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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ4025440 (VNO 0557895)
Regular
Mar 12, 2012

CHARLES B. HANLON vs. WYLE HOLDINGS, INC., AIG adjusted by CHARTIS CLAIMS, INC.

The Workers' Compensation Appeals Board granted reconsideration to clarify an ambiguous award for temporary disability benefits. The applicant sustained a cumulative injury resulting in temporary and permanent disability. The defendant argued the award was unclear regarding the coordination of temporary disability payments with benefits already paid by the Employment Development Department (EDD). The Board clarified that the applicant is to be compensated for temporary disability, less amounts paid by EDD, with adjustments potentially needed to match the agreed-upon temporary disability rate. Furthermore, the Board clarified that EDD's overpayments of unemployment benefits made after the applicant's permanent and stationary date are to be reimbursed from the applicant's permanent disability benefits.

Cumulative industrial injuryTemporary disability indemnityPermanent disability benefitsPetition for ReconsiderationFindings and AwardAmbiguous awardEDD benefitsLabor Code §4904Agreed Medical ExaminerTemporary total disability
References
Case No. ADJ4629950
Regular
Dec 21, 2012

JOHNNY BETTENCOURT vs. DONALD WILLIAMS, SAFECO INSURANCE COMPANY, UNINSURED EMPLOYERS' BENEFIT TRUST FUND DEPARTMENT OF INDUSTRIAL RELATIONS

The Uninsured Employers' Benefit Trust Fund (UEBTF) sought reconsideration, arguing Safeco's policy covered the applicant's injury. The Arbitrator previously ruled Safeco had no liability as its policy with Donald Williams did not include "comprehensive personal liability" insurance as required by Insurance Code section 11590. The Appeals Board affirmed this decision, finding the Safeco policy explicitly limited coverage to premises liability and lacked the necessary language for comprehensive personal liability coverage. Therefore, Safeco was correctly found not liable for the applicant's injury.

Uninsured Employers' Benefit Trust Fundcomprehensive personal liability insuranceLabor Code section 3351(d)Labor Code section 3352(h)Insurance Code section 11590premises liability insuranceSafeco Insurance CompanyDonald WilliamsJohnny Bettencourtworker's compensation coverage
References
Case No. ADJ2497883 (SFO 0450940) ADJ3261393 (SFO 0504693)
Regular
Apr 30, 2010

JANETTE HARDIN vs. COUNTY OF ALAMEDA, SEDGWICK CLAIMS MANAGEMENT SERVICES, CHARTIS INSURANCE, TRISTAR RISK MANAGEMENT

This case involves Chartis Insurance seeking reconsideration of an arbitrator's decision setting the date of cumulative trauma injury for Janette Hardin's breast cancer as May 28, 1997, not the previously stipulated date of May 16, 2001. Chartis argued the stipulated date was res judicata and could not be altered, especially in a contribution proceeding. The Workers' Compensation Appeals Board denied the petition, affirming that contribution proceedings allow for a relitigation of liability and the determination of the true date of injury based on facts, not prior stipulations between the applicant and one defendant. The Board reasoned that findings of liability in the primary case are not binding in supplemental contribution proceedings.

Cumulative traumaDate of injuryContribution proceedingsRes judicataStipulated awardLabor Code section 5500.5Apportionment of liabilityCase-in-chiefSupplemental proceedingsGreenwald v. Carey Distribution Company
References
Case No. ADJ1747488
Regular
Dec 19, 2011

ADRIENNE BOYLAN vs. NEW COVENANT CARE GROUP, STATE COMPENSATION INSURANCE FUND

This case concerns the defendant's petition for reconsideration of a prior Board decision. The Board previously affirmed the dates of temporary disability for the applicant but amended the original award to grant the full value of temporary disability indemnity, rather than an apportioned percentage. The defendant argued against this full award, but the Board found that while liability for indemnity can be apportioned between defendants, an employee's entitlement to temporary disability indemnity cannot be apportioned. The Board denied the petition for reconsideration, reaffirming that the defendant is solely liable for the full value of temporary disability indemnity.

Temporary Disability IndemnityCumulative Trauma InjuryApportionment of LiabilityExclusive LiabilityLabor Code Section 3208.2FibreboardGranadoWCAB OpinionPetition for ReconsiderationSpecific Injury
References
Case No. ADJ1200873 (OAK 0337904) ADJ479879 (OAK 0337905)
Regular
Apr 06, 2009

CARMEN CHACON vs. NATIONAL UPHOLSTERING CO., NATIONAL LIABILITY & FIRE INS. CO.

The Workers' Compensation Appeals Board (WCAB) rescinded an approved Compromise and Release (C&R) agreement due to potential mutual mistake of fact regarding duplicate payments of Temporary Disability Indemnity (TDI) and Unemployment Insurance (UI). Both the defendant and the Employment Development Department (EDD) sought reconsideration, arguing the original order did not adequately protect their interests regarding these duplicate payments. The WCAB found that EDD's due process rights were violated by a lack of proper notice and service regarding the C&R. The matter was returned to the trial level for a new decision to determine if a mutual mistake occurred and to consider EDD's lien.

