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

Case No. ADJ7395654
Regular
Dec 10, 2019

AUDREY UKKERD vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION; CSP SACRAMENTO

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration of an approved Compromise and Release agreement. The applicant alleged the agreement was fraudulently obtained. Since no evidence was presented to support these allegations, the Board found the petition premature. The Board recommends the case be remanded for a hearing to allow the applicant to present evidence and create a record for the judge to consider setting aside the settlement.

Workers' Compensation Appeals BoardAudrey UkkeredCalifornia Department of Corrections and RehabilitationCSP SacramentoState Compensation Insurance FundPetition for ReconsiderationCompromise and ReleaseFraudulentWCJReport and Recommendation
References
Case No. ADJ10485403
Regular
Aug 01, 2018

ALVARO JACKSON vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

This case involves an applicant seeking reconsideration of a Workers' Compensation Appeals Board decision that dismissed his claim. The administrative law judge found the claim barred by the statute of limitations, as it was filed over five years after the alleged date of injury and the last provision of benefits. The applicant's arguments regarding a fraudulent DWC-1 form and doctor's opinions were deemed irrelevant to the statute of limitations issue. The Board dismissed the petition because the applicant failed to demonstrate grounds for reconsideration and did not address the controlling legal issue of the statute of limitations.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactDWC-1 forminadmissiblestatute of limitationsLabor Code section 5405(a)Labor Code section 5405(c)actual knowledgeWCJ
References
Case No. ADJ7196811
Regular
May 17, 2012

ROBERTO LEDESMA vs. U.C. BERKELY, SEDGWICK CMS

Here's a summary for a lawyer: The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding a discovery order compelling production of non-privileged claims file notes from a specific prior period. The Board found these notes relevant to the time medical reports influencing the current Agreed Medical Evaluator were obtained. While one Commissioner concurred with allowing physician depositions, he dissented on the claims file notes, arguing their relevance and probative value were outweighed by undue consumption of time and questioning their necessity for the present admitted claim.

Petition for RemovalWorkers' Compensation Appeals BoardDiscovery OrderClaims File NotesAgreed Medical EvaluatorApportionmentFraudulent MeansDeposition of PhysiciansWCJ Report and RecommendationEvidence Code Section 352
References
Case No. SFO 0496743
Regular
Dec 07, 2007

JUAN OLIVARES vs. 3P DELIVERY, INC., CHESAPEAKE LIFE INSURANCE COMPANY, PEDRO MORALES, UNINSURED EMPLOYERS' BENEFIT TRUST FUND

The Workers' Compensation Appeals Board dismissed a petition for reconsideration because it was filed 35 days after the service of the decision, exceeding the 25-day jurisdictional deadline. The defendant's petition argued the applicant had a fraudulent claim and was injured while merely "riding along" with Mr. Morales. The Board found that the untimeliness of the petition prevented them from addressing the substantive arguments raised.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalUntimely FilingJurisdictional Time LimitLabor Code section 5903Employee Status DeterminationIndependent ContractorFraudulent ClaimService by Mail
References
Case No. ADJ4552841 (SBR 0338344)
Regular
Oct 03, 2014

ANTONIO PONCE GONZALEZ, vs. GRUMA CORPORATION; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA,

Defendant Gruma Corporation filed a Petition for Removal challenging the trial setting order and alleging applicant's fraudulent concealment of subsequent employment. However, at a subsequent hearing, the defendant withdrew its Petition for Removal. The Appeals Board dismissed the petition as withdrawn and moot. The Board also admonished defense counsel for behavior at a prior hearing that could warrant sanctions.

