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

Case No. ADJ3891195 (LBO 0394271)
Regular
Jul 26, 2010

Carlos Melara vs. GARDA USA, aka GARDA CL WEST, INC.; ESIS

The Workers' Compensation Appeals Board granted reconsideration and rescinded a previous award. The Board found that while the applicant sustained an industrial injury, it did not result from the employer's serious and willful misconduct. The Board determined that the employer's actions, including conducting safety meetings and having policies against firearm misuse, did not demonstrate the "positive and active disregard of the consequences" required for serious and willful misconduct. Therefore, the 50% increase in benefits for serious and willful misconduct was overturned.

Workers Compensation Appeals BoardSerious and Willful MisconductLabor Code Section 4553Industrial InjuryBilateral Lower ExtremitiesPsycheGarda USAESISCoin CounterArmored Trucks
References
Case No. ADJ374246
Regular
Apr 23, 2015

CAROLINE PARAS vs. LOS ANGELES TIMES/TRIBUNE, ACE USA

Defendant ACE USA filed a Petition for Removal seeking to overturn an order changing the claims administrator from Gallagher Bassett to CIGA. The Board found ACE USA's contentions unintelligible. However, both ACE USA and the applicant subsequently filed a Compromise and Release, which was approved. Consequently, ACE USA's Petition for Removal is now moot and has been dismissed by the Board.

Petition for RemovalOrder to Change AdministratorsCalifornia Insurance Guarantee AssociationCIGACompromise and Releasemootalter egothird party administratorTPAWorkers' Compensation Appeals Board
References
Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
Case No. ADJ248306 (SAC 0298167) ADJ870873 (SAC 0298071)
Regular
Jul 28, 2017

Lonnie Roberts vs. Capital Plumbing, California Insurance Guarantee Association, Reliance National Indemnity Company, SEDGWICK CLAIMS MANAGEMENT SERVICES, ACE USA

The Workers' Compensation Appeals Board granted reconsideration to clarify ACE USA's liability for reimbursement to CIGA. ACE USA argued that CIGA's claim lacked sufficient proof and that the initial order failed to specify an amount. The Board affirmed the finding that ACE USA is liable for reimbursement to CIGA for temporary disability, medical treatment, bill review, and utilization review for services paid after January 26, 2001. However, the Board amended the order to clarify that the parties must adjust the reimbursement amount, with the trial judge retaining jurisdiction if an agreement is not reached.

Workers' Compensation Appeals BoardCIGAACE USAReimbursementLiquidationJointly and Severally LiableOther InsuranceBenefit PrintoutLabor Code Section 5815Unclean Hands Doctrine
References
Case No. ADJ8902716
Regular
Oct 30, 2014

ANA GONZALEZ vs. NESTLE USA, INC.

The Workers' Compensation Appeals Board (WCAB) dismissed Nestle USA, Inc.'s Petition for Removal in the case of Ana Gonzalez. The Board adopted and incorporated the report of the workers' compensation administrative law judge, finding no grounds for removal. This order signifies the denial of the employer's request for further review.

Petition for RemovalDismissalReconsideration deniedWorkers' Compensation Appeals BoardSelf-insuredClaims Management ServicesAdministrative Law Judge reportVan Nuys District OfficeNestle USAAna Gonzalez
References
Case No. ADJ8319313
Regular
Oct 05, 2016

ARNULFO HERNANDEZ vs. NESTLE USA, INC.

Defendant Nestle USA, Inc. sought removal of an order that postponed a mandatory settlement conference to allow for the deposition of a qualified medical evaluator. The defendant argued this delay violated their due process right to a speedy determination, claiming the applicant was dilatory in scheduling the deposition. The Appeals Board denied removal, finding no substantial prejudice or irreparable harm and no violation of due process. The Board noted that any alleged error in rescheduling the deposition can be raised at trial and addressed through reconsideration of a final decision.

Petition for RemovalWorkers' Compensation Appeals BoardMandatory Settlement ConferenceQualified Medical EvaluatorDepositionDue ProcessSpeedy DeterminationCumulative Trauma InjurySubstantial PrejudiceIrreparable Harm
References
Case No. ADJ8394536
Regular
Jan 23, 2014

IVIN DREW vs. NESTLE USA, INC.

The defendant, Nestle USA, Inc., petitioned for removal, challenging a WCJ's order for a second QME appointment due to a late supplemental report. The Appeals Board granted the petition because the defendant's crucial exhibits and medical reports were not scanned into the electronic system, preventing a merits-based decision. Consequently, the Board rescinded the WCJ's prior order and returned the case to the trial level to establish a sufficient record. This action ensures the parties can properly litigate the dispute over the QME appointment rules.

Petition for RemovalQualified Medical EvaluatorLate Supplemental ReportAdministrative Director RuleEAMSMedical ReportsAppeals BoardWCJRescinded OrderTrial Level
References
Case No. SDO 0325797
Regular
Jan 25, 2008

Anthony Arinze vs. Labor Finders, ACE USA

This case involves an appeal by defendant ACE USA regarding an award for applicant Anthony Arinze's cumulative trauma injury. The Workers' Compensation Appeals Board granted reconsideration, rescinded the original award, and returned the case for further development of the medical record. The Board found insufficient medical evidence on apportionment of the applicant's back injury, particularly concerning pre-existing degenerative conditions. The matter will proceed to the trial level for a new Qualified Medical Evaluator to address these issues.

Labor FindersACE USAcumulative traumaright eye injuryhand injuryback injurypermanent disabilityapportionmentLabor Code section 5400Labor Code section 4663
References
Case No. ADJ4455621 (AHM 0086346)
Regular
May 14, 2014

ALVIN CAVALIER vs. BABCOCK & WILCOX; ACE USA, Administered By ESIS, INC.

This case involves Alvin Cavalier's workers' compensation claim against Babcock & Wilcox and its administrator, ACE USA. Cavalier petitioned for reconsideration of a prior decision by the Workers' Compensation Appeals Board (WCAB). The WCAB has denied Cavalier's petition, adopting the reasoning of the administrative law judge and incorporating it into their order.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportdeny reconsiderationAlvin CavalierBabcock & WilcoxACE USAESISInc.ADJ4455621
References
Case No. ADJ2296442 (VNO 0518441)
Regular
May 29, 2013

ENRIQUE DE LA TORRE vs. NESTLE USA, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case concerns a Petition for Reconsideration filed by an applicant against Nestle USA, Inc. and Sedgwick Claims Management Services, Inc. The Workers' Compensation Appeals Board (WCAB) dismissed the petition because it was not taken from a final order. However, the WCAB returned the matter to the trial level for further proceedings, including dismissal of a lien and potential sanctions.

Petition for ReconsiderationDismissedNot from Final OrderReturned to Trial LevelLien DismissalNotice of IntentSanctionsNestle USASedgwick Claims ManagementWorkers' Compensation Appeals Board
References
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