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

Case No. ADJ9569685
Regular
Oct 26, 2015

Oscar Cuellar vs. KLM Development, State Compensation Insurance Fund

The Workers' Compensation Appeals Board granted reconsideration to further develop the record concerning the applicant's employment status. The prior decision found the applicant was an independent contractor and not employed by KLM Development. The Board is returning the case to the trial level for analysis of Labor Code section 2750.5 and Business and Professions Code section 7125.2, particularly regarding the licensing and insurance status of the alleged independent contractor, Jaime Perez.

WCABPetition for ReconsiderationFindings and Orderindependent contractoremployee statusLabor Code 2750.5Business and Professions Code 7125.2license statusinsurance statusRinaldi v. Workers' Comp. Appeals Bd.
References
Case No. ADJ3885285 (FRE 0248529) ADJ3795787 (FRE 0247126)
Regular
Dec 30, 2008

Larry Shores vs. CITY OF MADERA; ACCLAMATION FRESNO

This case concerns a worker's compensation claim for a back and spine injury sustained by Larry Shores. The Board granted reconsideration, rescinded sanctions imposed on the defendant for litigation tactics, and rescinded a penalty for delayed temporary disability payments. However, it otherwise affirmed the finding of industrial injury, awarded penalties for unreasonable delay in medical treatment, and upheld the need for ongoing medical care, including surgery.

Workers' Compensation Appeals BoardLarry ShoresCity of MaderaAcclamation FresnoADJ3885285ADJ3795787Opinion and Order Granting ReconsiderationFindings and AwardWCJIndustrial Injury
References
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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ2834861 (GRO 00349120) ADJ3453107 (GRO 0031731) ADJ405168 (GRO 0034913)
Regular
Nov 14, 2019

TOM JANISE vs. DSH ATASCADERO, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted applicant's Petition for Removal, rescinding an order that closed discovery and set a trial date. This was because a court-ordered neurology panel Qualified Medical Evaluator (QME) was not selected until after discovery was closed, despite delays from the Medical Unit. The Board agreed that applicant should not be prejudiced by this delay and allowed for the QME evaluation to proceed. Consequently, the trial was converted to a status conference.

Petition for RemovalAppeals BoardWCJQualified Medical EvaluatorDWC Medical Unitneurologydiscovery closureproof of serviceStatus Conferencerescinded order
References
Case No. ADJ10330377
Regular
Jul 10, 2017

Taylor Baugh vs. Action Holdings, Inc., XL Specialty Insurance

This case concerns a defendant's petition for reconsideration regarding a 10% penalty for underpayment of temporary disability benefits. The Workers' Compensation Appeals Board granted reconsideration and amended the original decision. The penalty was adjusted to apply only to the specific amount of temporary disability that was delayed, not the entire awarded sum, in accordance with Labor Code section 5814.

Labor Code section 5814Petition for ReconsiderationTemporary DisabilityUnderpaymentPenaltyWCJWorkers' Compensation Appeals BoardFindings and AwardDecision After Reconsiderationunreasonable delay
References
Case No. ADJ10183558 ADJ10183560
Regular
2020-00-00

MONA BALDWIN vs. FRESH & EASY, LLC, AIG CLAIM SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior order, affirming sanctions against applicant's attorney, Joseph M. Roberts, individually, for engaging in tactics causing unreasonable delay and expense. The WCAB found that Roberts knew or should have known his actions regarding attorney's fees were frivolous and unnecessary. However, the WCAB amended the original order to remove sanctions against Roberts' law firm, as proper notice was not provided to the firm. The decision also clarified that the issue of attorney's fees and costs was not barred by res judicata and that the judge had authority to impose sanctions on the individual attorney.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings of Fact and OrdersSanctionsAttorney's FeesLabor Code section 5813Res JudicataDue ProcessWCJ AuthorityFrivolous Delay
References
Case No. ADJ7670126; ADJ7670124; ADJ8134230; ADJ8134232
Regular
May 24, 2012

WANDA MCNAIR vs. CITY OF INGLEWOOD

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal, reversing a prior order that had taken the case off calendar. The Board found that the defendant had not acted with due diligence in preparing its case, and the applicant argued this would cause unreasonable delay in adjudicating her benefits. The Board adopted the WCJ's recommendation to return the matters to the trial level due to unresolved factual issues. The case is now scheduled for a status conference to determine necessary further proceedings.

Petition for RemovalOff Calendar OrderDue DiligenceUnreasonable DelayAdjudicate EntitlementProcedural HistoryUnresolved Factual IssuesTrial LevelStatus ConferenceRescind Order
References
Case No. ADJ8035089, ADJ8033530, ADJ8033513
Regular
Jun 27, 2012

Linda Barajas vs. First Group America, Chartis

The Appeals Board overturned a WCJ's denial of reimbursement for a self-procured gym membership. The applicant's claim was in delay status when her physician prescribed the membership, and she notified the adjuster without objection before purchasing it. The Board found the gym membership reasonable and consistent with ACOEM guidelines for shoulder treatment, though limited to six months. Therefore, the applicant is awarded one-half the cost of her 12-month membership as reasonable self-procured medical treatment.

Workers' Compensation Appeals BoardReconsiderationSelf-procured medical treatmentGym membershipTreating physicianDelay statusACOEM guidelinesLabor Code 5402(c)Utilization reviewIndustrial injury
References
Case No. ADJ2464522 (OAK 0338150)
Regular
Feb 19, 2013

CHARLES COWART vs. JACK IN THE BOX, INC.

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior award of penalties for unreasonable delay in funding an annuity. The Board found that applicant's own delay in providing necessary information was the primary cause of the annuity funding delay, thus not warranting a penalty. However, the Board affirmed a $10,000 penalty for the employer's unreasonable delay in paying applicant's attorney's fees, to be paid to the applicant, not the attorney. Attorney's fees for enforcing the compromise and release were deferred for trial level resolution.

Workers' Compensation Appeals BoardCompromise and ReleaseLabor Code section 5814PenaltyUnreasonable DelayAnnuity FundingAttorney's FeesReconsiderationFindings and AwardDecision After Reconsideration
References
Case No. SDO 0345671
Regular
Jun 11, 2007

BONNIE JACKSON vs. STANDARD HOMEOPATHIC COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a petition for reconsideration by State Compensation Insurance Fund (SCIF) following an order for sanctions against them. The sanctions were imposed due to SCIF's failure to timely pay a Qualified Medical Evaluator (QME) for services rendered to an injured worker, and their subsequent failure to appear at hearings. The Workers' Compensation Appeals Board denied the reconsideration, adopting the Administrative Law Judge's report which found SCIF's actions constituted bad faith and delay tactics.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Denying ReconsiderationAdministrative Law JudgeLien ClaimantSanctionsLabor Code Section 4622(a)Bad FaithFrivolousDelay
References
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