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

Case No. WCK 45264
En Banc
Aug 25, 2004

James L. Leinon vs. Fishermen's Grotto, Mid-Century Insurance Company

The Appeals Board held that a penalty under Labor Code section 4650(d) does not apply to disputed disability indemnity payments that are made within 14 days of a final order, decision, or award that imposes liability for those benefits.

Workers' Compensation Appeals BoardLabor Code section 4650(d)Temporary Disability Indemnity (TDI)PenaltyReconsiderationEn Banc DecisionInjury disputeDisability disputeIndemnity rate disputeFinal order
References
Case No. ADJ864227 (LBO 350573) ADJ1635667 (LBO 350607)
Regular
Dec 29, 2008

LUIS ECHEVARRIA vs. FALCON WEST, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed the trial judge's award of attorney's fees under Labor Code section 5814.5. The Board reasoned that section 5814.5 requires an award of attorney's fees to be "in addition to" increased compensation under section 5814, which was not sought or awarded here. Furthermore, the Board found that any delay in payment was not unreasonable due to a good-faith dispute over the net settlement amount.

WORKERS' COMPENSATION APPEALS BOARDLUIS ECHEVARRIAFALCON WESTINC.STATE COMPENSATION INSURANCE FUNDADJ864227ADJ1635667OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONFindings and Orders
References
Case No. ADJ15763825
Regular
Sep 16, 2025

CLAUDIO CARDOZO vs. ROCK AND ROLL CAR WASH, REDWOOD FIRE AND CASUALTY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Reconsideration filed by Redwood Fire and Casualty Insurance Company dba Berkshire Hathaway Homestate Companies. The petition challenged a lien trial decision concerning a medical-legal evaluation performed by Dr. Michaels of Premier Psychological Services. The WCJ found that a medical dispute regarding psyche existed at the time of the evaluation, Dr. Michaels was validly designated as the Primary Treating Physician, and the evaluation was not barred by the 60-day rule for new claims as it was an amendment to an already accepted claim. The Appeals Board adopted the WCJ's reasoning and denied the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 5909Adjudication NumberOpinion and Order Denying PetitionWCJ ReportEAMS TransmissionNotice of TransmissionProof of ServiceFindings and Order
References
Case No. ADJ11364300
Regular
May 24, 2019

JOHN MANNING vs. ORANGE COUNTY FIRE AUTHORITY

This case involves a dispute over an applicant's entitlement to an Independent Medical Examiner (IME) under an Alternative Dispute Resolution (ADR) agreement governing workers' compensation claims. The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration, finding the original order was not a final decision. However, the WCAB granted the petition for removal, rescinded the administrative law judge's finding that no IME was warranted, and returned the case for further proceedings. The WCAB determined it was unclear whether it had jurisdiction to rule on the medical-legal discovery dispute, as parties cannot confer jurisdiction by stipulation, and ordered the trial judge to determine if the ADR program or the WCAB has jurisdiction.

ADR agreementCalifornia Labor Code §3201.7Independent Medical Examiner (IME)removalreconsiderationWorkers' Compensation Appeals Board (WCAB)specific injurycumulative traumafire captainskin cancer
References
Case No. ADJ9845532
Regular
Feb 03, 2017

DONNA PARKER ALVAREZ vs. MOTHER LODE UNION ELEMENTARY SCHOOL DISTRICT, SCHOOLS INSURANCE AUTHORITY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration regarding an award of increased benefits. The Board upheld the administrative law judge's finding that the employer unreasonably delayed benefits for the applicant's left knee injury by failing to provide treatment after receiving a QME report identifying the injury and recommending treatment. The employer's contention of a medical and legal dispute was rejected as there was no evidence of a dispute and the employer had previously provided treatment for the left knee. Consequently, the $25\%$ penalty for unreasonable delay under Labor Code section 5814 was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardLabor Code section 5814unreasonable delaymedical disputelegal disputeQualified Medical Evaluator (QME)Declaration of Readiness to ProceedLabor Code section 4063
References
Case No. ADJ2373559 (OAK 0280633)
Regular
Dec 29, 2008

LYNN JONES vs. INTERNEWS NETWORK, STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration, rescinded the prior award, and returned the case to the trial level to allow parties to complete the dispute resolution process regarding medical treatment denials. The Board found that after utilization review denied treatment, the parties failed to follow the required procedures under Labor Code sections 4610 and 4062 to resolve the dispute. Therefore, a new decision is to be made after the proper dispute resolution process is completed.

