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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. GOL 0100565
Regular
Oct 15, 2007

Felipe Quezada vs. EXCLUSIVE GERMAN AUTO REPAIR, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the original finding that his injury claim was barred by Labor Code section 3600(a)(10), the post-termination defense. Despite the applicant's argument that notice and termination were concurrent, the Board gave significant weight to the Workers' Compensation Judge's credibility assessment of the witnesses, who found the defense witnesses more credible. Therefore, the applicant will receive no compensation.

Felipe QuezadaExclusive German Auto RepairState Compensation Insurance FundLabor Code section 3600(a)(10)post-termination defenseconcurrent noticeterminationWCJcredibilitypetition for reconsideration
References
Case No. ADJ8310177
Regular
Apr 25, 2014

FELIPE HERNANDEZ (DECEASED) vs. SUPERIOR READY MIX CONCRETE, TRISTAR RISK MANAGEMENT

This case involves a Petition for Removal filed by a party in the workers' compensation matter of Felipe Hernandez (deceased) v. Superior Ready Mix Concrete. The petitioner subsequently withdrew the filed petition. Consequently, the Workers' Compensation Appeals Board has issued an order dismissing the petition for removal. No further action will be taken on this withdrawn petition.

Petition for RemovalWithdrawn PetitionDismissed PetitionWorkers' Compensation Appeals BoardSelf-InsuredTristar Risk ManagementDeceased ApplicantADJ8310177San Diego District OfficeOrder Dismissing
References
Case No. ADJ8419958
Regular
Jan 16, 2014

FELIPE RAMIREZ vs. D'ARCY & HARTY CONSTRUCTION, INC., OLD REPUBLIC GENERAL INSURANCE CORPORATION

This case involves a worker's compensation applicant, Felipe Ramirez, seeking approval for spinal surgery recommended by his treating physician, Dr. Naraghi. The defendants contested the surgery, and Utilization Review initially denied the request. The Administrative Law Judge (ALJ) awarded the surgery, finding the UR denial invalid as the reviewing doctor lacked crucial medical information. The Appeals Board denied the defendants' petition for reconsideration, affirming the ALJ's decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenialSpinal surgeryDr. NaraghiUtilization ReviewNon-certificationDr. DeutschSandhagenLabor Code §4610
References
Case No. ADJ8967361
Regular
Nov 26, 2014

FELIPE GARCIA (DECEASED) GUILLERMINA GARCIA (WIDOW) vs. SALVADOR GAYTAN dba G\&P AG MANAGEMENT CONTRACTORS, INC.; STAR INSURANCE, Adjusted by MEADOWBROOK INSURANCE GROUP

This case involved a petition for reconsideration by the applicant in a workers' compensation matter where the deceased worker, Felipe Garcia, was initially found to be an employee but later deemed an independent contractor by the Appeals Board. The applicant argued the Board erred by disregarding the WCJ's credibility assessment and by not applying Labor Code section 2750.5 to unlicensed contractors. The Board denied the petition, finding no evidence the deceased worker was engaged in activities requiring a contractor's license under Business and Professions Code sections 7000 and 7026. Therefore, Labor Code section 2750.5 was inapplicable, and the prior decision finding the applicant an independent contractor was upheld.

Workers' Compensation Appeals BoardIndependent contractorEmployee statusReconsiderationLabor Code section 2750.5Contractors' State License LawBlew v. HornerGarza v. Worker's Comp. Appeals Bd.Rinaldi v. Workers' Comp. Appeals Bd.Unlicensed contractor
References
Case No. ADJ3771318
Regular
May 13, 2009

FELIPE ANDRADE vs. UNION FRAMING, INC.

The Workers' Compensation Appeals Board affirmed the original award, finding that an injured employee sustained a low back injury and was entitled to self-procure medical treatment outside the defendant's Medical Provider Network (MPN). The defendant argued the employee should have been treated within the MPN and that self-procurement was improper. The Board adopted the WCJ's report, but excluded a portion regarding MPN transfers, as no such transfer had yet been attempted. A concurring opinion suggested the employer should not be allowed to transfer care into the MPN if a lawful physician-patient relationship already exists and treatment is adequate.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardApplicantDefendantLabor Code section 4600(a)Self-procure medical treatmentMedical provider network (MPN)Petition for ReconsiderationReport and Recommendation
References
Case No. ADJ7154927
Regular
Oct 02, 2015

FELIPE AVALOS vs. FRITO LAY, INC.

In *Avalos v. Frito Lay*, the Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration. The dismissal was based on the petition being untimely filed, exceeding the jurisdictional 25-day deadline for reconsideration after the WCJ's decision. Proof of mailing was insufficient; the petition had to be received by the WCAB within the statutory period. As the petition was filed significantly after the deadline, the WCAB lacked authority to consider it.

Petition for ReconsiderationUntimely filingWCJ decisionService by mailCalifornia addressTime extensionWeekend or holidayProof of mailingJurisdictional time limitAppeals Board authority
References
Case No. ADJ7928198
Regular
Mar 19, 2014

FELIPE AYALA vs. CUSTOM DELUXE LANDSCAPINT, ACE USA

The Workers' Compensation Appeals Board dismissed a petition for reconsideration because it was filed against a Notice of Intention, not a final order. The Board found the petition frivolous and warned against future similar filings. The case will be returned to the trial level for further proceedings and decision.

Petition for ReconsiderationNotice of Intention (NIT)Lien ClaimDismissalTrial LevelWCJ ReportFrivolous FilingSanctionsWorkers' Compensation Appeals BoardFinal Order
References
Case No. ADJ11314069
Regular
Nov 20, 2018

LUIS TOLENTINO vs. LUKE'S ROOFING, REDWOOD FIRE INSURANCE COMPANY

This case concerns the proper designation of a primary treating physician within a Medical Provider Network (MPN). The applicant selected Dr. Huang, who was employed by Casa Colina. The defendant argued this was improper because Casa Colina was only listed for ancillary services and Dr. Huang was not individually listed in the MPN. The Board affirmed the WCJ's decision, holding that Dr. Huang's designation was proper as long as he acted through Casa Colina, which was included in the MPN without restriction. Regulations permit an entity in the MPN to have its employee physicians considered part of the network, unless specifically excluded.

Workers' Compensation Appeals BoardPetition for ReconsiderationPrimary Treating PhysicianMedical Provider Network (MPN)Ancillary ServicesEmployee PhysicianNon-natural personApplicable RegulationsEntityEmployee
References
Case No. ADJ7590683
Regular
Mar 23, 2015

FELIPE GARCIA vs. E RECYCLING OF CALIFORNIA, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review a judge's decision awarding a hospital fees exceeding the Official Medical Fee Schedule (OMFS). The WCAB rescinded the judge's order, finding that the relevant statutes for payment in excess of the OMFS were deleted in 2004. Therefore, the lien claimant is entitled to payment only according to the OMFS. The case was returned to the trial level to determine if any additional OMFS payment is due.

Workers' Compensation Appeals BoardLien ClaimantOfficial Medical Fee ScheduleInpatient Hospital Fee ScheduleExtraordinary CircumstancesUrgent InjuryLabor CodeJurisdictionReconsiderationFindings and Order
References
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