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

Case No. LBO 0374533
Regular
Jul 02, 2008

, Applicant, ALYCE WENTZ vs. , Defendant(s). ST. MARY MEDICAL CENTER; PERMISSIBLY SELF-INSURED adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a dispute over the calculation of permanent disability indemnity in a workers' compensation claim. The employer sought reconsideration of an award that incorrectly calculated the total indemnity based on the maximum rate instead of the applicant's specific rate. The Appeals Board granted the employer's petition, correcting the total indemnity amount to $89,575.64 while affirming the permanent disability rating and life pension.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityIndemnityLife PensionNursing AssistantIndustrial InjurySt. Mary Medical CenterSedgwick Claims Management Services
References
0
Case No. POM 0281587
Regular
May 02, 2008

ALINDA YELLOWHAIR vs. HAIR MASTERS, THE HARTFORD, SPECIALTY RISK SERVICES (Adjusting Agent)

The Workers' Compensation Appeals Board granted reconsideration to correct a prior award that improperly included disability from an admitted non-industrial shoulder injury. The Board reduced the applicant's permanent disability rating from 24% to 16% by removing the shoulder component and found that the defendant failed to meet the burden of proof for apportioning head and neck injury disability due to a subsequent motor vehicle accident. Consequently, the award for permanent disability indemnity was adjusted to reflect the 16% rating.

Workers' Compensation Appeals BoardPermanent DisabilityReconsiderationApportionmentQualified Medical EvaluatorIndustrial InjuryNon-Industrial AccidentSubstantial EvidenceMedical OpinionCausation
References
6
Case No. ADJ7978937
Regular
Aug 26, 2014

KATHERINE JAMES vs. STATE OF CALIFORNIA, CSP KINGS COUNTY AT CORCORAN, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The Appeals Board granted reconsideration and amended the original award, admitting defendant's Exhibit E and adjusting the temporary disability indemnity rate. While affirming the finding of a psychiatric injury, the Board rescinded all penalties and sanctions previously awarded. Defendant's assertion of a good faith personnel action defense was deemed reasonable, thus precluding penalties for delayed payment. Temporary disability amounts are to be adjusted by the parties, with jurisdiction reserved for future disputes.

Workers' Compensation Appeals BoardReconsiderationPsychiatric InjuryGastrointestinal SystemDepressionAnxietyPanic AttacksLoss of AppetiteTemporary DisabilityPenalties
References
14
Case No. ADJ7054442
Regular
Jan 11, 2013

JARRAD JELSMA vs. WINE GROUP, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Board denied the defendant's petition for reconsideration of the WCJ's award of temporary disability indemnity. The defendant failed to demonstrate due diligence in producing a wage statement discovered after trial, which it claimed would lower the indemnity rate. While denying reconsideration of the retroactive award, the Board allowed the defendant to petition to reopen the award to prospectively adjust the temporary disability indemnity rate based on the disputed wage statement. The Board also denied credit to the defendant for any retroactive overpayment of temporary disability indemnity.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAverage Weekly EarningsTemporary Disability IndemnityWage StatementDue DiligenceNewly Discovered EvidenceReopen AwardRetroactive Overpayment
References
0
Case No. MISSING
Regular Panel Decision

Anthony L. Jordan Health Corp. v. Axelrod

The Anthony L. Jordan Health Center, a not-for-profit corporation, challenged the New York State Department of Health's recalculation of its Medicaid reimbursement rates for the 1983-1984 and 1984-1985 periods. Following an appeal, the parties entered into a stipulation agreement. However, the Department, while recalculating the rates in accordance with the stipulation, unilaterally changed the group composition, resulting in a significant negative adjustment and recoupment from Jordan. The court determined that this regrouping constituted an 'error of judgment,' not a permissible correction for mathematical error or an audit finding. Consequently, the court found that the Department did not have the right to retroactively adjust the rates based on this discretionary change. The petition was granted.

Medicaid ReimbursementRate RecalculationAdministrative ReviewStipulation AgreementError of JudgmentGroup CompositionRetroactive AdjustmentHealth Care LawJudicial ReviewDepartment of Health
References
5
Case No. ADJ4173733 (GRO 0033459) ADJ7235201
Regular
May 08, 2014

DONALD LUTES vs. NEW WEST COOLING, INC., STATE COMPENSATION INSURANCE FUND

This case involved an appeal by SCIF regarding permanent disability indemnity rates. The WCJ initially awarded $230/week for both case numbers, but SCIF argued the 2004 injury date in ADJ4173733 limited the rate to $200/week. The WCJ acknowledged this oversight and recommended the amendment. The Appeals Board granted reconsideration, affirming the award but amending the indemnity rate for ADJ4173733 to $200/week, totaling $18,100, and adjusting attorney fees accordingly.

