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

Case No. MISSING
Regular Panel Decision

Garden State Anesthesia Associates, PA v. Progressive Casualty Insurance

Garden State Anesthesia Associates (GSAA) sued Progressive Casualty Insurance Company for unpaid first-party no-fault benefits after providing services to Angela Gowan-Walker. Progressive delayed payment, citing the need for Gowan-Walker's examination under oath (EUO) and extensive medical and workers' compensation records. Although Gowan-Walker completed her EUO, Progressive continued to issue delay letters, requesting information primarily from third parties and Gowan-Walker's attorney, without directly contacting GSAA for verification. The court denied Progressive's motion for summary judgment, ruling that an insurer cannot indefinitely toll the 30-day payment period by requesting verification unrelated to the specific provider's claim or by failing to request verification directly from the provider.

No-fault benefitsSummary JudgmentInsurance LawVerification RequestDelay LetterEUOMedical RecordsInsurance ClaimsTimelinessTolling
References
9
Case No. ADJ207630 (VNO 0423900), ADJ4689357 (VNO 0462906)
Regular
Feb 11, 2015

MANUEL PASQUIER vs. VOLUTONE DISTRIBUTING COMPANY, VIRGINIA SURETY INSURANCE COMPANY

This case concerns applicant Manuel Pasquier's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB initially found that the defendant unreasonably delayed three lump sum payments, resulting in interest, a $10,000 penalty under Labor Code § 5814, and attorney's fees. Pasquier argued for multiple penalties, citing the distinct nature of the payments, while the WCAB affirmed the single penalty, viewing the late payments as one act of unreasonable delay. The majority also upheld the WCJ's attorney's fee calculation, disagreeing with Pasquier's claim for higher fees and hours. However, one Board member dissented, arguing that the three distinct payments (disability indemnity, MSA seed money, and attorney's fees) constituted separate acts of unreasonable delay, each warranting an individual penalty, and supported the higher attorney's fee rate.

Compromise and ReleaseJoint Findings of Fact and Orderunreasonable delaylump sum paymentsLabor Code section 5814attorney's feeLabor Code section 5814.5Petition for Reconsiderationworkers' compensation administrative law judgeseparate acts
References
12
Case No. ADJ2109115; ADJ3790194; ADJ4103411
Regular
Aug 01, 2013

LETICIA BENAVIDES vs. BON APPETIT DANISH; MACY'S; CHUBB GROUP OF INSURANCE CO.

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought penalties and attorney fees for the late payment of a Compromise and Release (C&R) settlement, alleging Chubb Group failed to make timely and correct payment. The Board found that the delay was due to a single instance of human error involving an incorrect address on the C&R, which was promptly corrected upon discovery. The applicant also contributed to the delay by not notifying Chubb of the non-receipt of payment for over three months. Therefore, the Board concluded there was no unreasonable delay justifying penalties.

Workers Compensation Appeals BoardPetition for ReconsiderationDeniedWCJ ReportDefective VerificationCured VerificationSupplemental PetitionCompromise and ReleaseLate PaymentChubb Group
References
3
Case No. ADJ7191867
Regular
Mar 23, 2012

ARTURO ESCOBAR vs. HENRY WINE GROUP dba ZEPHYR EXPRESS, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision because the WCJ's imposition of a 20% penalty for delayed payment did not adequately explain the penalty amount based on established legal factors. While a delay in payment was found, the Board remanded the case for the WCJ to re-evaluate penalties and interest by clearly applying factors from relevant case law and justifying the awarded amounts with specific evidence. The original decision also failed to separately address statutory interest owed on the delayed payment. The Board emphasized the need for decisions to articulate the evidentiary basis and reasoning for penalty assessments.

Labor Code section 5814Petition for ReconsiderationFindings and AwardWCJZurich American Insurance CompanyArturo EscobarHenry Wine GroupZephyr ExpressCompromise & Releasepenalty
References
7
Case No. ADJ1186395 (MON 0254521) ADJ1992738 (MON 0256181)
Regular
Jun 29, 2009

Lavon Leach vs. Los Angeles Unified School District, Adjusted by SEDGWICK CLAIMS MANAGEMENT

This case concerns penalties assessed against Los Angeles Unified School District for delayed or incorrect workers' compensation payments to Lavon Leach. The WCJ found the District liable for penalties under Labor Code sections 5814 and 4650(d) for various payment delays, including permanent disability, interest, and attorney fees. Both parties sought reconsideration; the applicant argued penalties should apply to the full award amounts, not just delayed portions, while the defendant contested liability for penalties and certain payment increases. The Appeals Board affirmed the WCJ's Supplemental Findings and Award, adopting the judge's reasoning and finding that claims not raised at trial could not be litigated.

