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

Case No. ADJ2569930 (OAK 0314153)
Regular
Aug 25, 2011

LOUIS DOBERT vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration and denied their petition for removal. The defendant sought to stay workers' compensation proceedings pending the outcome of criminal fraud charges against the applicant. The WCAB agreed with the administrative law judge that a stay was not warranted given the applicant's presumption of innocence and the lack of probable cause shown. The WCAB emphasized that if convicted, benefits could be denied and restitution sought, but a stay would unnecessarily delay claims if acquitted, contrary to constitutional mandates for swift justice.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalStay of ProceedingsCriminal ProceedingsWorkers' Compensation FraudInsurance FraudGrand TheftAttempted PerjuryPresumption of Innocence
References
Case No. ADJ2569930
Regular
Jul 30, 2012

LOUIS DOBERT vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board dismissed the City and County of San Francisco's petition for reconsideration. The Board affirmed the prior decision to grant removal and rescind a stay of proceedings, which had been sought pending the applicant's criminal fraud trial. The Board reasoned that continuing to provide workers' compensation benefits aligns with the applicant's presumption of innocence. Denying benefits before a conviction would unjustly prejudice the applicant, and restitution can be sought if convicted.

WCABPetition for ReconsiderationPetition for RemovalStay of ProceedingsPresumption of InnocenceWorkers' Compensation FraudInsurance FraudGrand TheftAttempted PerjuryFindings and Award
References
Case No. ADJ2272286 (LAO 0873209)
Regular
Jul 19, 2010

ENRIQUE CASTRO-AGUILAR vs. SECURITAS SECURITY SERVICES, BROADSPIRE

In this workers' compensation case, the Appeals Board granted reconsideration to determine if applicant's injuries were barred by the initial aggressor defense. The applicant, a security officer, was injured while using pepper spray and restraining a suspected shoplifter who was threatening him with a rock. The Board found that the applicant's actions, though potentially unauthorized in manner, were a good-faith attempt to prevent theft and did not constitute willful wrongdoing. Therefore, he was not the initial aggressor, and his claim for benefits is not barred.

initial aggressor defenseunauthorized mannerscope of employmentcourse of employmentaffirmative defensewillful wrongdoingintentional misconductreal present and apparent threat of bodily harmgood faith attemptprevent theft
References
Case No. ADJ10351206
Regular
Aug 02, 2017

GONZALO TAPIA vs. RIO GRANDE FARM, ZENITH INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award. The Board found the record inadequate to accurately determine the applicant's average weekly wage, as it lacked specific details on his hourly pay rate and hours worked in 2015. Therefore, the case was returned to the trial level for further proceedings to develop this evidence.

Petition for ReconsiderationAverage Weekly EarningsTemporary Disability IndemnityIndustrial InjuryField LaborerSeasonal EarningsEarning CapacityLabor Code Section 4453Wage CalculationWCJ Decision
References
Case No. ADJ3210598 (SAC 0322261)
Regular
Dec 24, 2010

JOAN NEWLANDS vs. MARRIOTT VACATION INTERNATIONAL, dba TIMBER LODGE & GRAND RESIDENCES CLUB

The Workers' Compensation Appeals Board granted reconsideration to correct a clerical error, amending the original finding to state the applicant was not temporarily totally disabled since January 7, 2005, rather than January 1, 2005. The Board affirmed the administrative law judge's decision, which was based on the applicant's poor credibility and conflicting medical evidence regarding her alleged condition. The judge's findings, particularly regarding credibility, were accorded great weight and supported by substantial evidence. The applicant's industrial injury to both upper extremities was admitted.

Workers' Compensation Appeals BoardMarriott Vacation InternationalTimber LodgeGrand Residences ClubPermissibly Self-InsuredApplicantDefendantIndustrial InjuryUpper ExtremitiesElbows
References
Case No. SAC 289086
Regular
Jun 09, 2008

SCOTT PACHECO vs. GRAND FLOOR DESIGNS, LIBERTY MUTUAL/GOLDEN EAGLE INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding industrial injury, including Crohn's disease, to the applicant. The Board rescinded the award and returned the case to the trial level due to a lack of substantial medical evidence regarding the Crohn's disease claim. Further proceedings, potentially including the appointment of an independent medical evaluator, are required to properly develop the medical record on this issue.

Workers Compensation Appeals BoardScott PachecoGrand Floor DesignsLiberty MutualGolden Eagle Insurance Companyindustrial injuryCrohn's diseasepsyche injurypermanent disabilityWCJ
References
Case No. ADJ10807559, ADJ11213172
Regular
Mar 04, 2019

KIM JOHNSTON JIMENEZ vs. ARROYO GRANDE COMMUNITY HOSPITAL

The WCAB granted reconsideration and rescinded the WCJ's decision, finding the medical record needed further development. The applicant sustained a left knee injury, and subsequently developed a severe infection requiring extensive treatment. Defendant argued the infection and treatment were not industrially caused, as an infection can arise independently of prior injury. The Board remanded for further proceedings to determine if the recommended treatment is necessary for the industrial condition or if it's independent of the injury.

Arroyo Grande Community HospitalSedgwick Claims ManagementPetition for ReconsiderationFindings of FactDr. Ferroindustrial basisstipulated Awardpermanent disabilitymedical treatmentrevision left knee arthroplasty
References
Case No. ADJ11206337
Regular
Aug 23, 2018

Stephen Rowe vs. Grand Pacific Resort Service, Zenith Insurance

Applicant Stephen Rowe sought reconsideration of an approved Compromise and Release, alleging fraud and misrepresentation by the defendants. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration. The WCAB found that Rowe's allegations of fraud, lacking supporting evidence or testimony, were premature for appellate review. Therefore, the case was returned to the trial level for the judge to treat the petition as a motion to set aside, allowing for a hearing and the presentation of evidence.

Stephen RoweGrand Pacific Resort ServiceZenith InsurancePetition for ReconsiderationOrder Approving Compromise and ReleaseWCJin pro percumulative traumaarm and wrist injuryfraud
References
Case No. ADJ493837
Regular
Nov 12, 2013

GABRIEL RUIZ vs. GRAND PARK CONVALESCENT HOSPITAL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration because it was taken from a non-final interlocutory order. Such orders, concerning procedural or evidentiary matters, do not determine substantive rights and are not appealable via reconsideration. The WCAB also denied the petition's request for removal, finding no showing of substantial prejudice or irreparable harm. Therefore, the Petition for Reconsideration was dismissed and removal was denied.

Petition for ReconsiderationFinal OrderSubstantive RightLiability DeterminationInterlocutory OrderProcedural DecisionEvidentiary DecisionRemovalSubstantial PrejudiceIrreparable Harm
References
Case No. ADJ8035405
Regular
Oct 08, 2012

KARRI WELLINGTON vs. DREYER'S GRAND ICE CREAM HOLDINGS, ACE AMERICAN INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration in this case. However, the parties subsequently reached a settlement and filed a Compromise and Release Agreement. Consequently, the WCAB rescinded its prior Findings of Fact/Award and returned the matter to the trial judge for action on the settlement agreement.

Workers' Compensation Appeals BoardReconsiderationCompromise and Release AgreementFindings of FactAwardRescindedTrial LevelDreyer's Grand Ice CreamAce American InsuranceSedgwick Claims Management
References
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