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

Case No. ADJ10021120 ADJ8949346
Regular
Apr 14, 2017

ANTHONY BERNARD EDWARDS (Dec'd), CANDACE EDWARDS (Widow), ASHLEY EDWARDS (Daughter), ANTHONY EDWARDS, JR. (Son) vs. CITY OF LOS ANGELES; LOS ANGELES WORLD AIRPORTS, Permissibly Self-Insured

This case involves a workers' compensation death benefit claim for Anthony Bernard Edwards, who died in the course of his employment. The dependents seek death benefits and burial expenses, which were initially awarded by the WCJ. The employer, City of Los Angeles, sought reconsideration, arguing it should receive credit for a third-party settlement the dependents obtained from Kaiser Permanente. The Board agreed to reconsider the issue of credit, specifically whether Civil Code section 3333.1 bars such credit. The Board ultimately deferred the credit issue, affirming the death benefit award and returning the matter for further proceedings to determine the applicability of Civil Code section 3333.1 and potential employer negligence.

Workers' Compensation Appeals BoardADJ10021120ADJ8949346death benefitsLabor Code section 4702burial expensesCivil Code section 3333.1Medical Injury Compensation Reform ActMICRAthird-party settlement
References
Case No. ADJ8005462
Regular
Dec 02, 2013

PEDRO VALDERRAMA, SR. (Deceased), MARIA SOLIS (Spouse) et al. vs. LOS AMIGOS CONSTRUCTION, ACEO PAYROLL CO., CASTLE POINT INSURANCE CO., ACE AMERICAN INSURANCE CO.

The Workers' Compensation Appeals Board denied the Petition for Reconsideration, upholding the original award finding that Pedro Valderrama's death on September 25, 2009, was industrially caused. The Board found substantial evidence supported that Castle Point Insurance Company was the insurer for Los Amigos Construction at the time of the injury, despite petitioners' claims that payroll services had switched to Select Focus. Evidence indicated that Select Focus had not finalized any agreement or secured insurance coverage for Los Amigos Construction before the date of injury, and that Castle Point's policy was still in effect. The Board also noted a prior OSHA decision that similarly found Select Focus was not the employer and had no exposure in this case.

Workers' Compensation Appeals BoardPedro ValderramaMaria SolisLos Amigos ConstructionACEO Payroll Co.Castle Point Insurance Co.ACE American Insurance Co.Petition for ReconsiderationFindings of Fact and Awardindustrial injury
References
Case No. ADJ7601670 ADJ9457797 ADJ9576710
Regular
Jun 28, 2016

MARGARITA GUTIERREZ vs. DYNAMIC DETAILS, INC, ACE FIRE UNDERWRITERS INS. CO., ESIS, THE HARTFORD INS. CO., EVEREST NATIONAL INS. CO., SEDGWICH CMS

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration. The WCJ had previously issued an order vacating the original findings and setting a status conference. This order vacating the decision was issued within the 15-day period allowed for a WCJ to amend, modify, or rescind an award after a petition for reconsideration is filed. Therefore, the applicant's petition for reconsideration became moot and was properly dismissed.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderWorkers' Compensation Administrative Law JudgeOrder VacatingWCAB Rule 10859Moot PetitionOrder Denying Petition for RemovalChairwoman CaplaneCommissioner Sweeney
References
Case No. ADJ4634338 (MON 0262377)
Regular
Jun 24, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

This case concerns a dispute over contribution claims following a cumulative injury to the applicant. The Workers' Compensation Appeals Board granted reconsideration, rescinded an arbitration finding, and remanded the matter for further proceedings. The Board found that Sedgwick, which paid over $180,000 in benefits, was not required to file a petition for contribution under section 5500.5 because it was not a signatory to the Compromise and Release (C&R). Furthermore, the Board held that even if Sedgwick had been required to file, the co-defendant CNA would be estopped from asserting the statute of limitations due to stipulations in the C&R reserving contribution rights. The Board concluded Sedgwick's claim for reimbursement was not time-barred.

Workers' Compensation Appeals BoardNina GoodrichUnilabQuest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.CNA ClaimsplusValley Health SystemsTristar Risk ManagementZurich Insurance Co.
References
Case No. POM 248928
Regular
May 12, 2006

MARK MICELI vs. JACUZZI, INC., REMEDYTEMP, INC., AMERICAN HOME ASSURANCE CO., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY CO., In Liquidation

The Court of Appeal reversed the Appeals Board's prior decision, finding that the special employer's insurance (American Home Assurance Co.) was not "other insurance" available to the applicant. This ruling invalidated the previous dismissal of CIGA and dictated that the case be returned for further proceedings. The Appeals Board, following this remittitur, rescinded the prior consolidation and stay order, denying RemedyTemp's request for dismissal and CIGA/RemedyTemp's request for a new consolidation. Assurance's petition for appeal costs was also dismissed as it was filed with the wrong entity.

