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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3976429 (AHM0117091) & ADJ2299501 (AHM0140858)
Regular
Feb 04, 2010

MARY JO WILLIAMS vs. ARTHUR J. GALLAGHER & CO.; HARTFORD SPECIALTY RISK SERVICES, administered by GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant sought to set aside a previous award based on allegations of fraud and physical improvement, but failed to provide sufficient evidence. The Board found the defendant's evidence of fraud unpersuasive and that a recent deposition did not establish such claims. Consequently, the petition for reconsideration was denied.

Petition for ReconsiderationStipulated Findings and AwardDue DiligenceFraudContinuous TraumaAOE/COEPermanent DisabilityStellate Ganglion BlocksRestless Leg SyndromeIntentional Fraud
References
Case No. ADJ9188852
Regular
Oct 24, 2014

MAURICIO FLORES vs. AMPAM PARKS MECHANICAL, AMERICAN INTERNATIONAL GROUP, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a dismissal order of the applicant's claim. This decision followed the applicant's assertion that their request for voluntary dismissal was procured by fraud. The WCAB adopted the trial judge's recommendation to return the case for further proceedings concerning the fraud allegations. Despite procedural defects in the petition, the WCAB exercised its discretion to grant reconsideration on the merits.

Petition for ReconsiderationOrder For Dismissal of Claim Without Prejudicefraudvoluntary dismissalWCJWCAB Rulesverification requirementsAppeals Board Rule 10856rescindedreturned for further proceedings
References
Case No. ADJ2941365 (BGN 0131581)
Regular
May 22, 2019

JOCELYN JOHNSON vs. COCA COLA BOTTLING COMPANY, KEMPER NATIONAL INSURANCE

The Workers' Compensation Appeals Board denied Jocelyn Johnson's petition for reconsideration of a prior decision that found no fraud in the procurement of earlier findings and awards. Johnson alleged an incorrect injury date, insufficient medical evaluation, and denial of due process. The Board found that Johnson failed to demonstrate extrinsic fraud, as the issues raised could and should have been litigated in prior proceedings or appeals. Therefore, good cause did not exist to reopen the 1996 and 2002 findings and awards.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFraudDate of InjuryAgreed Medical EvaluatorDue ProcessLabor Code Section 5803Continuing JurisdictionExtrinsic Fraud
References
Case No. ADJ6701886
Regular
Oct 03, 2014

SAM NIJEM vs. WASTE MANAGEMENT COMPANY OF ALAMEDA, ACE AMERICAN INSURANCE COMPANY

This case involves a defendant's petition for reconsideration of a workers' compensation award, arguing the applicant committed fraud and is thus barred from benefits. The Board denied the petition, agreeing with the WCJ's finding that the applicant sustained an industrial injury to his right shoulder. While acknowledging a prior fraud conviction, the Board held, citing *Tensfeldt*, that this conviction does not automatically bar all future benefits but only those directly procured by fraud. The Board also denied disqualification of the WCJ as the petition was untimely filed.

Workers' Compensation Appeals BoardSam NijemWaste Management Company of AlamedaACE American Insurance CompanyGallagher BassettADJ6701886Opinion and Order Denying Petition for ReconsiderationPetition for DisqualificationFindings and Awardindustrial injury
References
Case No. ADJ4560326 (OAK 0306464) ADJ3269047 (OAK 0314851)
Regular
Mar 13, 2009

HOWARD C. RICHARDS vs. CAST & CREW; ENTERTAINMENT PARTNERS by ZURICH NORTH AMERICA, Permissibly Self-Insured, by CNA CLAIMS PLUS

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration, treating a prior petition to set aside a Compromise and Release as timely. The applicant claimed the settlement was agreed to under duress and alleged fraud by the insurance company. The Board rescinded the prior order approving the settlement and returned the case to the trial level for further proceedings on the adequacy of the settlement and fraud claims. The judge will reinstate the approval if the settlement is found adequate and no fraud is proven.

Workers' Compensation Appeals BoardCompromise and ReleasePetition for ReconsiderationSet Aside Compromise and ReleaseStressDuressPressureInadequate SettlementFraudZurich Insurance Company
References
Case No. ADJ9240822
Regular
May 24, 2018

VICTOR PANIAGUA vs. GREATER LOS ANGELES COUNTY VECTOR CONTROL DISTRICT, PSI, administered by ACCLAMATION INSURANCE MANAGEMENT SERVICES

This case involved Victor Paniagua's petition for reconsideration of a workers' compensation claim denial for cervical spine injury. The Board denied the petition, upholding the finding that Paniagua did not sustain a cumulative trauma injury during the specified period. This decision was based on Paniagua's lack of credibility, inconsistent statements to medical examiners and doctors, and failure to disclose prior injuries. Furthermore, Paniagua's prior conviction for workers' compensation fraud for a separate incident undermined his claim.

Workers' Compensation Appeals BoardCumulative Trauma InjurySpecific InjuryAgreed Medical ExaminerInsurance FraudCredibility DeterminationWCJPetition for ReconsiderationCervical SpineMedical History
References
Case No. ADJ2037937, ADJ2440040, ADJ3804104, ADJ4186514
Regular
Mar 12, 2012

MARVA SAMUEL vs. CITY AND COUNTY OF SAN FRANCISCO, PLACEMENT PROS

The Workers' Compensation Appeals Board denied reconsideration of a WCJ's finding. The WCJ determined that applicant's claims for temporary disability after February 7, 2006, were not barred by Insurance Code section 1871.5, despite a prior fraud conviction. This ruling does not establish entitlement to future benefits or liability for them. The Board adopted the WCJ's report as the basis for denial.

Workers' Compensation Appeals BoardReconsiderationTemporary Disability IndemnityInsurance Code Section 1871.5Workers' Compensation FraudTensfeldt v. Workers' Comp. Appeals Bd.Industrial InjuryMedical EvidenceCredibilitySubsequent Surgeries
References
Case No. ADJ2569930
Regular
Jul 30, 2012

LOUIS DOBERT vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board dismissed the City and County of San Francisco's petition for reconsideration. The Board affirmed the prior decision to grant removal and rescind a stay of proceedings, which had been sought pending the applicant's criminal fraud trial. The Board reasoned that continuing to provide workers' compensation benefits aligns with the applicant's presumption of innocence. Denying benefits before a conviction would unjustly prejudice the applicant, and restitution can be sought if convicted.

WCABPetition for ReconsiderationPetition for RemovalStay of ProceedingsPresumption of InnocenceWorkers' Compensation FraudInsurance FraudGrand TheftAttempted PerjuryFindings and Award
References
Case No. ADJ2569930 (OAK 0314153)
Regular
Aug 25, 2011

LOUIS DOBERT vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration and denied their petition for removal. The defendant sought to stay workers' compensation proceedings pending the outcome of criminal fraud charges against the applicant. The WCAB agreed with the administrative law judge that a stay was not warranted given the applicant's presumption of innocence and the lack of probable cause shown. The WCAB emphasized that if convicted, benefits could be denied and restitution sought, but a stay would unnecessarily delay claims if acquitted, contrary to constitutional mandates for swift justice.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalStay of ProceedingsCriminal ProceedingsWorkers' Compensation FraudInsurance FraudGrand TheftAttempted PerjuryPresumption of Innocence
References
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