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

Case No. ADJ1078163 (BAK 0145426), ADJ3341185 (SJO 0254688)
Significant
Feb 03, 2009

Mario Almaraz, Joyce Guzman vs. Environmental Recovery Services (a.k.a. ENVIROSERVE), State Compensation Insurance Fund, Milpitas Unified School District, Permissibly Self-Insured, Keenan & Associates, Adjusting Agent

The Appeals Board held that the AMA Guides portion of the 2005 Schedule for Rating Permanent Disabilities is rebuttable by showing that an impairment rating based on the AMA Guides would be inequitable, disproportionate, and not a fair and accurate measure of the employee’s permanent disability.

AMA Guidesrebuttable presumptionpermanent disability rating2005 Scheduleimpairment determinationmedical opinionevidentiary standardequitable awardvocational specialistsactivities of daily living
References
61
Case No. ADJ124002
Regular
Apr 21, 2011

RAMON RUIZ vs. DOLE FRESH VEGETABLES, SPECIALTY RISK SERVICES

The Appeals Board granted reconsideration and modified a prior award regarding temporary disability overpayments. Defendant sought credit for temporary disability paid during the applicant's off-season and after the permanent and stationary date. The Board denied credit for off-season payments, finding them inequitable. However, credit was allowed for temporary disability paid after the permanent and stationary date, recognizing these payments as advances against permanent disability.

ADJ124002Findings Order AwardPermanent DisabilityTemporary DisabilityCredit for OverpaymentOff-Season EmploymentPermanent and Stationary DateLabor Code 4909Equitable PrinciplesDouble Recovery
References
1
Case No. ADJ4356161 (AHM 0116063)
Regular
Jul 22, 2010

CHARLES OLIVER vs. CITY OF COSTA MESA, Permissibly Self-Insured, Administered By CORVEL

The Workers' Compensation Appeals Board denied reconsideration of a decision that denied additional attorney's fees to a lien claimant. The applicant's attorney sought fees on retroactive Labor Code § 4850 benefits paid to the applicant, but the Board found no clear notice was given to the defendant before those benefits were paid and credited. Because the defendant had no reasonable opportunity to withhold fees and the benefits were primarily credits, it would be inequitable to award them now.

Labor Code § 4850Police OfficerSelf-InsuredReconsideration DeniedAttorney's FeesStipulated AwardDeferred IssueTemporary Total DisabilityNoticeLien Claimant
References
13
Case No. ADJ4045682 (BAK 0131878), ADJ2806318 (BAK 0143903), ADJ6769921
Regular
Nov 29, 2010

BILL DUNEHEW vs. DON KEITH TRANSPORTATION, CENTRAL CARTAGE COMPANY, AARLA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant sought credit for permanent disability advances paid for one injury against benefits owed for a separate injury. The Board affirmed its prior decision, declining to exercise its discretion under Labor Code section 4909 to allow such a credit, finding it inequitable. A commissioner dissented, advocating for reconsideration and reinstatement of the administrative law judge's original findings.

Workers' Compensation Appeals BoardPermanent Disability AdvancesCredit for PaymentsEquitable DoctrineEstoppelUnjust EnrichmentLabor Code Section 4909Discretionary StatuteSeparate InjuryReconsideration Denied
References
2
Case No. ADJ8860499
Regular
Aug 22, 2014

ANA BARILLAS vs. CELLAR MASTERS, INC., SECURITY NATIONAL INSURANCE, ZURICH AMERICAN INSURANCE

The Appeals Board granted Zurich's petition for reconsideration to correct an inequitable administrative appointment. Initially, the WCJ ordered Zurich, covering only 9% of liability, to administer the cumulative trauma award, which the Board found to be an abuse of discretion. The Board amended the decision to assign administration to Security National Insurance, which covered 91% of the liability, with Zurich having a right of contribution. Additionally, the Board corrected a clerical error to defer attorney fees.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryCumulative TraumaTemporary DisabilityJoint and Several LiabilityContributionAdministrator of AwardProportionate Share of Liability
References
2
Case No. ADJ5765976
Regular
Jun 21, 2010

JAMES KOGEL vs. METAL SIDING AND ROOFING, INC., SCIF

In this workers' compensation case, the defendant sought reconsideration of a prior ruling denying them a credit for temporary disability overpayments against the applicant's permanent disability award. The defendant argued they were entitled to the credit due to payments exceeding the statutory limit. However, the Board denied the petition, finding that allowing the credit would be inequitable and potentially prejudice the applicant. The Board also noted that since the permanent disability had already been paid, there were no outstanding benefits for the credit to be applied against.