Petition for RemovalWCABWorkers' Compensation Appeals BoardDiscoveryTrial SettingFraudulent ConcealmentWithdrawn PetitionMoot PetitionSanctionsInsolent Behavior
References
Case No. LAO 0874404
Regular
Mar 28, 2008

HELEN DEMBY vs. MAXIM HEALTHCARE, INC., INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, administered by BROADSPIRE

The Workers' Compensation Appeals Board denied Helen Demby's petition for reconsideration in this case against Maxim Healthcare, Inc. The Board adopted the WCJ's report, finding that even if fraud was present regarding prior back treatment, it does not automatically negate a finding of industrial injury. Benefits may be barred only if directly connected to the fraudulent misrepresentation, as determined on a case-by-case basis.

Petition for ReconsiderationInsurance Code section 1871.5fraudindustrial injuryworkers' compensation benefitsfraudulent misrepresentationTensfeldtFarmers Insurance GroupZenith Insurance Co.Miller
References
Case No. ADJ9030735
Regular
Jul 08, 2014

HECTOR CASILLAS vs. XERXES CORPORATION, BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board denied Xerxes Corporation's Petition for Removal. The Board found that while the defendant raised legitimate concerns about potential fraud, these issues were not relevant to the applicant's current claim. The Board adopted the administrative law judge's report, concluding that the evidence presented did not support a fraudulent claim and the forum was not appropriate for addressing concerns about running, capping, and steering. Therefore, the petition was denied.

Petition for RemovalWorkers' Compensation Appeals Boardrunningcappingsteeringfraudulent claimadministrative law judge reportADJ9030735Xerxes CorporationBroadspire Claims Services
References
Case No. ADJ7955260
Regular
Aug 21, 2013

VICTOR SALDIVAR vs. CROWN DISPOSAL, INC., CHARTIS COSTA MESA

This case involves a defendant seeking reconsideration of an approved Compromise and Release (C&R) settlement. The defendant claims newly discovered evidence suggests the applicant fraudulently obtained EDD benefits, which exceed the settlement amount. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the C&R approval, and remanded the case for further proceedings. The WCAB will allow the parties to re-litigate the C&R's approval or set the matter for trial.

Workers Compensation Appeals BoardCompromise and ReleaseEDD lienfraudulent benefitsreconsiderationrescind orderfurther hearingindustrial injuryconstruction demo pickerNational Union Fire Insurance
References
Case No. ADJ9687683
Regular
Jun 18, 2015

CRIS ARANDA vs. MORTIMER & WALLACE, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND, STATE NATIONAL INSURANCE COMPANY, INC., STATE COMPENSATION INSURANCE FUND, INSURANCE COMPANY OF THE WEST, ICW GROUP INSURANCE COMPANIES

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding the prior order that required reimbursement for applicant's deposition costs. The Board found that the employer was denied due process as they received no notice or opportunity to be heard before the order was issued. The case was returned to the trial level for further proceedings, allowing the employer to present arguments regarding alleged fraudulent statements made by the applicant during the deposition. This is permissible when the alleged deceit directly concerns the claim of injury itself.

Labor Code §5710Petition for ReconsiderationDue ProcessFair HearingDeposition CostsReimbursement of CostsWorkers' Compensation Appeals BoardWCJ Order RescindedFraudulent StatementsOpportunity to be Heard
References
Case No. ADJ1717428
Regular
Jul 10, 2017

JERZY PASZKOWSKI vs. SONY CORPORATION OF AMERICA, ATHENS ADMINISTRATORS

The Workers' Compensation Appeals Board denied applicant Jerzy Paszkowski's Petition for Removal and Disqualification. Applicant alleged the Workers' Compensation Judge committed a grave ethical breach by allowing the defense to use a purportedly fraudulent document concerning Dr. Moon's deposition. The Board found no merit to these claims, adopting the WCJ's report which addressed and refuted each contention. Consequently, the petition was denied, affirming the WCJ's prior order regarding the deposition and medical evaluations.

Petition for RemovalDisqualificationJudicial EthicsFraudulent DocumentPetition to QuashDepositionWCJ OrderSubstantial PrejudiceIrreparable HarmWCAB
References
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