Updated Daily

Case Law Database

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

Case No. ADJ7766654

Regular

Dec 10, 2015

Janice Taylor vs. Blue Go Transit Management, QBE North America

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review a decision regarding applicant Janice Taylor's industrial spine and psyche injuries. The defendant contended that a utilization review (UR) decision denying requested home health care services was timely communicated. However, the WCAB found the UR decision untimely because it was not served on the applicant's attorney as required by regulation. Consequently, the WCAB affirmed the applicant's entitlement to home health care services based on prior stipulations and substantial medical evidence, while deferring the issues of an epidural steroid injection and physical therapy.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAdministrative Law JudgeUtilization ReviewRequest for AuthorizationIndependent Medical ReviewLabor Code 4600(h)Neri HernandezActivities of Daily Living

References

Case No. AHM 70712

Significant

Jeannie Karaiskos vs. Metagenics, Inc., California Compensation Insurance Co., In Liquidation, California Insurance Guarantee Association, and Risk Enterprise Management Ltd. (Servicing Facility)

The Appeals Board, following a remittitur from the Court of Appeal, rescinds its 2002 decision and reinstates its 2001 decision, affirming that the California Insurance Guarantee Association (CIGA) is not obligated to pay the lien claim of the Employment Development Department (EDD).

RemittiturEn BancEmployment Development DepartmentEDD lienCalifornia Insurance Guarantee AssociationCIGAcovered claimState of Californiarescindedreinstated

References

Case No. ADJ3632525 (SBR 0271054) ADJ4163174 (SBR 0271055)

Regular

Nov 08, 2016

RANDAL DELAO vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND

This case involves two industrial injuries on June 13, 1996, and July 31, 1996, to the applicant's back, psyche, and internal systems. The defendant sought reconsideration of a decision that awarded 100% permanent disability for the July 31, 1996 injury, subsuming a prior 45.3% rating for the June 13, 1996 injury. The Workers' Compensation Appeals Board granted reconsideration solely to amend a finding of fact to correct the date of injury referenced for the 100% permanent disability award. The Board affirmed the WCJ's decision that the disability from the July 31, 1996 injury is subsumed within the 100% permanent disability attributed to the June 13, 1996 injury.

Workers Compensation Appeals BoardPermanent DisabilityApportionmentReconsiderationDate of InjuryCompensable ConsequenceAgreed Medical EvaluatorsMultiple Disabilities TableSubsumed DisabilityPermanent Total Disability

References

Case No. ADJ7613459

Regular

May 07, 2013

LUIS MARTINEZ vs. ANA TERRAZAS, ALLSTATE INSURANCE CO., ADMINISTERED BY SPECIALTY RISK SERVICES

The Appeals Board ruled that medical-legal expenses, including copy service costs for obtaining medical records, cannot be recovered through a general petition for costs under Labor Code section 5811. Such claims must instead be pursued through the established lien process, which now includes a lien activation fee under Labor Code section 4903.06. Lien claimants who withdrew their liens prior to this decision and filed petitions for costs are permitted to reinstate their liens to pursue recovery, provided they comply with the lien activation fee requirements and their liens were not otherwise dismissed. This decision aims to provide uniformity and prevent parties from avoiding statutorily mandated fees through procedural maneuvers.

SB 863Lien activation feeMedical-legal expensesPetition for costsLabor Code section 5811Labor Code section 4903.06En banc decisionReconsiderationWithdrawal of lienReinstatement principle

References

Case No. ADJ7890528

Regular

Dec 09, 2013

RUBEN CRUZ vs. PACIFIC RIDGE FARMS, ZENITH INSURANCE COMPANY

This case concerns a defendant's petition for reconsideration of a prior decision that allowed a lien for photocopy services. The defendant argued the lien for duplicating already-obtained medical records was improperly allowed. The Appeals Board granted reconsideration, rescinded its prior order, and returned the matter to the trial level. This was because the Board found the photocopy expenses were not reasonably and necessarily incurred when the injury was admitted and the records were duplicative.

Med-Legal Photocopylien claimantPetition for ReconsiderationFindings and Orderrescindedmedical recordsLabor Code Section 4603.2medical-legal costsreimbursementapplicant's injury

References

Case No. ADJ1003980 (SFO 0430815)

Regular

Jun 06, 2011

ROBERT WYNNE vs. LUMEND, INC., HARFORD INSURANCE COMPANY, AMERICAN MANUFACTURERS INSURANCE COMPANY (KEMPER)

This case involved a clerical error in the caption of a previous Workers' Compensation Appeals Board decision. The Board granted reconsideration to amend the April 4, 2011 decision nunc pro tunc. The amendment corrected the caption to include only the relevant case number, ADJ1003980 (SFO 0430815). No objections were received from the parties. The case is now returned to the trial level for further proceedings.

Workers' Compensation Appeals BoardNunc Pro TuncReconsiderationAmend DecisionClerical ErrorCase CaptionAdministrative Law JudgePetition to ReassignTrial Level ProceedingsInsurer

References

Case No. ADJ1925946 (VNO 0473346)

Regular

Feb 02, 2012

ELIZABETH GONIA vs. ROBIN, CARMACK & GONIA LLP, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board reversed an award for housekeeping services, finding the applicant failed to properly object to the utilization review denial for services requested after January 29, 2009. For services prior to that date, the Board found the applicant did not present sufficient medical evidence demonstrating the housekeeping was "medically necessary and reasonable" to treat her industrial injury. The applicant sustained multiple injuries in 1996, resulting in 100% permanent disability, and sought reimbursement for increased housekeeping due to her condition.

