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

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. 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. SAL 0107814
En Banc
Jun 13, 2007

VALERI HAWKINS vs. AMBERWOOD PRODUCTS, STATE COMPENSATION INSURANCE FUND

The Appeals Board held that the two-year limitation on temporary disability payments under Labor Code section 4656(c)(1) begins from the date the first payment is actually made, not the date for which the benefit is first owed.

Workers' Compensation Appeals BoardEn Banc DecisionTemporary Disability PaymentLabor Code Section 4656(c)(1)Commencement of PaymentDate of InjuryCompensable WeeksAggregate Disability PaymentsSB 899Legislative Intent
References
Case No. ADJ2759696 (VNO 0492027)
Regular
Oct 11, 2010

WOON YOUNG PARK vs. FILM PAYMENT SERVICES, INC., CHARTIS INSURANCE

The Board granted reconsideration, rescinding the WCJ's decision on the defendant's credit for overpaid temporary disability. The defendant is allowed credit for temporary disability payments made from March 26, 2009, to June 3, 2009, at the temporary disability rate. Further credit is granted for payments made from June 4, 2009, to December 7, 2009, at the permanent disability rate of $185.00 per week. The Board denied further credit due to insufficient evidence regarding post-AME report overpayments.

Petition for ReconsiderationPermanent DisabilityTemporary DisabilityCreditStipulated AwardAgreed Medical ExaminationPermanent and StationarySection 4909Abuse of DiscretionDue Process
References
Case No. ADJ7454224
Regular
May 13, 2016

JEFF REECE vs. SAN BERNARDINO COUNTY PROBATION DEPARTMENT; COUNTY OF SAN BERNARDINO

The Appeals Board denied the defendant's petition for reconsideration regarding the lien of the California Law Enforcement Association (CLEA). The defendant voluntarily paid CLEA before the WCJ's decision became final, despite knowing reconsideration could negate their liability. As this voluntary payment constitutes a new issue, any claim for credit must first be addressed at the trial level. The Board affirmed its prior decision to remove CLEA's lien from the award.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings Award and OrdersLien WithdrawalVoluntary PaymentLabor Code Section 4909Credit for PaymentTrial Level Jurisdiction
References
Case No. SAC 0336811
Regular
Aug 31, 2007

Robert McGraw vs. BC STOCKING DISTRIBUTING, INC., STATE COMPENSATION INSURANCE FUND

This case clarifies that the two-year limit for temporary disability payments under Labor Code section 4656(c)(1) begins on the date benefits are *first paid*, not when they are first owed. The Appeals Board found that the applicant was entitled to benefits up to 104 weeks within the two years following the initial payment date of May 19, 2004. The Board also affirmed that it lacks jurisdiction to rule on the constitutionality of statutory provisions.

Labor Code section 4656(c)(1)temporary disability indemnitycompensable weeksperiod of two yearsdate of commencement of temporary disability paymentdate of first paymentindustrial injuryheadneckback
References
Case No. ADJ937954 (POM 0254711)
Regular
Aug 18, 2010

ANGELITA (ANGIE) FERNANDEZ vs. OAK TREE RACING ASSOCIATION, LOS ANGELES TURF CLUB, CADDIE SERVICES, INCORPORATED, CIGA by its servicing agent CAMBRIDGE INTEGRATED SERVICES for LEGION INSURANCE, in liquidation, CRAWFORD & COMPANY on behalf of ZURICH INSURANCE

This case involved an applicant claiming industrial injury to her shoulders and upper extremities. A prior insurer, Legion Insurance, erroneously paid benefits through its administrator, REM, before its insolvency. The Workers' Compensation Appeals Board denied reconsideration of the arbitrator's decision, which held Zurich Insurance (adjusted by Crawford & Company) liable for reimbursement to CIGA. This is because Zurich provided "other insurance" for a portion of the cumulative trauma injury, making it solely responsible for benefits where both an insolvent and solvent insurer would be liable. The Board found CIGA could recover pre-insolvency and mistaken payments, and Zurich's due process claims were unpersuasive.

CIGAZurich InsuranceCrawford & CompanyOak Tree Racing AssociationLegion InsuranceFremont Indemnitycumulative traumainsolvent insurersolvent insurerreimbursement
References
Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
Case No. ADJ7124599
Regular
Apr 30, 2013

FUENTES vs. CEDARLANE NATURAL, LIBERTY MUTUAL

This case concerns a lien claimant's petition for reconsideration of a dismissed lien. The Workers' Compensation Appeals Board denied reconsideration, adopting the Judge's reasoning that the lien claimant failed to provide proof of timely payment of the lien activation fee. The Judge noted that the claimant did not present a receipt showing timely payment even when given an extended opportunity. Furthermore, the claimant failed to attach proof of timely payment of the lien activation fee to their petition, a requirement for reconsideration.

ADJ7124599Petition for ReconsiderationLien ClaimantWCJ OpinionReport and RecommendationFigueroa v. B.C. Doering Co.Lien Activation FeeDismissalLien ConferenceMinutes of Hearing
References
Case No. ADJ2529270 (MON0205624)
Regular
Dec 17, 2010

ZOI FOVOS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT permissibly self insured c/o SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a prior decision that found an award was paid timely without penalties. Applicant contended the defendant failed to include interest with the award payment, entitling them to penalties and attorney fees. The Board found the WCJ's decision failed to address the timeliness of interest payment and the applicability of penalties under Labor Code sections 5814 and 5814.5. The case is returned to the WCJ for further proceedings and a new decision regarding potential penalties and attorney fees for the delayed interest payment.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings of FactAwardPenaltyAttorney's FeeInterest on AwardLabor Code Section 4650Labor Code Section 5814Labor Code Section 5814.5
References
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