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

Case No. ADJ473373 (ANA 0406381)
Regular
Feb 10, 2012

FERNANDO GUTIERREZ vs. SOCAL FRAMING aka BMHC; ACE AMERICAN INSURANCE, administered by ESIS, INC.

This case concerns applicant's claim for extended temporary disability (TD) benefits beyond 104 weeks due to a left eye injury. The Appeals Board affirmed the WCJ's denial of the "amputation" exception, ruling that the surgical removal of an eye does not fit the statutory definition. However, the Board remanded the case for further development of the record on the "high-velocity eye injury" exception, as the velocity and force of the object that struck the applicant's eye were unclear. The applicant's Petition for Removal was dismissed as reconsideration was the appropriate remedy.

Workers' Compensation Appeals BoardFernando GutierrezSoCal FramingBMHCACE American InsuranceESISInc.ADJ473373ANA 0406381Opinion and Decision
References
Case No. ADJ7110968
Regular
Apr 09, 2013

CLAUDIA LARA vs. NORTHGATE MARKET, ESIS

This case involves Claudia Lara, applicant, versus Northgate Market and ESIS, defendants. The Workers' Compensation Appeals Board issued an Order Dismissing Petition for Reconsideration. The dismissal is due to the petitioner having withdrawn their petition for reconsideration of the January 13, 2012 decision. Therefore, the petition has been formally dismissed by the Board.

Petition for ReconsiderationWithdrawn PetitionDismissed OrderWorkers' Compensation Appeals BoardApplicantDefendantNorthgate MarketESISPomona District OfficeJanuary 13 2012 decision
References
Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
Case No. VNO 0518591
Regular
Feb 13, 2008

DOREEN WARD vs. APPLE ONE EMPLOYMENT SERVICES, ESIS, INC.

The Appeals Board granted reconsideration and rescinded the administrative law judge's (WCJ) dismissal of Apple One and ESIS, finding the dismissal was improper without a hearing. The WCJ improperly treated the defendants' petition for dismissal as a motion for judgment on the pleadings, violating procedural rules and due process. The case is returned to the WCJ for actual proceedings on the dismissal petitions and any objections.

Workers Compensation Appeals BoardDoreen WardApple One Employment ServicesESIS Inc.Labor Code section 3208.3(d)psychiatric injuryhostile work environmentpetition for dismissaldue processsection 5813
References
Case No. ADJ4609174 (RDG 0041947)
Regular
Oct 27, 2010

DOYLE CANADA vs. REDDING POWER SAWMILL DIVISION, ESIS PORTLAND

In this Workers' Compensation Appeals Board case, Doyle Canada's petition for reconsideration was denied. The Board adopted the findings of the Workers' Compensation Administrative Law Judge, whose report detailed the reasons for the denial. This order, dated October 27, 2010, upholds the original decision and denies further review. The defendants were Redding Power Sawmill Division and ESIS Portland.

WCABPetition for Reconsiderationworkers' compensation administrative law judgereport of the workers' compensation administrative law judgedeny reconsiderationADJ4609174Redding Power Sawmill DivisionESIS PortlandDoyle CanadaADJUDICATION
References
Case No. ADJ2624099 (AHM 0134865)
Regular
Nov 06, 2013

JACALYN HALE (Deceased) vs. MESA MEDICAL GROUP, ACE USA c/o ESIS, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Appeals Board dismissed ECIC's Petition for Reconsideration because the WCJ's order regarding contribution proceedings was not a final determination of substantive rights. The Board also denied ECIC's Petition for Removal, finding no evidence of substantial prejudice or irreparable harm from the WCJ's statement that the contribution issue might eventually be subject to mandatory arbitration. The WCJ had merely overruled ECIC's objection to ACE/ESIS's contribution petition and allowed discovery, not ordered arbitration itself. Therefore, any arguments about mandatory arbitration were premature.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWCJ OrderContribution ProceedingsMandatory ArbitrationLabor Code Section 5500.5ACE/ESISECICIndustrial Injury
References
Case No. ADJ2721650 (AHM 0082733) ADJ1775630 (AHM 0085375) ADJ3043671 (AHM 0094450)
Regular
Feb 13, 2009

