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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ4385559 (VNO 0415101) ADJ1435447 (VNO 0443013) ADJ838479 (VNO 0443014) ADJ847649 (VNO 0443015)
Regular
Jan 12, 2009

ERIK CORD vs. ALL PAYMENTS SERVICES, AIG CLAIM SERVICES, INC., 20TH CENTURY FOX, GALLAGHER BASSETT SERVICES, INC.

Reconsideration granted due to arbitrator's failure to submit reports and file to Appeals Board as per WCAB Rule 10866 (or old Rule 10867).

Workers' Compensation Appeals BoardReconsideration GrantedArbitrator's ReportFindings and AwardWCAB Rule 10866EAMSDecision After ReconsiderationPetition for ReconsiderationCase NumbersAll Payments Services
References
Case No. LBO 339165
Regular
Aug 28, 2007

ROBERT GILES vs. FILM PAYMENT SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for LEGION INSURANCE COMPANY, BROADSPIRE, KELLEY PRODUCTIONS, INC., FIREMAN'S FUND INSURANCE COMPANY

The Workers' Compensation Appeals Board rescinded a prior finding, remanding the case to determine if the Fireman's Fund policy constitutes "other insurance" under Insurance Code section 1063.1(c)(9) for the applicant's injury. The Board rejected the application of collateral estoppel based on a prior appellate decision, finding that the specific facts and intent of the parties regarding coverage must be evaluated anew. This allows for a full development of the evidentiary record to address CIGA's liability and Fireman's Fund's coverage for the applicant's injuries.

CIGALegion Insurance CompanyFireman's Fund Insurance CompanyKelley ProductionsInc.Film Payment ServicesRobert Gilesother insurancecovered claimInsurance Code section 1063.1(c)(9)
References
Case No. ADJ6604427, ADJ8192308
Regular
Jul 31, 2014

CHERRICE MORRIS-GAINES vs. AC TRANSIT, SEDGWICK CLAIMS MANAGEMENT SERVICES

In this workers' compensation case, the applicant initially stipulated to a lower average weekly wage, which the Board found to be a final determination that could not be revisited due to lack of good cause and the five-year statute of limitations. The Board affirmed the employer's credit for payments made to the Employment Development Department (EDD) to prevent double recovery. Furthermore, the Board found no unreasonable delay by the employer in payments to EDD, thus denying the applicant's penalty claim. Finally, the Board rescinded the order requiring the applicant's attorney to repay fees voluntarily paid by EDD, as such repayment was not mandated by law.

Workers' Compensation Appeals BoardAC TransitSedgwick Claims Management ServicesADJ6604427ADJ8192308bus drivercumulative traumatemporary disability indemnityLabor Code section 4656(c)(2)mandatory settlement conference
References
Case No. ADJ3196685 (PAS 0043967)MF ADJ2175299 (PAS 0043966)
Regular
Oct 02, 2019

ALICIA SZUMAN vs. JAY NOLAN COMMUNITY SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of HIH INSURANCE in liquidation, administered by INTERCARE, STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES-IN HOME SUPPORT SERVICES

This case involved applicant Alicia Szuman alleging cumulative and specific injuries as a home health provider resulting in multiple physical and psychological conditions. The administrative law judge initially awarded permanent total disability against the State of California, Department of Social Services (DSS), dismissing CIGA, which defendant DSS sought to overturn. The parties subsequently reached a Compromise and Release agreement for $618,313, providing an annuity and lump sum payment to the applicant. The Workers' Compensation Appeals Board approved this agreement, rescinding the prior award and deeming the settlement adequate and in the applicant's best interest.

COMPROMISE AND RELEASECALIFORNIA INSURANCE GUARANTEE ASSOCIATIONHIH INSURANCEINTERCAREDEPARTMENT OF SOCIAL SERVICESIN-HOME SUPPORT SERVICESYORK SERVICES GROUPCUMULATIVE INJURYPERMANENT TOTAL DISABILITYPERMANENT PARTIAL DISABILITY
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. ADJ1784264 (MON 0302991) ADJ2898466 (MON 0339769)
Regular
Oct 14, 2011

GIRGIS FAM vs. UCLA MEDICAL CENTER, permissibly self-insured, Administered by Sedgwick Claims Management Services

This case concerns the selection of a child care provider for a permanently and totally disabled applicant. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration. The WCAB reversed the judge's decision, allowing the applicant to select his own child care provider, reasoning that this service is personal, similar to selecting a physician. The Board emphasized that the continuity of care and applicant's confidence in the provider outweigh the employer's desire to use a licensed and bonded provider selected by them.

Workers' Compensation Appeals BoardPetition for ReconsiderationSupplemental Findings and AwardPermanently totally disabledCaretaking servicesChild care servicesGardening servicesPool maintenance servicesStructural modificationsCauda-equina syndrome
References
Case No. ADJ8543406
Regular
Jun 01, 2018

JOSE HERNANDEZ vs. ALBA CONSTRUCTION COMPANY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of a WCJ's denial of sanctions for delayed payment of interpreter services. The Board found that the interpreter services for the Compromise and Release were reasonable and necessary under AD Rule 9795.3. Defendant received the invoice on February 24, 2016, but did not pay it until August 2, 2017, exceeding the 60-day payment requirement of AD Rule 9795.4. Therefore, the Board rescinded the prior findings and returned the matter for further proceedings on the petitions for costs and sanctions.

WCABJoyce Altman InterpretersAD Rule 9795.4AD Rule 9795.3Labor Code Section 5813Petition for ReconsiderationFindings of FactCompromise and ReleaseInterpreter ServicesClaims Administrator
References
Case No. ADJ8475421
Regular
Mar 30, 2017

Jessica Duncan vs. Right At Home, Travelers Diamond Bar

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's claim for medical services. The Board found that the lien, filed on June 4, 2016, was barred by the 18-month statute of limitations under Labor Code section 4903.5(a). This was because the last date of service was August 8, 2013, which fell after the July 1, 2013, implementation date of the 18-month rule. The Board also held that it lacked the authority to rule on constitutional vagueness claims.

Labor Code section 4903.5(a)Lien claimStatute of limitationsReconsiderationWorkers' Compensation Appeals BoardWCJTimelinessDate of servicesContinuous treatmentUnconstitutionally vague
References
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
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