Petition for ReconsiderationJoint Findings and AwardPermanent DisabilityIndustrial InjuryWorkers' Compensation Appeals BoardWCJState Compensation Insurance FundDate of InjuryPermanent Disability IndemnityAttorney Fees
References
0
Case No. ADJ3483133 (LBO 0389333)
Regular
Jan 31, 2011

GENE BROWN vs. PEPSI BOTTLING GROUP, OLD REPUBLIC

In this case, the defendant sought reconsideration of an award finding a left shoulder injury and $12\%$ permanent disability for the applicant, Gene Brown. The core dispute involved a clerical error in the permanent disability indemnity rate, which was initially awarded at $\$270.00$ per week instead of the correct statutory rate of $\$230.00$. While the WCJ amended the award to correct the indemnity rate, this correction did not proportionately adjust the attorney fees. The Appeals Board granted reconsideration, rescinded both the original and amended decisions, and returned the matter to the trial level for recalculation of attorney fees and a new decision.

Permanent disability indemnityReconsiderationClerical errorIndemnity rateAmended Findings and AwardLabor Code sections 4658(d)Labor Code sections 4660(d)Offer of modified workAttorney feesWorkers' Compensation Appeals Board
References
0
Case No. ADJ3458168 (OAK 0347004)
Regular
Dec 09, 2011

JOSEPH BULGO vs. ALCATEL-LUCENT, LIBERTY MUTUAL INSURANCE COMPANY

This case involves a dispute over permanent disability benefits for an applicant who sustained industrial injuries to his bilateral upper extremities and cervical spine. The original award found 73% permanent disability, but both applicant and defendant sought reconsideration. The applicant argued the indemnity and life pension rates were incorrectly calculated and the award failed to address Labor Code section 4658(d) adjustments. The defendant contended the 73% rating was too high by including upper extremity strength loss. The Appeals Board granted reconsideration for the applicant, rescinded the original award, and deferred the issues of permanent disability rate, life pension, section 4658(d) adjustment, and attorney fees for further proceedings at the trial level, while denying the defendant's reconsideration request.

ALCATEL-LUCENTLIBERTY MUTUAL INSURANCE COMPANYWORKERS' COMPENSATION APPEALS BOARDFINDINGS AND AWARDRECONSIDERATIONPERMANENT DISABILITYBILATERAL UPPER EXTREMITIESCERVICAL SPINELABOR CODE SECTION 4658(d)LIFE PENSION
References
2
Case No. ADJ7754087
Regular
Jun 20, 2014

SUSAN WILLIAMS vs. CITY OF WEST COVINA, Permissibly Self-Insured, Adjusted By CORVEL

This case concerns a workers' compensation claim where the applicant sustained an industrial injury to her psyche. The defendant sought reconsideration, arguing the permanent disability indemnity rate was incorrectly calculated and requesting sanctions for discovery non-compliance. The Appeals Board granted reconsideration to correct a clerical error in the weekly indemnity rate, reducing it from $270.00 to $230.00, but otherwise affirmed the original award. The Board denied the request for sanctions, finding the defendant failed to present evidence to support their petition.

Workers' Compensation Appeals BoardPublic Information OfficerIndustrial InjuryPsychePermanent DisabilityWeekly RateClerical ErrorPetition for ReconsiderationPetition for SanctionsDiscovery
References
2
Case No. ADJ11816386
Regular
Nov 03, 2020

KRISTINA JONES vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, legally uninsured, administered by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to amend a prior decision, affirming the award of temporary total disability. The amended decision clarifies that the temporary disability indemnity rate is to be adjusted by the parties based on a stipulated monthly earnings of approximately $7,855.65. Jurisdiction is reserved at the trial level to resolve any disputes regarding the indemnity rate. The original award of temporary disability for the period found remains affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWorkers' Compensation Administrative Law JudgeTemporary Disability Indemnity RateStipulation of EarningsJudicial EfficiencyIndemnity Rate AdjustmentJurisdiction ReservedLabor Code Section 4656(c)(2)Petition to Terminate
References
0
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