Workers' Compensation Appeals BoardElizabeth GoniaRobin Carmack & Gonia LLPState Compensation Insurance FundFindings and AwardReconsiderationPermanent DisabilityMedical TreatmentHousekeeping ServicesUtilization Review

References

Case No. ADJ2765298 (RIV 0026091)

Regular

Aug 13, 2010

PETE SORIA vs. FLEETWOOD ALUMINUM PRODUCTS, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For RELIANCE INSURANCE, In Liquidation

The WCAB granted reconsideration and rescinded a WCJ's order awarding costs to lien claimants. The WCJ's original order lacked a proper evidentiary hearing, a summary of evidence, and an opinion explaining the grounds for the decision, violating due process and Board rules. The Board found the WCJ's subsequent attempt to rescind the order was untimely. The case is returned to the trial level for further proceedings, including an evidentiary hearing and a properly documented decision.

ADJ2765298RIV 0026091ReconsiderationLien ConferenceWCJ OrderStipulated AwardPermanent Total DisabilityRemovalRescinding OrderEvidentiary Hearing

References

Case No. ADJ1273857 (SAC 0323181)

Regular

Mar 15, 2010

Beatrice Givens vs. United International Investigations, ACE Property & Casualty Insurance Company

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The Board found the defendant failed to timely file a petition to terminate temporary disability benefits and provide proper notice to the unrepresented applicant. Consequently, the defendant is estopped from asserting the applicant was permanent and stationary prior to filing its petition. The Board amended the award to grant temporary disability indemnity through June 11, 2009, otherwise affirming the original decision.

Workers' Compensation Appeals BoardReconsiderationTemporary Disability IndemnityPermanent and StationaryPetition to TerminateLabor Code Section 4651.1EstoppelNotice RequirementsMedical ReportsQualified Medical Evaluator

References

Case No. GOL 0097493, GOL 0100342

Regular

Sep 11, 2007

JENA RAISROHANI vs. SAKS, INC., LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case to the trial level. The Board found insufficient development of the record regarding whether the applicant's left shoulder injury resulted from "overuse" as a compensable consequence of a right shoulder injury, or if it constituted a separate cumulative injury. The Board instructed further development of medical evidence and a new decision to clarify the distinction between overuse and cumulative trauma in this specific instance.

Compensable consequence injuryCumulative traumaLeft shoulder injuryRight shoulder injuryOveruse injurySudden onsetMedical causationApportionmentAgreed medical evaluatorWorkers' Compensation Appeals Board

References

Showing 1-10 of 12,347 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

Updated Daily

Case Law Database

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

Case No. ADJ7766654

Regular

Dec 10, 2015

Janice Taylor vs. Blue Go Transit Management, QBE North America

References

Case No. AHM 70712

Significant

Jeannie Karaiskos vs. Metagenics, Inc., California Compensation Insurance Co., In Liquidation, California Insurance Guarantee Association, and Risk Enterprise Management Ltd. (Servicing Facility)

RemittiturEn BancEmployment Development DepartmentEDD lienCalifornia Insurance Guarantee AssociationCIGAcovered claimState of Californiarescindedreinstated

References

Case No. ADJ3632525 (SBR 0271054) ADJ4163174 (SBR 0271055)

Regular

Nov 08, 2016

RANDAL DELAO vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ7613459

Regular

May 07, 2013

LUIS MARTINEZ vs. ANA TERRAZAS, ALLSTATE INSURANCE CO., ADMINISTERED BY SPECIALTY RISK SERVICES

SB 863Lien activation feeMedical-legal expensesPetition for costsLabor Code section 5811Labor Code section 4903.06En banc decisionReconsiderationWithdrawal of lienReinstatement principle

References

Case No. ADJ7890528

Regular

Dec 09, 2013

RUBEN CRUZ vs. PACIFIC RIDGE FARMS, ZENITH INSURANCE COMPANY

Med-Legal Photocopylien claimantPetition for ReconsiderationFindings and Orderrescindedmedical recordsLabor Code Section 4603.2medical-legal costsreimbursementapplicant's injury

References

Case No. ADJ1003980 (SFO 0430815)

Regular

Jun 06, 2011

ROBERT WYNNE vs. LUMEND, INC., HARFORD INSURANCE COMPANY, AMERICAN MANUFACTURERS INSURANCE COMPANY (KEMPER)

Workers' Compensation Appeals BoardNunc Pro TuncReconsiderationAmend DecisionClerical ErrorCase CaptionAdministrative Law JudgePetition to ReassignTrial Level ProceedingsInsurer

References

Case No. ADJ1925946 (VNO 0473346)

Regular

Feb 02, 2012

ELIZABETH GONIA vs. ROBIN, CARMACK & GONIA LLP, STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ2765298 (RIV 0026091)

Regular

Aug 13, 2010

PETE SORIA vs. FLEETWOOD ALUMINUM PRODUCTS, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For RELIANCE INSURANCE, In Liquidation

ADJ2765298RIV 0026091ReconsiderationLien ConferenceWCJ OrderStipulated AwardPermanent Total DisabilityRemovalRescinding OrderEvidentiary Hearing

References

Case No. ADJ1273857 (SAC 0323181)

Regular

Mar 15, 2010

Beatrice Givens vs. United International Investigations, ACE Property & Casualty Insurance Company

References

Case No. GOL 0097493, GOL 0100342

Regular

Sep 11, 2007

JENA RAISROHANI vs. SAKS, INC., LIBERTY MUTUAL INSURANCE COMPANY

References

Showing 1-10 of 12,347 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.