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

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ8964113
Regular
Jun 24, 2016

LISA LIU vs. ADVENTURER HOTEL, TOWER NATIONAL INSURANCE COMPANY

This case concerns a lien claim filed by Tri-County Medical Group for services provided to applicant Lisa Liu. The Administrative Law Judge (ALJ) dismissed the lien, finding it was filed untimely beyond the 18-month statutory limit. The lien claimant appealed, arguing the filing date of February 2, 2015, was within the period because the 18-month deadline of February 1, 2015, fell on a Sunday, extending the filing to the next business day. The Workers' Compensation Appeals Board granted reconsideration, rescinded the ALJ's order, and found the lien timely filed. The Board determined that per procedural rules, when the last day falls on a weekend, the deadline extends to the next business day.

Workers' Compensation Appeals BoardLien ClaimPetition for ReconsiderationLabor Code section 4903.5(b)Statute of Limitations18-month periodRules of Practice and ProcedureBusiness DayEAMS RecordJudicial Notice
References
Case No. ADJ10391495
Regular
Jun 20, 2019

EDNA DE LEON, vs. DEPALMA TERRACE SENIOR LIVING; BERKSHIRE HATHAWAY HOMESTATE COMPANIES; THE HARTFORD,

The Workers' Compensation Appeals Board dismissed Edna De Leon's Petition for Reconsideration because it was filed untimely. The Board noted that California law allows only 25 days to file a petition after a decision is served by mail. De Leon's petition was filed on April 22, 2019, which was more than 25 days after the WCJ's March 25, 2019 decision. The Board emphasized that timely filing is jurisdictional and they lacked authority to consider petitions filed outside this timeframe.

Petition for Reconsiderationuntimelydismissaljurisdictionalservice by mailtime limitWCABWCJdeadline25 days
References
Case No. ADJ9314776
Regular
May 16, 2018

Ken Sutton vs. San Jose Sharks, Federal Insurance Company

This case involves a professional hockey player's cumulative trauma claim against the San Jose Sharks. The employer sought exemption from California workers' compensation jurisdiction under Labor Code section 3600.5(d), arguing the player's last employer, the Ingolstadt Panthers, was exempt. The Workers' Compensation Appeals Board (WCAB) rescinded the prior finding, ruling that the Ingolstadt Panthers were not exempt under section 3600.5(c) as the player did not work temporarily in California for them. Consequently, the claim is not exempt under section 3600.5(d), and the WCAB retains jurisdiction.

Workers' Compensation Appeals BoardSan Jose SharksFederal Insurance Companycumulative trauma claimLabor Code section 3600.5(d)professional athleteIngolstadt Pantherssubject matter jurisdictionvocational rehabilitationduty days
References
Case No. ADJ9735466
Regular
Dec 07, 2015

DANIEL KAVANAGH vs. COUNTY OF SANTA BARBARA

The Appeals Board granted reconsideration, rescinded the WCJ's decision, and found applicant's claim barred by the going and coming rule. The Board determined that the applicant's commute to a mandatory monthly sergeants' meeting, even on his day off and in uniform, did not constitute a special mission. The court reasoned that the meeting's location, timing, and nature were not extraordinary relative to routine duties, and thus no exception to the rule applied. Consequently, the applicant was ordered to take nothing by way of his claim.

Going and coming ruleSpecial mission exceptionAOE/COECustody sergeantDeputy sheriffMandatory meetingDay offExtra ordinary activityRoutine dutiesEmployer benefit
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. ADJ7850439
Regular
Oct 15, 2012

Edgar Tabo vs. CITY AND COUNTY OF SAN FRANCISCO POLICE DEPARTMENT

The applicant, a police officer, injured himself in an off-duty bicycle crash. The Board denied compensation because the applicant failed to establish that his subjective belief of needing to train for an optional bicycle patrol course was objectively reasonable. His off-duty recreational activity did not meet the requirements for an exception to the exclusion for such injuries under Labor Code section 3600(a)(9). Therefore, the applicant takes nothing by way of his claim.

Workers' Compensation Appeals BoardEdgar TaboCity and County of San Francisco Police DepartmentPermissibly Self-InsuredADJ7850439Oakland District OfficeOpinion and Order Granting ReconsiderationFindings and AwardWCJindustrial injury
References
Case No. ADJ1543782 (VNO 0540728)
Regular
May 27, 2009

Richard E. Knudsen vs. CITY OF BEVERLY HILLS

The Workers' Compensation Appeals Board granted reconsideration, reversing a previous decision that denied benefits for a police officer's shoulder injury. The Board found the injury sustained in the on-duty gym was industrial because the applicant's belief that working out was expected was objectively reasonable, given the employer provided gym facilities and allowed officers to stay overnight for safety and duty readiness. The injury is now considered a compensable industrial injury.

Workers' Compensation Appeals BoardCity of Beverly Hillspolice officeroff-duty injuryindustrial injuryreasonable expectancypersonal comfort doctrineexertional injurygym workoutpremises
References
Case No. ADJ3854591 (VNO 0264467)
Regular
Jan 07, 2020

ANDRZEJ WASOWICZ vs. J.L. FISHER, INC., STATE COMPENSATION INSURANCE FUND

This case concerns the timeliness of a Utilization Review (UR) denial for requested medical treatment. The applicant argued the UR denial was untimely because it was issued on the 15th calendar day, exceeding the 14-day statutory limit under Labor Code section 4610(i)(1). The Appeals Board granted reconsideration, rescinding the prior decision that found the UR timely. The Board determined the UR denial was indeed untimely and remanded the case for a new decision on the medical necessity of the treatment.

Utilization ReviewRequest for Authorizationtimelinesscalendar daysworking daysjurisdictionmedical necessityLabor CodeFindings of FactPetition for Reconsideration
References
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