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

Case No. ADJ2154550 (MON 0115928)
Regular
Oct 14, 2008

JAMES PERRY vs. ALCO PACIFIC, AIG DOMESTIC CLAIMS, INC. for AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior order disallowing lien claims, and remanded the case for further proceedings. The Board found that Labor Code section 4903.5(a) was not applicable as the liens were filed prior to its enactment, and the defendant failed to establish the equitable defense of laches. The original compromise and release agreement also explicitly stated that all liens would be adjusted outside of the settlement.

Labor Code section 4903.5(a)lien claimantsreconsiderationcompromise and releaselachesprejudicejurisdictionstatutory applicationequitable doctrinerescinded order
References
Case No. ADJ4662216 (MON 0235398) ADJ1137113 (MON 0264731)
Regular
Jul 17, 2017

REBECCA WERTZ vs. HERBALIFE, AIG CLAIMS SERVICES

This case concerns Dr. Silver's lien claim for fees exceeding the Official Medical Fee Schedule (OMFS). The Appeals Board affirmed the WCJ's decision denying the lien claim, finding no statutory or regulatory basis for an "extraordinary circumstances" exception to the OMFS for services rendered after January 1, 2004. The Board also rejected due process claims regarding the exclusion of evidence and the inability to cross-examine the defendant's bill review expert. The Board concluded that lien claimant failed to prove the services were extraordinary or to demonstrate entitlement to equitable relief.

Workers' Compensation Appeals BoardLien ClaimantOfficial Medical Fee ScheduleOMFSExtraordinary CircumstancesAdministrative Director RuleSB 228Labor Code Section 5307.1Equitable ReliefDue Process
References
Case No. ADJ8276740
Regular
Sep 19, 2012

Kim Jaszewski vs. The Regents of the University of California

The Workers' Compensation Appeals Board denied reconsideration of a take-nothing award, finding the applicant's claim untimely. The applicant argued that short-term disability payments tolled the one-year statute of limitations, but failed to provide evidence of such payments. Furthermore, the employer's denial of the claim on March 23, 2011, provided a clear date from which the one-year filing period began to run. The Board also rejected the applicant's attorney's attempt to seek relief under Code of Civil Procedure section 473, as it does not grant relief from jurisdictional deadlines like statutes of limitations.

Workers' Compensation Appeals BoardApplication for Adjudication of Claimstatute of limitationstollingshort-term disability benefitsdenial of claimLabor Code section 5405Code of Civil Procedure section 473jurisdictional deadlinecumulative trauma injury
References
Case No. ADJ2225912
Regular
Jun 26, 2015

HUMBERTO OROZCO vs. LATIN AMERICAN SECURITY SERVICE, STATE COMPENSATION INSURANCE FUND

This case concerns a lien claimant's petition for reconsideration after their lien was dismissed for failing to appear at a lien conference and subsequently failing to object to a notice of intention to dismiss. The claimant argued inadvertence and improper service of the notice by the defendant. The Workers' Compensation Appeals Board denied the petition, adopting the WCJ's reasoning that the claimant failed to demonstrate good cause for relief. The Board found the claimant's arguments regarding service discrepancies were not sufficiently supported and did not excuse their failure to appear or object.

Lien claimantPetition for ReconsiderationDismissal of Lien Claimsfailure to appearlien conferenceNotice of Intention to Dismissequitable reliefFox v. Workers' Comp. Appeals Bd.Code of Civil Procedure section 473due process
References
Case No. ADJ2041939 (SBR 0340035)
Regular
Dec 14, 2016

Carlos Garcia vs. Department of Transportation, State Compensation Insurance Fund

This case concerns petitions for reconsideration of three dismissed medical liens filed by Pinnacle Lien Services (PLS) on behalf of three doctors. PLS failed to appear at a lien conference and did not respond to Notices of Intent to Dismiss. The WCAB denied reconsideration, finding PLS provided insufficient justification for its failures to appear and respond, and that relief under CCP § 473 was not warranted due to lack of proper documentation and communication breakdowns. The Board emphasized the need for a substantial explanation for non-appearance and failure to respond to dismissal notices.

