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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ9473670
Regular
Nov 02, 2020

SANDRA UYAGUARI GARCIA vs. CLAUDIA MENDOZA Dba SWEET MELODY EXPRESS, UEBTF

This case concerns an applicant seeking workers' compensation benefits for an injury sustained while cleaning a defendant's residence. The primary issue was whether the applicant was an employee of the defendant's business, Sweet Melody Express, or an independent residential employee. The Board affirmed the WCJ's finding that the applicant was not an employee of Sweet Melody Express at the time of the injury, deeming her services to the defendant's home to be sporadic and casual housecleaning for the individual, not the business. Therefore, her claim for workers' compensation was denied.

Workers' Compensation Appeals BoardReconsiderationEmployee StatusResidential EmployeeCasual EmploymentLabor Code Section 3351Labor Code Section 3352(a)(8)Burden of ProofCredibility FindingEmployer Capacity
References
Case No. ADJ6995425
Regular
Apr 27, 2012

SERGIO SANCHEZ vs. LIDA KOHANSAMEH, PACIFIC SPECIALTY INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior ruling finding the applicant an employee of Lida Kohansameh. While agreeing the applicant was not an employee of Pacific Great West Construction, the Board remanded the case for further proceedings. The trial judge must now determine if the applicant is excluded from workers' compensation coverage under Labor Code sections 3351(d) and 3352(h), specifically regarding residential or casual employment and hours worked. This decision avoids a final determination on employment status and focuses on potential statutory exclusions.

Workers' Compensation Appeals BoardLida KohansamehPacific Specialty InsuranceTristar Risk ManagementSergio SanchezFindings and OrderEmployee statusPacific Great West ConstructionReport and RecommendationPetition for Reconsideration
References
Case No. ADJ8190306
Regular
Jan 07, 2013

Silvestre Sanchez vs. Robert E. Town, Allied Insurance, A Nationwide Company

This case concerns whether an injured worker, Silvestre Sanchez, was an employee of Robert E. Town for workers' compensation purposes. The Board granted reconsideration to reverse the WCJ's finding of employment. The primary issue was whether Sanchez met the 52-hour work requirement within the 90 days preceding injury under Labor Code section 3352(h), which excludes certain residential employees. The Board found that based on conflicting testimony regarding a second payment, the applicant did not prove he worked over 52 hours, thus excluding him from coverage.

Workers' Compensation Appeals BoardSilvestre SanchezRobert E. TownAllied InsuranceLabor Code section 3352(h)excluded employeeresidential employee90-day perioddate of injuryFindings of Fact
References
Case No. ADJ12830624
Regular
Feb 13, 2023

RICHARD HERRERA vs. MICHAEL PAIVA, STATE FARM FIRE AND CASUALTY COMPANY, SEDGWICK CLAIMS MANAGEMENT

This case concerns whether applicant Richard Herrera was an employee or independent contractor when injured while working on defendant Michael Paiva's residence. The Workers' Compensation Appeals Board (WCAB) affirmed the finding of employee status, finding that Paiva retained sufficient control over the work and that secondary *Borello* factors, such as Paiva providing materials and the place of work, supported an employment relationship. The WCAB also found applicant's testimony credible and deemed the issue of Labor Code section 2750.5 moot due to the employee determination.

Independent contractorEmployee statusLabor Code sections 33513357Section 2750.5WCJPetition for ReconsiderationEmployee LedgerHourly payCash payment
References
Case No. SJO 0210015
Regular
Mar 04, 2008

CARLOS SALAZAR vs. JOSE VIDRIO, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns whether a comprehensive personal liability policy provided by Liberty Mutual to Jose Vidrio covered applicant Carlos Salazar's workers' compensation claim for injuries sustained while working at Vidrio's residence. The Appeals Board affirmed the arbitrator's decision, finding that Insurance Code section 11590 mandates such coverage for residential employees incidental to the dwelling's use, regardless of specific policy wording. The Board also confirmed Salazar met the statutory employee criteria of working over 52 hours and earning over $100 in the 90 days prior to injury.

Workers' Compensation Appeals BoardIndustrial InjuryResidential EmployeeComprehensive Personal Liability InsuranceLabor Code section 3351(d)Insurance Code section 11590Labor Code section 3352(h)Incidental DutiesDwelling MaintenanceUninsured Employers Benefits Trust Fund
References
Case No. B167017
Significant
Nov 18, 2004

General Casualty Insurance and Regent Insurance, Joseph A. Lane, American Home Assurance Company vs. Workers' Compensation Appeals Board and California Insurance Guarantee Association

The court has requested responses from the Workers' Compensation Insurance Rating Bureau (WCIRB) and the California Insurance Commissioner regarding the exclusion of special employees from a special employer's workers' compensation policy, specifically questioning the use and requirements of Form No. 11 for this purpose.

WCIRBForm No. 11limiting endorsementsrestricting endorsementsspecial employeesgeneral employerstemporary employeesleased employeesInsurance CommissionerCalifornia Code of Regulations
References
Case No. ADJ8759396
Regular
Feb 27, 2015

Jose Diaz vs. Timber Works Construction, Berkshire Hathaway

This Workers' Compensation Appeals Board case involves applicant Jose Diaz seeking reconsideration of a prior order regarding his employer's Medical Provider Network (MPN). The primary issue is whether the MPN's physician accessibility standards, which are tied to the "workplace" or residence, are met. The Board granted reconsideration, rescinded the previous order, and remanded the case, finding the MPN may be defective if it doesn't comply with physician access standards relative to the applicant's residence, given the employer's failure to meet the "workplace" standard. The Board also noted that the applicant's inability to travel, while a factor, was not the deciding point in this decision to remand.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNWorkplaceResidencePhysician Access StandardsTitle 8 Section 9767.5Pain ManagementPhysical MedicineCannot Travel Exception
References
Case No. ADJ7874903
Regular
Feb 22, 2018

Abraham Gonzalez vs. Jose Echeverry, Echeverry Family Trust

The Workers' Compensation Appeals Board (WCAB) rescinded the trial judge's finding that the applicant was not an employee. The applicant claimed an industrial injury while working as a laborer for the defendant, who was uninsured. The core issue was whether the applicant was an employee or an independent contractor, with the defense arguing an exemption under Business and Professions Code section 7048 for jobs under $500. The WCAB found the record insufficient, particularly regarding the total contract price of the project, and returned the case for further development and a new decision.

Workers' Compensation Appeals BoardADJ7874903Abraham GonzalezJose EcheverryEcheverry Family TrustOpinion and Decision After ReconsiderationFindingsregular hourly employeeemployment relationshipuninsured
References
Case No. ADJ7994981
Regular
Feb 19, 2013

Timothy Sabedra vs. Magic Messenger, Inc., Gallagher Bassett Services

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, finding the applicant, Timothy Sabedra, was an employee of Magic Messenger, Inc. The Board found that despite a transportation agreement designating Sabedra as an independent contractor, Magic Messenger exercised sufficient control over his work. Key factors included the provision of employee handbooks, mandated uniforms, start times, and dispatch radio use, all indicating an employer-employee relationship.

WORKERS COMPENSATION APPEALS BOARDIndependent ContractorEmployee StatusRight to Control TestBorello TestTruck DriverMagic Messenger Inc.Gallagher Bassett ServicesTimothy SabedraLabor Code Section 3351
References
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