RAINEY RANDALL vs. SOUTHERN WINE & SPIRITS, TIG INSURANCE COMPANY, ACE USA/ESIS, EXPLORER INSURANCE COMPANY

This case involves a dispute over the date of injury for a workers' compensation claim of cumulative upper extremity and neck trauma. The applicant alleges injury during her employment with Southern Wine & Spirits. One defendant insurer, ESIS, contends the original finding of a single date of injury was incorrect and argues for two separate cumulative trauma injuries. The Appeals Board rescinded the original order, finding the record requires further development to definitively determine the date(s) of injury under Labor Code section 5412. The matter is returned to the trial level for further evidence, including potentially further medical evaluation, to establish the correct injury date(s) before allocation of liability is addressed.

WCABReconsiderationDate of InjuryCumulative TraumaUpper ExtremitiesACE USA/ESISTIG Insurance CompanySouthern Wine & SpiritsLabor Code Section 5412Temporary Disability
References
Case No. ADJ9527444
Regular
May 23, 2018

, REYES P. HERNANDEZ, vs. , QUALI RUN RANCH; STATE COMPENSATION INSURANCE FUND; OMA OJAI PACIFIC; ZENITH INSURANCE COMPANY; ACE USA INSURANCE COMPANY, Administered By ESIS; MICHAEL AND JODY CROMER, Homeowners; STATE FARM INSURANCE,

The Workers' Compensation Appeals Board granted ESIS's Petition for Removal because the WCJ's order denying ESIS a panel Qualified Medical Evaluator (PQME) evaluation was found to cause significant prejudice and irreparable harm. ESIS was not a party to the original Agreed Medical Examiner (AME) agreement between the applicant and SCIF, and the WCJ's decision unfairly bound ESIS to the AME's findings and effectively closed ESIS's discovery rights. The Board rescinded the WCJ's decision and ordered a PQME evaluation for ESIS, recognizing the denial violated ESIS's due process rights.

Petition for RemovalQualified Medical EvaluatorAgreed Medical ExaminerDue ProcessSignificant PrejudiceIrreparable HarmDiscoveryFindings and OrderWorkers' Compensation Appeals BoardCumulative Trauma
References
Case No. ADJ639961
Regular
Aug 08, 2011

BAUDELIO REGALADO vs. SNELLING PERSONNEL, ESIS

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration of an administrative law judge's prior findings. This action was taken due to statutory time constraints and the need for further review of the factual and legal issues. The WCAB requires additional study of the record to ensure a just and reasoned decision. All future filings in this matter should be directed to the Office of the Commissioners in San Francisco pending the WCAB's Decision After Reconsideration.

Petition for ReconsiderationFindings and AwardAdministrative Law JudgeWorkers' Compensation Appeals BoardStatutory time constraintsFactual and legal issuesJust and reasoned decisionDecision After ReconsiderationOffice of the CommissionersSnelling Personnel
References
Case No. ADJ10301756
Regular
Oct 03, 2016

SOCORRO GONZALES vs. ABM INDUSTRIES, ESIS

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal in this case. Removal is an extraordinary remedy that is only granted if substantial prejudice or irreparable harm will occur and reconsideration will not be an adequate remedy. The Board found that the applicant failed to demonstrate either of these conditions, adopting the WCJ's reasoning. Therefore, the Petition for Removal was denied.

Petition for RemovalDeniedSubstantial PrejudiceIrreparable HarmReconsideration Adequate RemedyWCJ Report AdoptedExtraordinary RemedyCortez v. Workers' Comp. Appeals Bd.Kleemann v. Workers' Comp. Appeals Bd.Cal. Code Regs. tit. 8 § 10843(a)
References
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