Temporary disability overpaymentPermanent disability creditLabor Code section 4656WCJ discretionEquitable principlesIntentional overpaymentGood faith benefitsDisruption of benefitsPrejudice to employeeFindings and Order
References
3
Case No. ADJ7878653, ADJ7060658
Regular
May 13, 2013

DONALD LUMB vs. CITY OF CHULA VISTA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration, amending two prior Findings and Awards. The WCAB allowed the defendant, City of Chula Vista, a credit of $2,499.73 for an overpayment of permanent disability indemnity in a specific injury case against indemnity owed in a cumulative trauma injury case. This decision overturned the original finding that such a credit would be inequitable. The WCAB determined the credit was permissible as the overpayment amount was small and would not significantly interrupt applicant's benefits.

Cumulative traumaSpecific injuryPermanent disability indemnityOverpaymentCreditApportionmentAgreed Medical EvaluatorPrimary treating physicianFindings and AwardPetition for Reconsideration
References
5
Case No. ADJ11061012
Regular
Aug 28, 2019

MARACHELLE JACKSON vs. DOOR TO HOPE, LWP CLAIMS

Applicant sought reconsideration of an order approving a $95,000 compromise and release, claiming she was pressured into signing due to a mental health crisis and misinformation. The Board dismissed the petition as untimely, noting the lack of proof of service for the original order. However, the Board remanded the case to the WCJ to determine if the applicant's allegations constitute good cause to set aside the compromise and release. This involves evaluating whether the settlement was secured by fraud, mistake, duress, or undue influence, rendering it inequitable.

Compromise and ReleasePetition for ReconsiderationWCABAdministrative Law JudgeIndustrial InjuriesNeck InjuriesWrist InjuriesHand InjuriesArm InjuriesHead Injuries
References
13
Case No. ADJ7895581
Regular
Feb 01, 2013

RAVEENA WATERS vs. HOMETOWN BUFFET, ACE AMERICAN INSURANCE COMPANY

The applicant sought reconsideration of a finding regarding her average weekly earnings (AWE) in a workers' compensation case. The WCJ initially calculated AWE based on one year of actual earnings, which applicant argued was inequitable due to a significant increase in her income from concurrent employment in the final months before her injury. The Board granted reconsideration, rescinded the previous order, and returned the case for a new decision. This was because averaging the entire year's earnings did not accurately reflect her earning capacity due to a recent, substantial increase in hours and income from her other job.

Workers' Compensation Appeals BoardRaveena WatersHometown BuffetAce American Insurance CompanyAverage Weekly Earnings (AWE)Cumulative InjuryRight WristElbowLeft WristConcurrent Employment
References
4
Case No. ADJ8531799
Regular
Aug 14, 2013

ELIZABETH JANIAK HOLCOMB vs. COUNTY OF YUBA

This case involves a defendant's petition for reconsideration regarding the timeliness of an applicant's workers' compensation claim. The Administrative Law Judge (ALJ) denied reconsideration, finding that the applicant's testimony regarding non-receipt of a crucial denial letter rebutted the presumption of delivery. The ALJ also determined that, despite the denial letter's content, the defendant's continued interaction with the applicant and lack of clear notice of the statute of limitations made it inequitable to bar the claim. The Workers' Compensation Appeals Board adopted and incorporated the ALJ's report, denying the petition.

WORKERS' COMPENSATION APPEALS BOARDCOUNTY OF YUBAYORK RISK SERVICES GROUPINC.ADJ8531799Petition for ReconsiderationWorkers' Compensation Administrative Law JudgeGarza v. Workmen's Comp. Appeals Bd.Case ManagerPsyche
References
2
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