Workers' Compensation Appeals BoardOrders Dismissing LiensPetitions for ReconsiderationLien ConferenceNotices of Intent to DismissFailure to AppearExcusable NeglectCCP § 473Fox v. Workers' Comp. Appeals Bd.Discretionary Relief
References
Case No. ADJ2523054 (POM 2523054) ADJ8607480 ADJ9435881
Regular
Feb 18, 2020

JOSE SALAZAR vs. JAMES JONES COMPANY, INC.; MUELLER GROUP C/O SEDGWICK

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior administrative law judge's decision. The Board held that the applicant failed to demonstrate extrinsic fraud or mistake to set aside a 2004 stipulated award, as the petition was filed over fifteen years after the award, well beyond the five-year statutory limit. The applicant's claim of not understanding the settlement documents, even if accepted, did not show he was prevented from presenting his case or that he diligently pursued relief. Therefore, the applicant's petition to set aside the stipulated award was denied.

Workers' Compensation Appeals Boardpetition for reconsiderationextrinsic fraudstipulated awardset asideLabor Code section 5803Labor Code section 5804five-year periodgood causeequitable relief
References
Case No. ADJ3637976 (BAK 0135676)
Regular
Jul 17, 2012

ANGEL VILLATORO vs. KERN LABOR CONTRACTING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PAULA INSURANCE, in liquidation

The Workers' Compensation Appeals Board affirmed the disallowance of the Center for Orthopedic Surgery's (COS) lien for unpaid medical treatment. COS provided treatment in 2001, received a partial payment from the insurer, Paula Insurance, and later filed a lien claim in 2011. The Board found the lien claim was barred by the statute of limitations under Labor Code Section 4903.5, which dictates specific filing deadlines after injury, service, or case resolution. Arguments for equitable tolling or estoppel were rejected, as COS unreasonably delayed filing its lien for nearly nine years after the insurer's partial payment.

CIGAPaula InsuranceCenter for Orthopedic SurgeryLien claimStatute of limitationsLabor Code § 4903.5Compromise & ReleaseReconsiderationMedical treatment lienEquitable estoppel
References
Case No. MON 0325089 MON 0325090
Regular
Oct 05, 2007

NORA MEDEARIS vs. COUNTY OF LOS ANGELES

This case concerns the denial of an applicant's petition for reconsideration of a workers' compensation award. The applicant sought further temporary disability benefits beyond the 104-week limit imposed by Labor Code § 4656(c)(1). The Workers' Compensation Appeals Board denied the petition, finding the applicant failed to prove equitable estoppel against the defendant's application of the statutory limit, despite the defendant's initial refusal to authorize shoulder surgery. The Board adopted the WCJ's reasoning that the applicant did not demonstrate reliance on any conduct by the defendant that prevented her from timely pursuing authorization for the surgery.

Workers' Compensation Appeals BoardNora MedearisCounty of Los AngelesPermissibly Self-InsuredMON 0325089MON 0325090Opinion and Order Denying Petition for ReconsiderationInterim Joint Findings and AwardCentral Services TechnicianIndustrial Injury
References
Case No. ADJ8130064
Regular
Mar 29, 2019

Victor Juarez vs. Masonry by Joe, State Compensation Insurance Fund, Imperium Insurance Company, Athens Administrators, Endurance Southern Insurance

This case involves lien claimants who filed their liens in 2012 but failed to submit timely Labor Code section 4903.8(d) declarations, which were required for liens filed before January 1, 2013, by January 1, 2014. The WCAB granted reconsideration, rescinded the WCJ's order dismissing the liens, and returned the matter for further proceedings. The Board found that while the declarations were untimely, the specific remedy for such untimeliness for pre-2013 liens is not defined in the statute. However, the Board noted that the WCAB possesses equitable powers, including the application of the doctrine of laches, to address unjustifiable delay in lien claims.

Labor Code section 4903.8(d)Lien claimantsPetition for ReconsiderationFindings and Orderuntimely declarationsLabor Code section 4903.8(e)Senate Bill 863equitable doctrine of lachesunjustifiable delayequitable powers
References
Case No. ADJ8853372
Regular
Dec 15, 2014

FRANK SOFER vs. VERA CAMPBELL KDWZ, TOWER GROUP COMPANIES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that the applicant was an employee of Vera Campbell and KDWZ. The Board agreed with the Administrative Law Judge's report, which found the applicant's claim was not barred by the statute of limitations due to equitable tolling. This equitable tolling was based on the applicant's timely civil lawsuit against the employer for failing to provide workers' compensation insurance, which alerted the defendant to the potential claim. The Board also noted the defendant presented no evidence to rebut the applicant's medical evidence of injury.

ADJ8853372Petition for ReconsiderationEmployee statusLabor Code 2750.5Statute of limitationsEquitable tollingMedical evidenceEstoppelLachesTraumatic brain injury
References
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