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

Case No. ADJ6604427, ADJ8192308
Regular
Jul 31, 2014

CHERRICE MORRIS-GAINES vs. AC TRANSIT, SEDGWICK CLAIMS MANAGEMENT SERVICES

In this workers' compensation case, the applicant initially stipulated to a lower average weekly wage, which the Board found to be a final determination that could not be revisited due to lack of good cause and the five-year statute of limitations. The Board affirmed the employer's credit for payments made to the Employment Development Department (EDD) to prevent double recovery. Furthermore, the Board found no unreasonable delay by the employer in payments to EDD, thus denying the applicant's penalty claim. Finally, the Board rescinded the order requiring the applicant's attorney to repay fees voluntarily paid by EDD, as such repayment was not mandated by law.

Workers' Compensation Appeals BoardAC TransitSedgwick Claims Management ServicesADJ6604427ADJ8192308bus drivercumulative traumatemporary disability indemnityLabor Code section 4656(c)(2)mandatory settlement conference
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. ADJ7917429
Regular
Mar 10, 2014

ROBERTO SALAZAR vs. WTS INTERNATIONAL, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns a dispute over defendant's credit for Employment Development Department (EDD) payments against the applicant's permanent disability award. Initially, the WCJ granted the defendant credit for the entire period EDD paid benefits. Upon reconsideration, the Appeals Board clarified that the defendant is only entitled to credit for EDD payments made from January 2, 2012, to May 10, 2012, as these were effectively permanent disability advances. The Board rescinded the original award and amended the findings to reflect this adjusted credit.

Petition for ReconsiderationStipulated AwardPermanent DisabilityTemporary DisabilityCredit for PaymentsEmployment Development DepartmentEDDState Disability InsuranceSDIReimbursement
References
Case No. VNO 541859
Regular
Jan 03, 2008

FAUSTINO SANDOVAL vs. NUTRITION PLUS, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend a Stipulation and Award, allowing defendants credit for EDD payments made to the applicant. The Board affirmed the $\$ 240.00$ temporary disability rate, finding no basis to set aside the stipulation as defendant attempted to rely on a wage statement that was available prior to the agreement. The amendment ensures reimbursement to EDD for benefits paid during the applicant's temporary disability period.

Stipulation and AwardPetition for ReconsiderationAgreed Medical ExaminersMPNTemporary Disability RateCredit for EDD PaymentsWeatherall v. WCABFraudMutual MistakeNewly Discovered Evidence
References
Case No. ADJ212916 (VNO 0334702)
Regular
Feb 09, 2011

PETER L. WASCHER vs. AIDS HEALTHCARE FOUNDATION INC., CIGA FOR CAL. COMP. (IN LIQUIDATION), STATE COMPENSATION INSURANCE FUND

This case involves a dispute over reimbursement for workers' compensation payments made by CIGA (California Insurance Guarantee Association) on behalf of an insolvent insurer. The arbitrator initially ordered State Compensation Insurance Fund (SCIF) to reimburse CIGA only $105,511.94, pending further proof of payment. CIGA petitioned for reconsideration, arguing it had provided sufficient evidence of payment for the full $719,238.12. The Workers' Compensation Appeals Board granted the petition, finding CIGA's payment records were reliable and unrebutted. Consequently, SCIF was ordered to reimburse CIGA the entire $719,238.12.

CIGASCIFreimbursementarbitrationreconsiderationindustrial injuryAids Healthcare FoundationCal Compmedical paymentsproof of payment
References
Case No. ADJ1167245
Regular
Jun 03, 2013

RONALD THOMPSON vs. BLOCKA CONSTRUCTION, INC., SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend an award concerning an electrocution injury. The Board modified the award to have the EDD lien for duplicative payments deducted from the applicant's permanent disability award, rather than reimbursed separately by the defendant, and rescinded the award of interest to EDD. The Board affirmed the WCJ's findings of 100% permanent disability without apportionment and the exclusion of sub rosa video evidence. The matter was returned to the WCJ to recalculate the commutation of the award to incorporate the EDD lien payment.

Electrocution injuryPermanent disabilityApportionmentSub rosa videoEDD lienCommutationDuplicative paymentsVocational rehabilitationMedical evidenceCardiac disability
References
Case No. ADJ3872960
Regular
May 06, 2013

ALONZO WATKINS vs. LONG BEACH UNIFIED SCHOOL DISTRICT

This case concerns applicant Alonzo Watkins' petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying his claim for unpaid benefits totaling $14,269.10. The WCAB denied reconsideration, finding that Watkins failed to provide substantial evidence of non-payment, as the employer presented proof of payment via checks issued over 16 years prior. The WCAB also ruled that Watkins raised the issue of the employer's failure to produce payment records for the first time on appeal, which is impermissible. Furthermore, the WCAB clarified that the record retention requirements for adjusting agencies do not mandate indefinite maintenance of claim files.

Petition for ReconsiderationFindings and OrderIndustrial InjuryBack InjuryLower ExtremitiesTeacherCompromise and ReleasePayment RecordsProof of PaymentNon-Payment
References
Case No. SDO 0328208
Regular
Mar 17, 2008

ARMANDO ADAME vs. AUTOMOTIVE ENGINEERED PRODUCTS, INC. (dba JBA HEADERS), ZENITH INSURANCE COMPANY

The Appeals Board clarified that for Labor Code section 4656(c)(1) purposes, the commencement of temporary disability payments is the date the employer first mails a temporary disability indemnity check, not when EDD benefits begin. Furthermore, EDD benefits, even if reimbursed by the employer, do not count towards the 104-week cap on temporary disability payments. Consequently, the employer's liability for further temporary disability payments extends from the date of the first actual indemnity payment until October 6, 2007.

Workers Compensation Appeals BoardArmando AdameAutomotive Engineered ProductsZenith Insurance CompanyLabor Code section 4656(c)(1)Temporary Total DisabilityTemporary Disability IndemnityEmployment Development DepartmentUnemployment Compensation DisabilityHawkins v. Amberwood Products
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. ADJ9298442
Regular
May 16, 2016

JOSEPH TREVINO vs. UNITED PARCEL SERVICE, LIBERTY MUTUAL INSURANCE COMPANY

This case involves an appeal by United Parcel Service (UPS) regarding a workers' compensation award to Joseph Trevino for a back injury. UPS challenged the temporary disability period, the weekly rate, liability for an EDD lien, and the percentage of permanent disability apportionment. The Appeals Board granted reconsideration to amend the temporary disability award period and rate as recommended by the WCJ. The Board otherwise affirmed the original decision, including the allowance of the EDD lien and the $31 \%$ permanent disability finding without section 4664 apportionment.

WCABPetition for ReconsiderationFindings and AwardTemporary DisabilityPermanent DisabilityLabor Code Section 4664ApportionmentEDD LienAverage Weekly EarningsCredit for Payments
References
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