Labor Code section 5814Labor Code section 4650(d)permanent disabilitypenaltiesinterestattorney's feesdelayed paymentsreconsiderationSupplemental Findings and AwardWCJ
References
0
Case No. SBA 0076630
Regular
Mar 03, 2008

Janice Brackenridge-DeGraff vs. ACTMEDIA, INC., INTERCARE INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, overturning a prior decision that denied penalties for delayed payment. The Board found the employer unreasonably delayed payment of the compromise and release agreement by 10 days beyond the agreed-upon 30-day deadline. Consequently, the Board awarded a 5% penalty on the delayed amount and a separate 5% penalty for the unreasonable delay in paying the legally owed interest.

Labor Code section 5814ReconsiderationCompromise and ReleasePenaltyUnreasonable DelayPaymentInterestAttorney's FeesCIGAWCJ
References
1
Case No. OXN 0134891; OXN 0134895 OXN 0134908; OXN 0147440 OXN 0147441; OXN 0147444
Regular
Jun 06, 2008

CRYSTAL BROWN vs. OXNARD SCHOOL DISTRICT, Permissibly Self-Insured, Administered By SOUTHERN CALIFORNIA RISK MANAGEMENT ASSOCIATES

The Workers' Compensation Appeals Board denied reconsideration of a decision finding no delay in payment of a compromise and release (C&R). The applicant argued that payment was delayed because she received the settlement check after the 30-day deadline, but the Board found that payment was timely tendered when the check was issued and mailed on the 30th day. Therefore, the defendant is not liable for penalties, interest, or attorney's fees.

Workers' Compensation Appeals BoardOxnard School DistrictSouthern California Risk Management AssociatesOrder Approving Compromise and ReleaseChild Nutrition WorkerUpper Extremities InjuryKnee InjuryLow Back InjuryDelay in PaymentMailbox Rule
References
4
Case No. ADJ10834446
Regular
Sep 22, 2017

Miguel Cueva vs. Pacific American Fish, Alaska National Insurance Co.

Applicant sought reconsideration of an order approving a compromise and release, alleging the defendant unreasonably delayed payment and seeking penalties. The Appeals Board dismissed the petition, clarifying that it was not a proper petition for reconsideration of the original order. Instead, the applicant's claims regarding delayed payment should be addressed at the scheduled status conference. The Board emphasized that a petition for reconsideration must be taken from a final order, not a procedural dispute about payment execution.

Workers' Compensation Appeals BoardMiguel CuevaPacific American FishAlaska National Insurance Co.ADJ10834446Petition for ReconsiderationOrder Approving Compromise and ReleaseWCJLabor Code Section 5814(a)Penalty
References
4
Case No. MON 248520, MON 248521 MON 244922
Regular
Oct 01, 2007

MARIA MARQUEZ vs. GEORGE INDUSTRIES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INDEMNITY COMPANY, CAMBRIDGE INTEGRATED SERVICES GROUP

The Workers' Compensation Appeals Board granted reconsideration, finding that Insurance Code section 1063.1(c)(8) does not bar penalties against the California Insurance Guarantee Association (CIGA) for its *own* unreasonable delays in payment. The Board held that this exclusion specifically applies to delays caused by the insolvent insurer, not CIGA's subsequent administration. The case was returned to the trial level to determine if CIGA unreasonably delayed payments and to potentially award penalties.

CIGA liabilityInsurance Code 1063.1(c)(8)Unreasonable delayTemporary disability indemnityFremont Indemnity liquidationStipulated awardLabor Code 5814Labor Code 4650(d)Insolvent insurerCovered claims exclusion
References
16
Case No. ADJ2464522
Regular
May 06, 2013

CHARLES COWART vs. JACK IN THE BOX, INC.

This case concerns a workers' compensation applicant's petition for reconsideration of a prior Appeals Board decision. The Board previously rescinded one of two penalties awarded to the applicant for an employer's delay in paying settlement proceeds. The Board found the delay in applicant's net payment was due to the applicant's own failure to provide necessary information for an annuity purchase. Reconsideration is denied, reaffirming that the employer acted reasonably and the applicant's own actions caused the payment delay.

Workers' Compensation Appeals BoardPetition for ReconsiderationCompromise and ReleaseUnreasonable DelayLabor Code section 5814AnnuityAttorney's FeesLabor Code section 5814.5Findings and AwardWCJ
References
0
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