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

Case No. ADJ2417702
Regular
Jun 18, 2012

SANDRA MEJIA vs. JACKSON'S CATERING & EVENTS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board dismissed the Petition for Reconsideration in *Mejia v. Jackson's Catering & Events* because it was not verified, violating Labor Code section 5902. Had it been verified, the Board would have denied it on the merits. The lien claimant failed to prove the medical necessity of transportation services, and the defendant was not required to prove compliance with certain notification requirements. The Board also admonished the petitioner for failing to adhere to form requirements for filed documents.

Petition for ReconsiderationVerifiedLabor Code section 5902DismissedMedically reasonableNecessaryLabor Code section 4610(g)Medical provider network noticesMPNForm requirements
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
Case No. ADJ10079944
Regular
Feb 26, 2019

Robert Fndkyan vs. Opus One Labs, Employers Compensation Insurance Company

This case concerns an applicant's entitlement to a Supplemental Job Displacement Voucher (SJDV). The original decision denied the SJDV due to the absence of a specific Physician's Return-to-Work form. However, the Appeals Board granted reconsideration, finding that the employer was sufficiently informed of the applicant's permanent disability status and work restrictions through a Qualified Medical Evaluator's report. Therefore, the Board determined that the applicant substantially complied with the requirements and is entitled to the SJDV, prioritizing substance over strict adherence to a particular form.

Supplemental Job Displacement VoucherPhysician's Return-To-Work and Voucher formQualified Medical Evaluation ReportLabor Code section 4658.7(b)permanent and stationary statuspermanent partial disabilityvocational statuswork capacitysubstantial complianceform over substance
References
Case No. ADJ2983259 (MON 0280452)
Regular
Jul 25, 2013

LARRY WATERS II vs. RENT-A-CAR, TRAVELERS INSURANCE COMPANY

This case involves a petition for reconsideration by Specialty 26 Chiro Medical Group, a lien claimant, whose lien claim was dismissed by the WCJ. The dismissal was based on the claimant's failure to appear at a lien conference and subsequently failing to object to a Notice of Intention to Dismiss. The Appeals Board denied reconsideration, finding no good cause for the failure to appear or object. The Board also admonished the petitioner for failing to comply with the form requirements for petitions.

Petition for ReconsiderationOrder of Dismissing Lien ClaimLien ClaimantWorkers' Compensation Appeals BoardWCJNotice of Intention to Dismiss Lien ClaimBoard Rule 10562Failure to AppearDeclaration of ReadinessProof of Service
References
Case No. ADJ4276340 RDG 0095395 ADJ7960157
Regular
Aug 15, 2013

David Sandrock vs. Independent Business Forms, Inc., Preferred Employers Insurance Company

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and amended a prior decision regarding David Sandrock's cumulative trauma claim. The WCAB found that Sandrock's cumulative trauma injury ending July 28, 2006, is not presumptively compensable because no claim form was filed with the employer, as required by Labor Code sections 5401 and 5402. The Board determined that the insurer, Preferred Employers, did not violate due process by submitting the case on briefs at a conference. The WCAB deferred the issue of injury arising out of and occurring in the course of employment (AOE/COE) and returned the matter to the trial level for further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderCumulative TraumaPresumptive CompensabilityClaim Form90-Day Investigation PeriodDue ProcessIndustrial InjuryAOE/COE
References
Case No. ADJ982471 (LAO 0859620)
Regular
Apr 28, 2014

JUVENCIO TORRES-RAMOS vs. FELIX MARQUEZ, REDWOOD FREE INSURANCE COMPANY, BERKSHIRE HATHAWAY

The Workers' Compensation Appeals Board denied the defendant's petition for removal and dismissed the applicant's petition for reconsideration. The Board adopted the WCJ's report, finding that the defendant failed to show significant prejudice or irreparable harm to warrant removal. The applicant voluntarily withdrew their reconsideration petition after understanding that their pain management treatment request lacked the required authorization form. The case was referred to the Independent Medical Review (IMR) process for a decision on the applicant's need for pain management treatment.

