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

Case No. 533269
Regular Panel Decision
Jan 12, 2023

In the Matter of the Claim of Hector Tejada Lopez

The claimant, a carpenter, filed for workers' compensation benefits after sustaining injuries from a fall while employed. Platoon Construction, Inc. (Platoon) was identified as the employer and failed to appear at scheduled hearings, leading the Workers' Compensation Law Judge to establish the claim. Platoon's subsequent request for a rehearing or reopening was denied by the Workers' Compensation Board. Platoon then sought reconsideration and/or full Board review, which was also denied. The Appellate Division affirmed the Board's denial of reconsideration, holding that the merits of the underlying decision were not reviewable and found no arbitrary or capricious action or abuse of discretion by the Board.

Workers' CompensationAppellate ReviewBoard DecisionReconsideration ApplicationEmployer-Employee DisputeIndependent Contractor ClaimProcedural DefaultAbuse of DiscretionJudicial AffirmationNew York Law
References
7
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
0
Case No. ADJ 7620353
Regular
Feb 06, 2012

HECTOR BECERRA vs. CITY OF FRESNO

In this case, both the applicant, Hector Becerra, and the defendant, City of Fresno, sought reconsideration of a prior decision. The Workers' Compensation Appeals Board (WCAB) granted both petitions. This grant allows the WCAB to conduct a more thorough review of the factual and legal issues. The purpose of this reconsideration is to ensure a complete understanding of the record and to issue a just decision.

Workers' Compensation Appeals BoardPetitions for ReconsiderationGranting ReconsiderationStatutory Time ConstraintsFactual and Legal IssuesJust and Reasoned DecisionFurther ProceedingsOffice of the CommissionersSan FranciscoDecision After Reconsideration
References
0
Case No. ADJ6941377
Regular
Nov 07, 2017

HECTOR CAMPOS vs. DAVID PEET, ALLSTATE INSURANCE

This case involves a petition for reconsideration filed by Hector Campos (Applicant) regarding a Workers' Compensation Appeals Board (WCAB) decision. The WCAB dismissed the petition because it was untimely filed. The applicant had until August 14, 2017, to file, but the petition was not received until September 11, 2017. Filing deadlines for reconsideration are jurisdictional, meaning the Board lacks authority to consider petitions filed outside the prescribed timeframe.

Petition for ReconsiderationUntimely FilingDismissalWorkers' Compensation Appeals BoardWCJLab. CodeCal. Code Regs.Jurisdictional LimitService by MailProof of Mailing
References
4
Case No. ADJ726748 (AHM 0090482) ADJ8296550
Regular
May 13, 2013

JOYCE HECTOR vs. JVC OF AMERICA, LIBERTY MUTUAL

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision concerning Joyce Hector's case. This action was taken because the lien claimant, Rehab Solutions, filed a petition for reconsideration. The WCAB requires more time to thoroughly review the factual and legal issues to ensure a just and reasoned decision. All future filings related to this case must now be submitted in writing directly to the Office of the Commissioners of the WCAB and cannot be e-filed.

Rehab SolutionsLien ClaimantReconsiderationPetition for ReconsiderationWorkers' Compensation Appeals BoardStatutory Time ConstraintsFactual IssuesLegal IssuesJust and Reasoned DecisionFurther Proceedings
References
0
Case No. MISSING
Regular Panel Decision
Jun 21, 2000

Hector v. Wal-Mart Group Health Plan

Plaintiff Garfield Hector sued Wal-Mart Associates Health and Welfare Plan after being denied coverage for medical bills resulting from an automobile accident. Plaintiff alleged timely claim submission in May 1995, while the defendant disputed this, claiming submission in April/May 1999, which exceeded the plan's 12-month limit. The defendant moved for summary judgment, arguing that the plaintiff failed to exhaust administrative remedies as required by the Plan, and also failed to submit the claim within the stipulated timeframe and commence the lawsuit within two years. The plaintiff failed to oppose the motion or appear for oral argument. The court found that the plaintiff did not exhaust the administrative review procedures mandated by the Plan, which explicitly requires pursuing these remedies before initiating legal action. Consequently, the court granted the defendant's motion for summary judgment and dismissed the plaintiff's complaint.

ERISAEmployee BenefitsHealth PlanClaim ExhaustionSummary Judgment MotionPlan AdministrationDenial of BenefitsTimely FilingFederal JurisdictionProcedural Dismissal
References
10
Case No. ADJ9688843
Regular
Oct 29, 2019

HECTOR VILLAFAN vs. EXIDE TECHNOLOGIES, TRISTAR RISK MANAGEMENT

This case involves an applicant, Hector Villafan, seeking reconsideration of a workers' compensation decision. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirming the original August 6, 2019 decision with amendments. The WCAB clarified that an industrial injury need only be a contributing cause to the disability, citing *South Coast Framing*. The amended findings establish new and further disability to the head, brain, stroke, and hypertension, deferring other issues and ordering further medical treatment.

WCABPetition for ReconsiderationWCJ reportSouth Coast Framinglegal causationcontributing causenew and further disabilityindustrial injuryhead and brainstroke
References
1
Case No. ADJ8205235
Regular
Feb 06, 2013

HECTOR GOMEZ vs. FASTENAL, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns an injured worker, Hector Gomez, who sought medical treatment outside his employer's Medical Provider Network (MPN). The Board overturned the finding that the employer lost control of medical treatment, finding that the employer's technical failure to schedule the initial MPN visit did not deny treatment. The Board also held that the worker could not select a non-MPN specialist simply because an MPN specialist declined to act as a primary treating physician. Therefore, the applicant must obtain treatment through the defendant's MPN.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Primary Treating Physician (PTP)SpecialistLabor Code section 4616.3Administrative Director's Rule 9767.6initial medical evaluationchange of physicianforfeiture of medical controlaccess standards
References
1
Case No. ADJ8191203
Regular
Mar 07, 2014

HECTOR SOSA vs. JUSTO CESAR TERCERO, individually and doing business as GERMAN CAR SERVICE AND TOWING

The Workers' Compensation Appeals Board denied a petition for reconsideration filed in the case of Hector Sosa vs. Justo Cesar Tercero. The Board adopted and incorporated the reasoning of the administrative law judge's report. Therefore, the petition for reconsideration was denied.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDADMINISTRATIVE LAW JUDGEGERMAN CAR SERVICE AND TOWINGVan Nuys District OfficeADJ8191203
References
0
Case No. ADJ1614204
Regular
Apr 26, 2013

HECTOR LOPEZ vs. CHAMPION ENTERPRISES, CHAMPION HOMES, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior decision concerning a lien claim by Accounts Receivable Acquisitions against applicant Hector Lopez and defendant Champion Enterprises. The Board amended the original decision to award the lien claimant $28,530.76. The Board adopted the Workers' Compensation Judge's report, which found that the defendant failed to present evidence disproving the lien's validity, reasonableness, or the necessity of the authorized surgery. Defendant's objections to lien claimant's exhibits were deemed without merit.

LIEN CLAIMANTACCOUNTS RECEIVABLE ACQUISITIONSUTILIZATION REVIEWOFFICIAL MEDICAL FEE SCHEDULERECONSIDERATIONFINDINGS OF FACT AND AWARDAMENDMENTWCABADMINISTRATIVE LAW JUDGEEAMS
References
0
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