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

Case No. ADJ10343251, ADJ10713340, ADJ10713342
Regular
Apr 27, 2023

JOSE CORTES vs. ST. JOHN'S REGIONAL MEDICAL CENTER, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Workers' Compensation Appeals Board denied reconsideration of a decision that awarded temporary disability benefits to Jose Cortes. The employer petitioned for reconsideration, seeking credit for alleged temporary disability payments previously made in one claim against an award in a related cumulative trauma claim. However, the Board found the employer waived this issue by failing to raise it in pre-trial statements and by not presenting evidence of the payments. The Board also noted that the employer specifically raised the issue of credit for permanent disability advances, suggesting they omitted the temporary disability credit intentionally.

WORKERS' COMPENSATION APPEALS BOARDPETITION FOR RECONSIDERATIONDENYINGADJUDICATION NUMBERSSTIPULATIONS WITH REQUEST FOR AWARDRE-OPENAPPLICATIONS FOR ADJUDICATIONINJURY ARISING OUT OF AND OCCURRING IN THE COURSE OF EMPLOYMENTEXCESSIVE AND REPETITIVE USEJOINT FINDINGS AWARD AND ORDERS
References
Case No. ADJ6581535
Regular
Nov 15, 2017

Angel Mendez vs. Maple Dairy, Zenith Insurance Company

The Workers' Compensation Appeals Board denied Angel Mendez's petition for reconsideration. Mendez sought a finding of $100\%$ permanent disability, arguing total loss of use of his dominant right upper extremity. The Board affirmed the WCJ's prior award of $75\%$ permanent disability, finding no presumption of total disability for the loss of use of only one hand. The evidence did not support a finding of total loss of use of the upper extremity.

Petition for ReconsiderationPermanent Disability ApportionmentVocational EvidenceDominant Upper ExtremityLoss of UsePresumption of Permanent Total DisabilityLabor Code Section 4662(a)(2)Substantial EvidenceLeBoeuf v. Workers' Comp. Appeals Bd.Dairy Worker
References
Case No. ADJ9896370
Regular
Oct 19, 2017

GUILLERMO RESTREPO vs. SAN GORGONIO MEMORIAL HOSPITAL, ALPHA FUND

The applicant sought compensation for an industrial injury sustained in a car accident while commuting to work, arguing it fell under exceptions to the going and coming rule. The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's denial of the claim. The WCAB found the applicant's testimony regarding the necessity of using his personal vehicle for work-related tasks lacked credibility. Crucially, the evidence did not establish that the employer expressly or impliedly required the applicant to use his vehicle or that such use was a custom and practice relied upon by the employer.

Going and Coming RuleIndustrial InjuryWorkers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrdersWCJDirector of Environmental ServicesMotor Vehicle AccidentEmployment ContractJob Duties
References
Case No. ADJ1527853 (WCK 0005092)
Regular
Dec 05, 2013

JEFF MILLMAN vs. CONTRA COSTA COUNTY

The Workers' Compensation Appeals Board (WCAB) affirmed a prior ruling that it lacks jurisdiction over a contract dispute between Contra Costa County and its excess insurer, General Reinsurance Corporation (GRC). The dispute concerns whether GRC must reimburse the County for certain bill review expenses under their excess policy. The Board determined this is a contract issue between insurer and insured, not a workers' compensation insurance coverage dispute subject to mandatory arbitration under Labor Code section 5275. The parties may pursue remedies like declaratory relief in civil court.

Workers' Compensation Appeals BoardReconsiderationJurisdictionContract DisputeExcess InsuranceSelf-Insured EmployerInsurance CoverageArbitrationLabor CodeInsurance Code
References
Case No. ADJ7882921 ADJ7883975 ADJ8176306
Regular
May 01, 2017

SANTIAGO GUTIERREZ vs. VALLEY CREST LANDSCAPE MAINTENANCE, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration regarding an injury to the applicant's right hand. While upholding the finding of industrial injury, the Board amended the administrative law judge's award to reflect a correct occupational variant (491F) and a reduced permanent disability rating of 3%. The opinions of the Agreed Medical Evaluator were deemed substantial evidence, and the defendant's challenge to them was unsuccessful. The Board affirmed the findings on the other two injury claims, as they were not contested in the petition.

Workers' Compensation Appeals BoardSantiago GutierrezValley Crest Landscape MaintenanceAce American Insurance CompanyESIS Inc.ADJ7882921ADJ7883975ADJ8176306Opinion and OrderPetition for Reconsideration
References
Case No. ADJ3885724 (LBO 0381454) ADJ2220204 (LBO 0381455) ADJ1309821 (LBO 0381456)
Regular
Dec 24, 2015

Regina Weaver vs. Los Angeles Unified School District, Federal Express

The Workers' Compensation Appeals Board affirmed the prior decision awarding applicant 19% permanent disability for each upper extremity, rejecting the "loss of use" rating methodology. Applicant's contention that the Agreed Medical Evaluator's (AME) rating should have been higher based on a loss of use analogy was deemed unsubstantiated and inconsistent with AMA Guides principles. The Board remanded the case to the trial level to address the applicability of Labor Code section 4658(d) and attorney's fees.

