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

Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ8475421
Regular
Mar 30, 2017

Jessica Duncan vs. Right At Home, Travelers Diamond Bar

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's claim for medical services. The Board found that the lien, filed on June 4, 2016, was barred by the 18-month statute of limitations under Labor Code section 4903.5(a). This was because the last date of service was August 8, 2013, which fell after the July 1, 2013, implementation date of the 18-month rule. The Board also held that it lacked the authority to rule on constitutional vagueness claims.

Labor Code section 4903.5(a)Lien claimStatute of limitationsReconsiderationWorkers' Compensation Appeals BoardWCJTimelinessDate of servicesContinuous treatmentUnconstitutionally vague
References
Case No. ADJ5836855
Regular
Dec 11, 2012

Malory Wheat vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award allowing a lien for living expenses claimed by the CCPOA Benefits Trust Fund. The WCAB held that liens in workers' compensation are strictly statutory and the CCPOA's claim for reimbursement of benefits advanced did not fit within the specific provisions of Labor Code sections 4903 or 4903.1 for "living expenses" or benefits provided by a "self-insured employee welfare benefit plan." The Board clarified that liens for living expenses are intended for those who loan money or extend credit, not for contractual obligations of insurance or benefit plans.

Workers' Compensation Appeals BoardMalory WheatState Compensation Insurance FundCCPOA Benefits Trust Fundlien claimantLabor Code section 4903(c)Labor Code section 4903.1(a)(1)Labor Code section 4903.1(a)(2)Labor Code section 4903.1(a)(3)living expenses
References
Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ4408007 (STK 0205209)
Regular
Sep 20, 2013

CLIAS MONTES vs. TRUEGREEN LANDCARE, ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board dismissed the petition for reconsideration in case ADJ4408007. This dismissal was based on the fact that the Workers' Compensation Judge had already vacated the original Findings and Award on August 1, 2013. Therefore, the petition for reconsideration of the July 26, 2013 decision was rendered moot.

Petition for ReconsiderationMootVacatedFindings and AwardWorkers' Compensation Appeals BoardDismissedJuly 262013August 12013
References
Case No. ADJ8969505
Regular
Sep 08, 2016

BLANCA RUIZ vs. BEST AMERICAN HOSPITALITY, INC., dba CHURCH'S CHICKEN, PMA INSURANCE

This case concerns Tri-County Medical Group's lien for services provided to an applicant between April and August 2013. The Workers' Compensation Appeals Board affirmed the administrative law judge's decision that the lien is barred by Labor Code section 4903.5(a). The Board found that the 18-month limitation period applies to services provided on or after July 1, 2013, and the lien was filed too late. This interpretation ensures a single, non-absurd statute of limitations for services provided after the effective date.

Labor Code section 4903.5lien claimantreconsiderationadministrative law judgefindings and order18-month limitation periodJuly 12013KindelbergerCoachella Valley Mosquito & Vector Control Dist.
References
Case No. ADJ8759866
Regular
Sep 01, 2016

ERNESTINA ESCAMILLA vs. PELICAN PRODUCTS, INC., UNITED STATES FIRE INSURANCE COMPANY

This case addresses a lien claimant's petition for reconsideration of a denied lien. The Workers' Compensation Appeals Board denied the petition, affirming the administrative law judge's finding that the lien was barred by Labor Code section 4903.5(a)'s 18-month limitations period. The Board ruled that because services were provided after July 1, 2013, the lien claimant was obligated to file within 18 months of the last service date, which they failed to do. The Board reasoned that the statute provided reasonable time for filing after its enactment.

Labor Code section 4903.5(a)lien claimantreconsideration18-month limitation periodJuly 12013reasonable timeretroactive applicationproceduralvocational rehabilitation
References
Case No. ADJ9097334
Regular
Apr 25, 2016

CHARLES GELETKO vs. CALIFORNIA HIGHWAY PATROL, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of an award granting applicant benefits, arguing the administrative law judge (WCJ) improperly calculated the applicant's permanent disability. The SIBTF contended the WCJ erred by applying a 1.4 adjustment factor and by adding individual impairments rather than combining them. The Appeals Board granted reconsideration, agreeing with the WCJ's report to affirm the award while correcting a mathematical error, ultimately awarding applicant 82% permanent disability. The Board found the 1.4 modifier applicable under the relevant statute, but upheld the prohibition against using the Combined Values Chart when assessing SIBTF eligibility due to statutory exclusions for age and occupation adjustments.

Subsequent Injuries Benefits Trust FundLabor Code section 4751permanent disability thresholdwhole-person impairmentsection 4660.11.4 modifierCombined Values ChartCalifornia Highway Patrolcumulative trauma injurycardiovascular system
References
Case No. ADJ6822166
Regular
May 27, 2011

Jackie Thompson vs. Los Angeles Unified School District

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior finding that a school district police officer was entitled to a cancer presumption for his prostate cancer. The Board found that while the applicant was a peace officer, his authority was defined by Penal Code section 830.32, not section 830.1 as initially determined. Because Labor Code section 3212.1's cancer presumption specifically lists peace officers defined under certain Penal Code sections and does not include those under 830.32, the applicant is not entitled to the presumption.

Labor Code 3212.1Penal Code 830.32Peace OfficerSchool District Police OfficerCancer PresumptionIndustrial InjuryReconsiderationWCABLaw Enforcement ActivitiesWilliam Dallas Jones Cancer Presumption Act
References
Case No. SAU2262762
Regular
Sep 17, 2019

KEVIN TUCKER vs. E.L. YEAGER CONSTRUCTION CO., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRISTAR RISK MANAGEMENT

This case concerns whether the California Insurance Guarantee Association (CIGA) must pay a medical lien assigned to EDS Financial Services. The Workers' Compensation Appeals Board denied EDS's petition for reconsideration, upholding a prior ruling that issue preclusion bars EDS from relitigating the lien's status as a "covered claim." The Board found that the identical issues of whether the assigned lien constituted a covered claim under Insurance Code section 1063.1 were actually litigated and decided in a previous case, *Wanda Fullylove*. EDS's arguments regarding separate statutory provisions and the nature of assignments were rejected, as prior litigation fully addressed the claim's covered status under CIGA's statutory framework, including the exclusion for assignee claims.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGACovered ClaimIssue PreclusionCollateral EstoppelInsurance Code Section 1063.1(c)(1)(F)Insurance Code Section 1063.1(c)(9)(B)AssigneeLien Claimant
References
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