WCABPetition for RemovalPetition for ReconsiderationIndependent Medical ReviewIMRsubstantial evidenceutilization reviewtimelyprimary treating physicianDWC Form PR-2
References
Case No. ADJ7908352 (MF) ADJ8456209 ADJ7908386 ADJ8336972
Regular
Dec 12, 2017

DANIEL WALSH vs. LIVE NATION, INC., NEW HAMPSHIRE INSURANCE, ACE AMERICAN INSURANCE COMPANY

This case involves applicant Daniel Walsh's claims for three specific injuries against Live Nation, Inc. The workers' compensation administrative law judge (WCJ) initially found these claims barred by the statute of limitations. However, the Appeals Board rescinded these findings, determining there was conflicting evidence regarding whether the employer had notice of the injuries and failed to provide the required claim form under Labor Code section 5401. The Board found that the employer's duty to provide a claim form is triggered by notice of an injury resulting in lost time or medical treatment beyond first aid, and that the issue of notice and resulting tolling of the statute of limitations requires further development at the trial level.

Workers Compensation Appeals BoardReconsiderationStatute of LimitationsLabor Code Section 5401Claim FormNotice of Potential EligibilityTollingDate of InjuryMedical TreatmentLost Time
References
Case No. ADJ8413347
Regular
Sep 23, 2013

GARY BRODIE vs. CARMAX, TRAVELERS INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a finding that he treated outside the defendant's Medical Provider Network (MPN) without justification. The applicant argued he was denied access to MPN treatment due to the defendant's non-compliance and sought to introduce new evidence of physician licensing issues. The Appeals Board denied the petition for reconsideration, adopting the WCJ's report which found no legal basis for the applicant's claims. The Board also strongly admonished the applicant's attorney for improperly attaching exhibits not in the trial record and raising issues not previously litigated, noting potential sanctions.

Medical Provider NetworkMPN compliancestatutory requirementsregulatory requirementsphysician identificationpractice groupslicensing requirementsmedical malpractice judgmentdisciplinary actionnewly discovered evidence
References
Case No. ADJ9066748
Regular
May 23, 2014

RAMATU KABBA vs. DAMERON HOSPITAL ASSOCIATION

Applicant Ramatu Kabba sought reconsideration of a finding that her psychiatric injury claim was not presumed compensable. The applicant argued the 90-day presumption period under Labor Code § 5402(b) began when the employer allegedly failed to provide a claim form promptly after receiving notice of injury. However, the Board denied reconsideration, adhering to the holding in *Honeywell v. Workers' Comp. Appeals Bd.* that the 90-day period runs from the filing of the claim form, not the employer's breach. Absent evidence of the employer misleading the applicant into not filing, the presumption did not arise.

Labor Code section 5402(b)presumption of compensabilitypetition for reconsiderationclaim formdenial of liabilityHoneywell v. Workers' Comp. Appeals Bd. (Wagner)estoppelDWC Form 1industrial injurypsyche
References
Case No. ADJ4678016 (VNO 0340831) ADJ543807 (VNO 0340832) ADJ1072800 (VNO 0372652) ADJ8135564
Regular
May 13, 2019

WAYNE MUSGROVE vs. ASTRO BUSINESS PRODUCTS/CANON BUSINESS SOLUTIONS, YASUDA now SOMPO JAPAN OF AMERICA

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the prior decision that the applicant's 1992 injury claim was not barred by the statute of limitations. The Board found the evidence supported the conclusion that the applicant completed and filed a claim form with his employer. Furthermore, the Board clarified it did not adopt the WCJ's laches analysis, and any such defense would require a showing of prejudice, which was not established. The defendant's arguments regarding the claim form and laches were thus rejected.

Statute of LimitationsClaim FormLachesPetition for ReconsiderationWorkers' Compensation Appeals BoardEstoppelWindow Period CasePrejudiceUnreasonable DelayWCJ Report
References
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