Almaraz-GuzmanAgreed Medical EvaluatorPermanent Disability RatingUpper Extremity ImpairmentCarpal Tunnel SyndromeDe Quervain's TenosynovitisGrip StrengthLoss of Use AnalogyAMA GuidesLabor Code Section 4658(d)
References
Case No. ADJ10954204
Regular
Sep 15, 2022

MARIA FLORES vs. PINNACLE HEALTH CORP., SUMMARY OF EVIDENCE INSURANCE COMPANY OF THE WEST, AFFINITY HOME HEALTH CARE SERVICES, FALLS LAKE FIRE & CASUALTY INSURANCE, SEDGWICK CMS, HOME HEALTH CARE SOLUTIONS, INC.

The Workers' Compensation Appeals Board denied a petition for reconsideration filed by Home Health Care Solutions. The applicant, an LVN, was injured in a car accident while traveling between patients for multiple agencies. The Board adopted the WCJ's report, which found the injury arose out of and occurred in the course of employment for Home Health Care Solutions. This decision was based on the fact that the applicant was required to use her own vehicle, which extended the employer-employee relationship beyond direct service. The WCJ also found the going and coming rule did not bar the claim due to the required use of transportation between patient locations.

Workers' Compensation Appeals BoardPetition for ReconsiderationGoing and Coming RuleAOE/COELVNCar AccidentAutomobile ExceptionTransitEmployment RelationshipRequired Vehicle Use
References
Case No. ADJ793678 (OAK 0338326)
Regular
Sep 07, 2010

ARMENDO CASAS vs. LOS ANGELES CHEMICAL and EXCESS SPECIALTY INSURANCE, GAB ROBINS, BRENNTAG and EXCESS SPECIALTY INSURANCE, SPECIALTY RISK SERVICES

This case involves a petition for reconsideration by Excess Specialty Insurance regarding a workers' compensation award. The original award found the applicant sustained a cumulative trauma injury ending November 2, 2006, but deferred key issues like sleep disorder, permanent disability, and liens. The Board granted reconsideration, rescinded the original award, and returned the case for a new decision at the trial level. The Board believes piecemeal adjudication should be avoided and all issues should be decided concurrently after further development of the record.

Cumulative traumaThoracic spineLumbar spinePsycheSleep disorderGastrointestinal disorderSexual dysfunctionPermanent disabilityEmployment Development Department lienPetition for Increase in Compensation
References
Case No. AD10634736
Regular
Nov 16, 2019

ORACIO CARRANZA vs. COUNTY OF IMPERIAL

This case concerns a deputy probation officer's claim for industrial heart injury. Initially, the administrative law judge (WCJ) found the applicant's claim rebutted the presumption of industrial injury. Both applicant and defendant sought reconsideration, with the defendant arguing the presumption didn't apply and the applicant asserting it was improperly rebutted. The Appeals Board denied both petitions, affirming the applicant is covered by the presumption under Labor Code section 3212.10, but agreeing the presumption was rebutted by independent medical evidence pointing to non-industrial causes.

Workers' Compensation Appeals BoardLabor Code section 3212.10peace officer presumptionheart troubleindustrial injurydeputy probation officerindependent medical evaluatorpresumption rebuttalanti-attribution clausepreponderance of the evidence
References
Case No. ADJ10075042
Regular
Nov 23, 2020

ANGEL FLORES vs. THE KROGER COMPANY, ADMINISTERED BY SEDGWICK CLAIMS MANAGEMENT SERVICES

Defendant Kroger Company sought reconsideration of a Workers' Compensation Appeals Board decision awarding applicant Angel Flores benefits for bilateral knee and right shoulder injuries sustained as a maintenance worker from 1995 to 2015. The defendant argued the Qualified Medical Evaluator's (QME) opinion was not substantial evidence. The Board denied the petition, finding the QME's later reports, after clarifying applicant's 20-year work history and job duties, provided substantial evidence of cumulative trauma injury. The QME's initial opinion was based on a misunderstanding of applicant's symptom onset, which he later corrected after further evaluation.

Permanent DisabilityCumulative TraumaSpecific InjuryPanel Qualified Medical EvaluatorPQMEIndustrial InjuryCausationSubstantial Medical EvidencePetition for ReconsiderationWCJ
References
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