Workers' Compensation Appeals BoardUtilization ReviewMedical Treatment DisputeLabor Code Section 4610Labor Code Section 4062Qualified Medical ExaminerGym MembershipPhysical TherapyIndustrial InjuryTreating Physician
References
Case No. ADJ8147593
Regular
Dec 16, 2019

BETZAIDA MENDEZ vs. COUNTY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration of a fee dispute. The Board found that an express contract, including an arbitration clause, existed between the lien claimant and the defendant for medical services. Pursuant to Labor Code Section 5304, the Board lacks jurisdiction to resolve fee disputes arising from such express agreements. Therefore, the petition was denied, affirming the WCJ's finding of an arbitrable contract.

Lien claimantPPO Contractfee disputearbitration provisionexpress agreementWCAB jurisdictionSection 5304medical treatment disputescontract interpretationexclusive jurisdiction
References
Case No. ADJ393547 (ANA 0389753)
Regular
Apr 06, 2010

TOMAS GARCIA vs. METERMAN INC, STATE COMP. INSURANCE FUND

This case involves a dispute over the authorization of an orthopedic mattress for a workers' compensation applicant. The defendant denied the request through utilization review, citing lack of supporting medical guidelines. The Appeals Board reversed the WCJ's award, finding the applicant failed to properly initiate the dispute resolution process under Labor Code section 4062(a). The matter was returned to the trial level for referral to the Agreed Medical Examiner to address the medical necessity of the mattress.

Utilization ReviewLabor Code Section 4610Labor Code Section 4062(a)Agreed Medical ExaminerOrthopedic MattressMedical Treatment DisputeReconsiderationFindings and AwardExpedited HearingWorkers' Compensation Appeals Board
References
Case No. ADJ7523380
Regular
Jul 17, 2015

SALVADOR ULLOA vs. PRAXAIR, INC.

The Appeals Board granted applicant's Petition for Removal, rescinding the WCJ's order taking the case off the expedited hearing calendar. The Board found that a dispute over medical treatment for a serious injury, despite a disputed psychiatric component, warrants expedited review. While a complexity may necessitate redesignation as a Mandatory Settlement Conference, the OTOC itself caused substantial prejudice due to delays in crucial psychiatric treatment. The matter is returned to the WCJ to be reset on the expedited hearing calendar.

RemovalOrder Taking Off CalendarExpedited HearingMandatory Settlement ConferenceDisputed Body PartMedical TreatmentPsychiatric ConditionSerious InjuryUpper ExtremitiesAOE/COE Dispute
References
Case No. ADJ7275781
Regular
Jun 17, 2013

DAINA ROBERTSON vs. VETERINARY CENTERS OF AMERICA, ZURICH AMERICAN INSURANCE CO.

This case concerns a WCJ's imposition of a 25% penalty for defendant's failure to include a 10% self-imposed penalty under Labor Code section 4650(d) when paying a previous award. The defendant argued no penalty was due as they disputed indemnity periods and paid within fourteen days of the award. The Appeals Board granted reconsideration, rescinded the supplemental award, and returned the matter for further proceedings. This action was taken because the record was unclear regarding whether the defendant's dispute over indemnity payments constituted a genuine dispute that would excuse the 10% increase under section 4650(d).

Labor Code section 4650(d)Supplemental Findings and Awardtemporary total disability indemnitypermanent disability indemnityindustrial injuryleft ankleregistered veterinary technicianAgreed Medical Evaluator (AME)permanent and stationarysurgery
References
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