Workers' Compensation Appeals BoardCarmen ChaconNational Upholstering Co.National Liability & Fire Ins. Co.Employment Development Department (EDD)Compromise and Release (C&R)Order Approving Compromise and Release (OACR)Mutual Mistake of FactDuplicate PaymentsTemporary Disability Indemnity (TDI)
References
Case No. ADJ683696 (OXN 0130382) ADJ2849597 (OXN 0135814) ADJ2954957 (OXN 0136101)
Regular
Nov 25, 2009

JORGE BARBOZA vs. MICROPULSE, INC., STATE COMPENSATION INSURANCE FUND, GAB ROBINS for CALIFORNIA INDEMNITY INS. CO., ANDREW CORPORATION, ZURICH NORTH AMERICA

Defendant California Indemnity Insurance Company sought reconsideration of an arbitrator's award concerning liability apportionment among multiple insurers. The arbitrator had assigned specific percentages of responsibility to State Compensation Insurance Fund and Zurich for benefits paid. The defendant argued the arbitrator erred by disregarding medical evidence, ignoring liability percentages, and improperly inferring liability. The Appeals Board granted reconsideration to clarify that miscoded medical treatment expenses, erroneously labeled VRMA, should be considered as benefits paid for contribution purposes. The original award was otherwise affirmed with amendments clarifying what constitutes "moneys paid to and on behalf of the Applicant."

Workers' Compensation Appeals BoardReconsiderationAmended Findings and AwardContributionLiabilityMedical EvidenceVRMABenefits PaidMedical Treatment ExpensesTemporary Total Disability
References
Case No. ADJ9349646
Regular
Jul 05, 2016

JONATHAN BASSETT vs. CITY OF VISALIA

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award because it was unclear and unenforceable. The Board found the Administrative Law Judge erred by issuing an award with unspecified credits for payments to EDD and the applicant, and by not clearly defining defendant's liability. The case is returned to the trial level to clarify the exact amounts due, resolve the EDD lien, determine attorney's fees, and clearly outline the defendant's credit for indemnity already paid. The Board affirmed the ALJ's analysis on all other respects.

Workers' Compensation Appeals BoardReserve Police OfficerTemporary Partial DisabilityTemporary Total DisabilityPetition for ReconsiderationCredit for IndemnityWage LossInsurance PremiumsLabor Code Section 4458.2Maximum Temporary Disability Rate
References
Case No. ADJ3588884 (FRE 0222309) ADJ4330880 (FRE 0223217)
Regular
Feb 22, 2011

ENEDELIA LUNA vs. FRESNO UNIFIED SCHOOL DISTRICT, UNITED ARTISTS THEATRE CIRCUIT; AMERICAN MOTORISTS INSURANCE COMPANY, Administered By BROADSPIRE

This case concerns American Motorists Insurance Company's petition for reconsideration of a Joint Findings and Award. The original award addressed two admitted industrial injuries sustained by the applicant, one against Fresno Unified School District (FUSD) and another against United Artists Theatre Circuit, insured by American Motorists. The petition specifically challenges the WCJ's failure to incorporate a stipulated liability apportionment between the defendants into the award. The Appeals Board denied the petition, ruling that the WCJ correctly deferred the issue of contribution between co-defendants, as they remain jointly and severally liable to the applicant.

Petition for ReconsiderationJoint Findings and AwardSpecial Education Teacher's AideCumulative InjuryBilateral Upper ExtremitiesPermanent DisabilityFurther Medical TreatmentPermissibly Self-InsuredStipulated Percentage of LiabilityContribution Between Co-Defendants
References
Case No. ADJ950908 (VNO 0491784) ADJ3156869 (VNO 0491787)
Regular
Apr 26, 2010

LUZ E. VERA vs. ACOUSTIC AUTHORITY, INC., VALLEY FORGE INSURANCE, CNA CLAIMS PLUS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, RELIANCE INSURANCE

This case involves a workers' compensation applicant who sustained both a specific low back and psyche injury in 1997 and a cumulative trauma injury to multiple body parts over a later period. The defendant, Valley Forge Insurance, sought reconsideration of the Findings and Awards, primarily arguing it should not be responsible for administering the 1997 specific injury award, which was correctly assigned to CIGA. The Board denied reconsideration, affirming the original decision, and also addressed premature arguments regarding EDD liens and potential third-party liability.

Workers' Compensation Appeals BoardSpecific InjuryCumulative TraumaPermanent Partial DisabilityCalifornia Insurance Guarantee AssociationCIGAReliance InsuranceValley Forge InsuranceCNA Claims PlusEmployment Development Department
References
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