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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ473373 (ANA 0406381)
Regular
Feb 10, 2012

FERNANDO GUTIERREZ vs. SOCAL FRAMING aka BMHC; ACE AMERICAN INSURANCE, administered by ESIS, INC.

This case concerns applicant's claim for extended temporary disability (TD) benefits beyond 104 weeks due to a left eye injury. The Appeals Board affirmed the WCJ's denial of the "amputation" exception, ruling that the surgical removal of an eye does not fit the statutory definition. However, the Board remanded the case for further development of the record on the "high-velocity eye injury" exception, as the velocity and force of the object that struck the applicant's eye were unclear. The applicant's Petition for Removal was dismissed as reconsideration was the appropriate remedy.

Workers' Compensation Appeals BoardFernando GutierrezSoCal FramingBMHCACE American InsuranceESISInc.ADJ473373ANA 0406381Opinion and Decision
References
Case No. ADJ6778298
Regular
Jul 14, 2010

STEPHANIE KOENIG vs. AT&T MOBILITY, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case involves a petition for removal regarding an applicant's ex parte communication with a Qualified Medical Evaluator (QME) after her psychiatric examination. The defendant argued the applicant's phone call, seeking advice for obsessive thoughts, violated Labor Code section 4062.3, which prohibits ex parte communications with QMEs. The Board majority found the communication was "in the course of the examination" due to its proximity in time and subject matter to the evaluation, thus denying the petition. A dissenting opinion argued the call, initiated six weeks post-examination for emergency advice, fell outside the statutory exceptions.

QMEex parte communicationLabor Code section 4062.3in the course of examinationindustrial injurypsyche injuryqualified medical evaluatorpetition for removalAppeals Boarddissenting opinion
References
Case No. ADJ10045939
Regular
Feb 05, 2016

Raymond Ames vs. Goodman Global, ACE American Insurance Company

This case involves an employer's petition to remove a workers' compensation matter to the Appeals Board for review of an order allowing the applicant to obtain additional Qualified Medical Evaluator (QME) panels. The employer argued that further QME panels were not permitted without a treating physician's determination supporting the disputed body parts injured. The Appeals Board denied the petition, finding the employer failed to demonstrate irreparable harm or significant prejudice. The majority affirmed the judge's order, concluding the record supported further development of disputed body parts. One commissioner dissented, arguing the applicant failed to establish a dispute with a treating physician's report as required by statute.

QME panelpetition for removaldisputed body partsmedical record developmentirreparable harmsubstantial prejudicetreating physicianDWC Rule 31.7Labor Code section 5310WCAB Rule 10843
References
Case No. ADJ9646455
Regular
Nov 01, 2016

AMEENAH HANIFAH vs. CITY AND COUNTY OF SAN FRANCISCO

The WCAB granted reconsideration to amend its prior decision, affirming that the applicant sustained an industrial injury on September 8, 2014. However, the WCAB deferred specific findings on which body parts were injured, remanding this issue to the trial level for further proceedings. The defendant sought reconsideration, arguing the Board erred in reversing the original WCJ's denial of the claim. A dissenting commissioner believed the record did not establish a causal link between the fall and the alleged injuries, highlighting undisclosed prior accidents and lack of contemporaneous medical evidence.

WCABPetition for ReconsiderationOpinion and Decision After ReconsiderationFindings of Fact and Ordertake nothing orderburden of proofindustrial injurymultiple body partsevidentiary recordappropriate weight
References
Case No. ADJ2070973 (SAL 0092454)
Regular
Jun 12, 2015

CHARLENE MEEKS-CLOSE vs. RIVER RANCH FRESH FOODS, SEDGWICK CMS

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration due to untimely service on the applicant's counsel of record. The defendant failed to properly serve the petition, which is a procedural defect that deprives the applicant of due process rights. While one commissioner concurred with the dismissal on procedural grounds, she dissented regarding the merits, arguing the petition should have been granted to develop the record on the permanent disability rating. The majority opinion noted that even if properly served, the petition would have been denied on its merits.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderPermanent DisabilityLife PensionHousekeeping ExpensesMileage ExpensesUnreasonable DelayPenaltyAgreed Medical Evaluator
References
Case No. ADJ7781989
Regular
May 29, 2012

MIRIAN GARCIA vs. COOPER COLD FOODS, INC., ILLINOIS, MIDWEST INSURANCE AGENCY, admin for STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the finding of a 2% permanent disability to the right knee and denying claims for injury to other body parts. The applicant argued the decision lacked substantial medical evidence and that exhibits were wrongly excluded due to an invalid Medical Provider Network. One Board member dissented, believing Dr. Saucedo's report was insufficient as it didn't address activities of daily living or all claimed injuries, recommending further development of the medical record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityIndustrial InjurySubstantial Medical EvidenceMedical Provider Network (MPN)Whole Person Impairment (WPI)Activities of Daily Living (ADLs)Further Development of Medical Record
References
Case No. ADJ8533165
Regular
Mar 08, 2016

Margarito Trujillo vs. Cardenas Markets, Inc.

This case involves a worker claiming industrial injury to multiple body parts. The WCJ initially found injury only to the abdomen but applicant argued other claimed injuries were not addressed. The Appeals Board granted reconsideration to clarify the issues. They are rescinding the WCJ's decision and deferring the determination of injured body parts and the nature/extent of injury for further proceedings at the trial level.

Workers' Compensation Appeals BoardReconsiderationFindings of FactInjury AOE/COELabor Code section 5402Presumption of CompensabilityMandatory Settlement ConferencePre-Trial Conference StatementParts of Body InjuredNature and Extent of Injury
References
Case No. ADJ11039762
Regular
Aug 06, 2018

ALFRED GUILING vs. GODEFELLOW BROTHERS CONSTRUCTION, LLC, AMERICAN CONTRACTORS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration and dismissed their Petition for Removal. The defendant argued the judge's finding of injury to specific body parts was premature and lacked substantial evidence, as the PQME process was incomplete. The Board found removal was inappropriate, as the injury finding is a final order subject to reconsideration. They adopted the WCJ's report, concluding the applicant met their burden of proof for industrial injury to the disputed body parts.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings of Factindustrial injurybody partssubstantial evidencePanel Qualified Medical EvaluationPQMEextraordinary remedy
References
Case No. ADJ6439173
Regular
Jan 19, 2017

JULIETA CEBALLOS vs. SUNVIEW VINEYARDS of CALIFORNIA, WAUSAU INSURANCE COMPANIES

The Workers' Compensation Appeals Board (WCAB) rescinded the original award, finding the primary treating physician's (PTP) report insufficient to establish injury to all claimed body parts. The WCAB also raised concerns about the admissibility of a supplemental PTP report obtained after the Mandatory Settlement Conference without a showing of due diligence. The case is returned to the trial level for further proceedings to adequately address the admitted body parts and develop the record. A dissenting opinion argued the PTP's reports constituted substantial evidence and no further development was needed.

WCABReconsiderationPrimary Treating PhysicianQualified Medical Evaluatorsubstantial evidencePetition for ReconsiderationFindings Orders and AwardMandatory Settlement ConferenceLabor Code Section 5502due diligence
References
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