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

Case No. MON 262132
Regular
May 01, 2008

MARLENE FIGUEROA vs. TOM H. TOVOULARIS, M.D., INC., FIREMAN'S FUND INSURANCE CO.

This case involves a lien claimant, Intercommunity Medical Group (IMG), seeking reconsideration of an order holding them liable for unnecessary litigation costs and sanctions. IMG argued they filed in good faith, the defendant waived objections, and informal resolution was not attempted. The Appeals Board denied IMG's petition, finding their Declaration of Readiness contained false statements and that their service of the petition was improperly executed.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationDeclaration of ReadinessWCJSanctionsInformal ResolutionProof of ServiceJudicial AuthorityAdministrative Law Judge
References
Case No. ADJ9776185
Regular
Jun 18, 2015

MICHAEL WAUGH vs. VALVOLINE INSTANT OIL CHANGE, LIBERTY MUTUAL INSURANCE COMPANY

The Appeals Board denied the applicant's petition for removal, which sought to rescind a notice of intention to dismiss his petition for deposition attorney fees. The judge intended to dismiss the fee petition for failing to show good faith efforts at informal resolution before filing. While no rule mandates such pre-filing efforts, the Board found the applicant failed to demonstrate substantial prejudice or irreparable harm from the notice itself, as no formal order had yet been issued. Therefore, the petition for removal was denied.

Petition for RemovalNotice of Intention to DismissDeposition Attorney FeeLabor Code § 5710Good Faith EffortsInformal ResolutionSubstantial PrejudiceIrreparable HarmWCAB Rule 10843(a)Order Allowing Attorney Fees
References
Case No. ADJ1009271 (AHM 0055424)
Regular
Apr 27, 2009

MYRNA PEREZ vs. FIDELITY FEDERAL BANK, TIG SPECIALTY INSURANCE CO., REM, LTD, GOLDEN EAGLE

This case concerns a contribution dispute between two insurance carriers, TIG and Golden Eagle, for a cumulative trauma injury claim. Golden Eagle sought reconsideration of an order compelling it to pay over $\$101,000$ in contribution to TIG. Golden Eagle argued it was never properly served with a notice of intention and that Labor Code section 5275 mandates arbitration for contribution disputes. The Appeals Board agreed that mandatory arbitration applies, rescinded the order, and remanded the case for either informal resolution or arbitration.

Workers' Compensation Appeals BoardOrder of ContributionPetition for ReconsiderationLabor Code section 5275mandatory arbitrationContributionCumulative Trauma InjuryCompromise and Release AgreementPetition for ContributionNotice of Intention
References
Case No. ADJ10393903
Regular
Jan 07, 2019

LOS ANGELES UNIFIED SCHOOL DISTRICT vs. SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) granted the applicant's Petition for Reconsideration concerning a prior finding that required the applicant to seek medical treatment within the defendant's Medical Provider Network (MPN). Subsequently, the parties informed the WCAB that they had reached a resolution on the issue. Therefore, the WCAB has rescinded the prior Findings and Order and returned the matter to the WCJ for further proceedings, should the parties fail to finalize their resolution. This decision is not a final determination on the merits of the case.

Petition for ReconsiderationMedical Provider NetworkFindings and OrderWorkers' Compensation Appeals BoardAdministrative Law JudgeRescindedReturned to WCJPermissibly ServicePermittingSedgwick Claims Management Services
References
Case No. ADJ6542776
Regular
Jun 22, 2012

CARLOS LOPEZ vs. R AND M PACIFIC RIM INC., STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, former counsel Leo H. Hernandez, seeking reconsideration of an approved $\$75,000$ compromise and release. The claimant argued his attorney fee lien was dismissed and he was entitled to a share of the awarded $15\%$ fee. The Workers' Compensation Appeals Board dismissed the petition, finding the claimant was not aggrieved as the WCJ retained jurisdiction over lien claims. The Board clarified that the claimant could proceed with a Declaration of Readiness to Proceed to resolve the fee division if no informal agreement is reached.

Workers' Compensation Appeals BoardPetition for ReconsiderationCompromise and ReleaseLien claimantAttorney feesDivision of feesWCJ ReportDeclaration of Readiness to ProceedDue processLabor Code sections
References
Case No. ADJ3540065 (SAC 0361552)
Regular
Jan 23, 2017

BRADLEY MAXHAM vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted the defendants' Petition for Removal, rescinding a prior WCJ order. The Board clarified that "information" provided to an Agreed Medical Evaluator (AME) includes treating physician records and relevant medical/non-medical records. A communication becomes "information" if it contains, references, or encloses such records. The case was returned for further proceedings to determine if applicant's letters to the AMEs improperly conveyed "information" without party agreement.

Agreed Medical EvaluatorInformationCommunicationLabor Code Section 4062.3Petition for RemovalEn Banc DecisionWorkers' Compensation Appeals BoardPrejudiceIrreparable HarmSubstantial Evidence
References
Case No. MON 284627
Regular
Aug 11, 2008

BEVERLY DE ROSA vs. STATE OF CALIFORNIA

The Workers' Compensation Appeals Board granted reconsideration to review a sanctions order against the defendant for alleged willful failure to comply with a prior order. The defendant's claims adjuster asserted they had provided the required earnings information within the deadline, which conflicted with the initial finding of non-compliance. The Board rescinded the sanctions and returned the case for further proceedings to determine whether the defendant actually complied with the order.

Workers' Compensation Appeals BoardBeverly De RosaState Compensation Insurance FundLabor Code section 5813willful failure to complySupplemental Findings and Order Imposing Sanctionsapplicant's earningscervical spinepsychestipulated Findings and Award
References
Case No. ADJ3540065
En Banc
Jan 23, 2017

BRADLEY MAXHAM vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board clarifies the distinction between "information" and "communication" under Labor Code § 4062.3, holding that a communication to a medical evaluator becomes "information" if it contains, references, or encloses medical or nonmedical records relevant to the medical issue, which requires prior agreement between the parties.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical Evaluator (AME)Labor Code section 4062.3WCAB Rule 35informationcommunicationprejudiceirreparable harmex parte communication
References
Case No. ADJ8796181
Regular
Sep 20, 2013

JEFFREY HORDWEDEL vs. COUNTY OF LOS ANGELES

The Appeals Board dismissed the applicant's petition for reconsideration as it challenged an interim order, not a final decision. Removal was granted because the WCJ's denial of the applicant's petition to strike an IME report, based on procedural grounds, could cause significant prejudice. The case is returned to the trial level for a hearing to determine whether the dispute resolution agreement requires the Labor-Management Committee to address the applicant's ex parte communication claims first, or if the WCAB should proceed on the merits of the petition. The WCJ will then issue a decision based on the developed record.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWorkers' Compensation Administrative Law JudgePetition to Strike IME Medical-Legal ReportLabor-Management Workers' Compensation Dispute Resolution AgreementIndependent Medical ExaminerEx Parte CommunicationLabor Management CommitteeScope of Agreement
References
Case No. ADJ3540065
Significant

Bradley Maxham, Applicant vs. California Department of Corrections and Rehabilitation, State Compensation Insurance Fund

The Appeals Board granted the employer's petition for removal, holding that a 'communication' to an Agreed Medical Evaluator (AME) can be considered 'information' under Labor Code § 4062.3 if it contains, references, or encloses medical or non-medical records, and returned the matter to the trial level for reassessment.

RemovalPetition for RemovalAgreed Medical EvaluatorAMELabor Code § 4062.3WCAB Rule 35InformationCommunicationAdvocacy LetterSubstantial Evidence
References
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