Sinai's claim being barred by a prior settlement with LA County-EMS for the same services. The WCAB also deferred the defendant's claim for reimbursement of an overpayment.

Workers Compensation Appeals BoardRudy FloresHyatt West HollywoodBroadspireCedars-Sinai Medical CenterIndustrial InjurySyndrome of Inappropriate Anti-diuretic HormoneLabor Code Section 5304JurisdictionPetition for Reconsideration
References
1
Case No. MISSING
Regular Panel Decision
Jan 03, 2001

Aussie Construction Corp. v. Empire Insurance

This case involves an appeal regarding a plaintiff's claim of overpayment for a general liability insurance policy provided by the defendant. The Supreme Court, New York County, initially granted partial summary judgment to the plaintiff, awarding $37,341, allowed amendment of the complaint, but also granted the defendant's cross-motion to dismiss. On appeal, the court unanimously modified the decision, increasing the plaintiff's award to $39,341 due to an acknowledged inadvertent error in the initial motion papers. The appellate court further denied the defendant's cross-motion to dismiss the complaint, citing inconsistency with other rulings. The court also addressed the defendant's claim for a setoff concerning a separate workers' compensation policy, finding insufficient evidence to link the policy to the plaintiff due to distinct entities. The action's transfer to Civil Court for resolution of workers' compensation coverage issues was affirmed.

OverpaymentGeneral Liability InsuranceSummary JudgmentWorkers' Compensation PolicySetoffAppellate ReviewCivil Court TransferInadvertent ErrorEntity IdentificationInsurance Dispute
References
1
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