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

Case No. ADJ8831581
Regular
Oct 07, 2013

DARLEEN DE LUNA vs. BUFFALO WILD WINGS, INC.; THE HARTFORD, Adjusted By SEDGWICK CLAIM MANAGEMENT SERVICES

This case involved an applicant injured while taking out trash. The defendant employer sought reconsideration of an award finding the injury industrial, arguing the applicant was engaged in horseplay and misrepresented facts. The Appeals Board denied reconsideration, upholding the finding that the applicant's injury was industrial. The Board deferred to the judge's credibility assessment, finding the applicant credible and the witness alleging horseplay not so. Even if the applicant rode the cart, it was considered performance of authorized work in an unauthorized manner, not disqualifying horseplay.

Workers' Compensation Appeals BoardIndustrial injuryPetition for ReconsiderationFindings and AwardExpediterHorseplayWitness credibilityMaterial fact misrepresentationTrash cartCurb-cut
References
Case No. ADJ1 0300458
Regular
Aug 01, 2016

CD MAHEDE HASAN vs. UNIVERSAL CITY NISSAN, INC, INSURANCE COMPANY OF THE WEST WOODLAND HILLS

The Workers' Compensation Appeals Board denied reconsideration of an applicant's claim for benefits. The applicant sustained an arm fracture while arm wrestling with a colleague during a lull at work. The Board adopted the Administrative Law Judge's findings that the injury resulted from horseplay, which was not condoned by the employer. Because injuries from un-condoned horseplay are not considered to arise out of employment, the claim was denied.

WCABPetition for ReconsiderationDeniedHorseplayEmployer CondonationWCJ FindingsCredibility DeterminationSubstantial EvidenceProximate CauseCourse of Employment
References
Case No. ADJ10914107
Regular
Jun 11, 2018

Jose Mireles vs. S.O.S. STEEL COMPANY, INC., FEDERAL INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, finding the applicant's injury arose out of and in the course of employment. The Board determined the employer failed to prove the applicant's fall from a steel column constituted prohibited "horseplay" or a deviation from employment. Crucially, the parties had stipulated that but for the horseplay defense, the injury would be considered industrial. The Board found the applicant's activity, even if not for the stated purpose of checking plumbness, was not so removed from his duties as to be outside the scope of employment.

AOE/COEAffirmative DefenseHorseplayIronworkerPetition for ReconsiderationScope of EmploymentStipulationUnauthorized MannerWCJWorkers' Compensation Appeals Board
References
Case No. ADJ7902287
Regular
Feb 21, 2012

ROBERT BAEZA vs. FEDERAL EXPRESS, Permissibly Self-Insured, Administered By SEDGWICK

This case involved a workers' compensation claim where the applicant, Robert Baeza, alleged injury arising out of and in the course of employment. The employer, Federal Express, argued the claim was barred by the "horseplay" defense, as the applicant was shoved by a coworker who admitted to engaging in horseplay. However, the Workers' Compensation Appeals Board denied reconsideration of the WCJ's findings. The Board found that while the coworker may have been engaged in horseplay, the applicant's reaction did not constitute horseplay, thus the defense was not applicable.

AOE/COEhorseplay ruleindustrial injuryPetition for ReconsiderationWorkers' Compensation Appeals BoardWCJtortious conductemployer's premisescausal connectionpreponderance of the evidence
References
Case No. ADJ6571874, ADJ7967746
Regular
Oct 21, 2013

DARYL BRISTOL vs. CITY OF SANTA MONICA, CITY OF SANTA MONICA RISK MANAGEMENT

The Board denied the applicant's reconsideration regarding his claimed cumulative trauma injury of multiple myeloma, agreeing with the WCJ that employment exposure to benzene was insufficient to establish causation. The Board granted the defendant's reconsideration regarding a specific arm/shoulder injury, affirming it was not due to horseplay. However, the Board amended the award for this specific injury to limit temporary disability benefits to August 26, 2008, finding subsequent disability was due to the applicant's non-industrial cancer. All other issues related to the specific injury remain deferred.

Workers Compensation Appeals BoardCumulative TraumaInternal SystemCancerMultiple MyelomaLabor Code Section 3212.1Presumption of Compensable InjurySpecific InjuryRight Arm and ShoulderHorseplay
References
Case No. ADJ8739446
Regular
Aug 26, 2014

SAMUEL TAPIA, JR. vs. GOLDEN STATE HEALTH CENTERS, INC., dba SYLMAR HEALTH AND REHABILITATION CENTERS, Permissibly Self-Insured; METRO RISK MANAGEMENT

This case concerns a workers' compensation claim where the applicant sustained an injury during a workplace "dog pile." The initial decision denied the claim, finding it barred by the horseplay defense. On reconsideration, the Appeals Board found the applicant to be a non-participant, despite evidence of prior similar incidents and alleged invitations, and therefore not barred from recovery. The Board rescinded the original denial and found the injury to be industrial, though one Commissioner dissented, deferring to the WCJ's credibility findings that the applicant was a participant.

horseplay defenseindustrial injuryco-workersinstigatorsinnocent bystanderdog pileskylarkingemployer awarenessclocked outWCJ credibility
References
Case No. ADJ10056628
Regular
Jul 09, 2019

RON ESPINOZA vs. CONSTRUCTION SPECIALTY SERVICES, ZURICH NORTH AMERICAN INSUANCE COMPANY

This case involves a dispute over temporary disability indemnity for an injured crane operator, Ron Espinoza. The defendant argues Espinoza's termination for cause should bar his indemnity claim, while the EDD contends its lien for SDI payments was improperly limited. The Appeals Board granted reconsideration, rescinded the prior decision, and returned the matter for further proceedings. The Board requires a proper analysis of whether Espinoza's termination was justified, as opposed to the trial judge's prior reasoning about rehire possibility.

Temporary disability indemnityPetition for reconsiderationFindings Orders and AwardLabor Code section 4656(c)(2)Lien claimant Employment Development Department (EDD)Dismissal for causeRefusal to workEstoppelSuitable modified workJustified termination
References
Case No. ADJ7082245
Regular
Jul 06, 2015

RONALD KLINE vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the Administrative Law Judge's (ALJ) decision regarding Ronald Kline's claim against the Los Angeles Unified School District (LAUSD). The WCAB affirmed the original award of temporary and permanent disability benefits but rescinded the order holding accrued permanent disability indemnity in trust pending resolution of LAUSD's third-party credit claim. The Board found that this issue was improperly deferred at trial and the order violated due process by withholding benefits without proper adjudication of LAUSD's credit rights. Finally, the WCAB affirmed the ALJ's finding of no serious and willful misconduct by the employer, as the evidence did not establish the necessary intent for such a claim.

Petition for ReconsiderationFindings Award and OrdersTemporary total disabilityPermanent partial disabilityThird party credit claimAct of ViolenceSerious and willful misconductHorseplayCo-employee assaultExclusive remedy
References
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. ADJ7500681
Regular
Jul 05, 2012

MICHAEL TEXEIRA vs. BIG O TIRES, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant claimed injury AOE/COE from an incident at work but had no recollection and relied solely on hearsay from third parties and an unverified email from his employer. The Administrative Law Judge found this evidence insufficient to establish causation. The Board adopted the judge's report, concluding the applicant failed to meet his burden of proof for injury arising out of and in the course of employment.

AOE/COEPetition for Reconsiderationunverified petitionhearsay evidenceapplicant's burden of proofprobative valuemechanism of injurycondoned horseplayemployer emailinsufficient evidence
References
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