CIGARemedyTempJacuzziAmerican Home Assurance Co.Reliance National Indemnity Co.special employergeneral employerother insuranceInsurance Code section 1063.1(c)(9)remittitur
References
Case No. ADJ2841961 (SJO 0191311)
Regular
May 03, 2012

DERRICK LITTLE vs. WALKER CONCRETE CO., LIBERTY MUTUAL INS. CO.

Applicant Derrick Little filed an "appeal" of an order denying his motion to change venue, which the Board treated as a Petition for Removal. The Petition was dismissed because it failed to articulate any specific factual or legal contentions justifying the removal. Furthermore, the Petition did not demonstrate significant prejudice or irreparable harm, which are required for a grant of removal. The Board adopted the WCJ's report and recommendations in its entirety when dismissing the petition.

Petition for RemovalChange of VenueWCJ OrderOrder Denying MotionDismissed PetitionSkeletal PetitionSignificant PrejudiceIrreparable InjuryWCAB Rule 10842WCAB Rule 10846
References
Case No. ADJ1200873 (OAK 0337904) ADJ479879 (OAK 0337905)
Regular
Apr 06, 2009

CARMEN CHACON vs. NATIONAL UPHOLSTERING CO., NATIONAL LIABILITY & FIRE INS. CO.

The Workers' Compensation Appeals Board (WCAB) rescinded an approved Compromise and Release (C&R) agreement due to potential mutual mistake of fact regarding duplicate payments of Temporary Disability Indemnity (TDI) and Unemployment Insurance (UI). Both the defendant and the Employment Development Department (EDD) sought reconsideration, arguing the original order did not adequately protect their interests regarding these duplicate payments. The WCAB found that EDD's due process rights were violated by a lack of proper notice and service regarding the C&R. The matter was returned to the trial level for a new decision to determine if a mutual mistake occurred and to consider EDD's lien.

Workers' Compensation Appeals BoardCarmen ChaconNational Upholstering Co.National Liability & Fire Ins. Co.Employment Development Department (EDD)Compromise and Release (C&R)Order Approving Compromise and Release (OACR)Mutual Mistake of FactDuplicate PaymentsTemporary Disability Indemnity (TDI)
References
Case No. ADJ4634338 (MON 02262377) ADJ614711 (MON 0288710)
Regular
Dec 07, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

Zurich's petition for reconsideration of the June 24, 2009 Opinion and Order Granting Reconsideration and Decision After Reconsideration is denied for the reasons stated in prior opinions.

Workers' Compensation Appeals BoardNina GoodrichUnilab/Quest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.Valley Health SystemsTristar Risk ManagementZurich Insurance Co.Labor Code section 5500.5Arbitration Finding of Facts
References
Case No. ADJ1355980 (SAC 0285830) ADJ760169 (SAC 0285829)
Regular
May 28, 2013

BETTY FRISBY (Deceased), GEORGE FRISBY (Spouse) vs. THE PRESS TRIBUNE, INC.; TIG INSURANCE CO., TRISTAR RISK MANAGEMENT; RELIANCE INSURANCE CO., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by TPA SEDGWICK CMS

This case concerns a deceased worker's cumulative injury claims against multiple insurers. The Appeals Board rescinded the arbitrator's decision, finding that crucial findings regarding the period of cumulative injury and whether the worker was an employee were missing. The Board remanded the case for the arbitrator to determine the precise injury dates, body parts affected, and the insurer(s) liable during the statutory period. This is necessary to ascertain if TIG Insurance provided coverage and thus constitutes "other insurance" before determining CIGA's liability.

Workers' Compensation Appeals BoardBetty FrisbyGeorge FrisbyThe Press TribuneTIG Insurance Co.Tristar Risk ManagementReliance Insurance Co.California Insurance Guarantee Association (CIGA)Sedgwick CMScumulative injury
References
Case No. ADJ7432904
Regular
Sep 24, 2012

NEDA MOTAVAKEL vs. FANTASTIC SAM'S, TOWER SELECT INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, STAR INSURANCE CO., ILLINOIS MIDWEST INSURANCE AGENCY, LLP, ENDURANCE WORKERS' COMPENSATION, SOUTHERN INSURANCE CO., FIRSTCOMP OMAHA

This case involves an appeal by Star and Tower Insurance Companies regarding a workers' compensation award. The primary issue is the applicant's average weekly earnings, specifically the inclusion of tip income, which was not adequately substantiated by documentary evidence. The Appeals Board found the initial decision lacked substantial evidence regarding earnings and rescinded the award. The matter is remanded for further proceedings to properly develop the evidentiary record on earnings and insurance coverage dates before a new decision is issued.

Workers' Compensation Appeals BoardNeda MotavakelFantastic Sam'sTower Select Insurance CompanyStar Insurance CompanyIllinois Midwest Insurance AgencyLLEndurance Workers' CompensationSouthern Insurance CompanyFirstComp Omaha
References
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