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

Case No. ADJ6755820, ADJ7231247, ADJ6777953
Regular

NORMA HERNANDEZ vs. KRAGEN AUTO PARTS, ZURICH NORTH AMERICA INSURANCE COMPANY

This case involves a Petition for Removal filed by Norma Hernandez against Kragen Auto Parts and its insurer, Zurich North America. The applicant, Hernandez, subsequently withdrew the petition. Consequently, the Workers' Compensation Appeals Board has dismissed the petition. No further action will be taken on this matter.

Petition for RemovalDismissedWorkers' Compensation Appeals BoardApplicantDefendantKragen Auto PartsZurich North America Insurance CompanyLong Beach District OfficeOrder Dismissing PetitionWithdrawn Petition
References
Case No. ADJ6624821
Regular
Oct 10, 2014

ED WACKERMAN vs. NAPA AUTO PARTS, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted a petition for reconsideration filed by defendant Napa Auto Parts. This action was taken due to statutory time constraints and an initial review of the record, necessitating further study of the factual and legal issues. The WCAB requires more time to thoroughly understand the case and issue a just decision. All future communications regarding this case must be filed in writing directly with the WCAB Commissioners' office, not with any district office or via e-filing.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOPINION AND ORDERADJ6624821Napa Auto PartsEmployers Compensation Insurance CompanyJuly 18 2014statutory time constraintsfactual and legal issuesjust and reasoned decision
References
Case No. ADJ9950339
Regular
Jan 05, 2017

JAMES GARZA vs. OREILLYS AUTO PARTS, CORVEL

The Workers' Compensation Appeals Board (WCAB) denied James Garza's Petition for Removal because it found the WCJ's determination that the orthopedic panel was correct was within the WCAB's jurisdiction. Removal is an extraordinary remedy granted only when substantial prejudice or irreparable harm will result, and reconsideration is an inadequate remedy. The WCAB was not persuaded that these conditions were met. Therefore, the Petition for Removal was denied.

Petition for RemovalMedical Unit PanelOrthopedic PanelJurisdictionSubstantial PrejudiceIrreparable HarmExtraordinary RemedyReconsiderationWorkers' Compensation Appeals BoardWCJ
References
Case No. ADJ10896105
Regular
Mar 22, 2018

MICHAEL GHATTAS vs. O'REILLY AUTO PARTS, SAFETY NATIONAL CASUALTY COMPANY

This case concerns whether an employer must authorize requested medical treatment for a denied workers' compensation claim. The Appeals Board denied the applicant's petition for reconsideration, upholding its prior decision. The Board concluded that the employer's timely denial of the claim under Labor Code section 5402 terminated their responsibility to authorize medical treatment. Therefore, the employer was not obligated to submit the physician's request for authorization (RFA) to utilization review despite it being pending when the denial was issued.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order DenyingDecision After ReconsiderationFindings of Fact Award and OrderRequest for AuthorizationUtilization ReviewLabor Code Section 5402Claim DenialMedical Treatment Authorization
References
Case No. ADJ3133627 (SAL 0114355) ADJ1802214 (SAL 0110847) ADJ3324036 (SAL 0111146)
Regular
Oct 16, 2012

DAVID TANNAHILL vs. SKIP'S AUTO PARTS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, in liquidation, SENTRY INSURANCE COMPANY

This case concerns Sentry Insurance's petition for reconsideration of a previous Appeals Board decision. The Board denied Sentry's petition, upholding its prior ruling that the California Insurance Guarantee Association (CIGA) is entitled to reimbursement for reasonable bill review costs, not the specific $35,152.88 initially claimed. The amount of reimbursement remains to be determined by the workers' compensation judge if the parties cannot resolve it themselves. This decision allows for further development of the evidentiary record to ensure substantial justice.

CIGASkip's Auto PartsSuperior National Insurance CompanySentry Insurance CompanyPetition for ReconsiderationBill Review CostsReimbursementAdministrative Law JudgeOpinion and OrderWorkers' Compensation Appeals Board
References
Case No. ADJ3546267 (LBO 0364744)
Regular
Apr 02, 2013

JOSE ZAVALA vs. CAL-STATE AUTO PARTS, INC., AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA

This order from the Workers' Compensation Appeals Board dismisses Applicant Jose Zavala's Petition for Reconsideration and denies removal. The Board adopted and incorporated the reasoning from the workers' compensation administrative law judge's Report and Recommendation. Therefore, the petition is dismissed, and removal is denied.

WORKERS' COMPENSATION APPEALS BOARDPETITION FOR RECONSIDERATIONDENY REMOVALADMINISTRATIVE LAW JUDGEREPORT AND RECOMMENDATIONDISMISSEDDENIEDADJ3546267LBO 0364744CAL-STATE AUTO PARTS
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. ADJ9927385
Regular
Sep 12, 2016

VAHAK AMIRIAN vs. MERCEDES & BMW AUTO PARTS & DISMANTLING, INCOPRORATED, A CALIFORNIA CORPORATION, UNINSURED

This case involves a defendant, Mercedes & BMW Auto Parts & Dismantling, Inc., seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB denied the petition, upholding the finding that the applicant, Vahak Amirian, was an employee, not a partner, based on a lack of credible evidence of a partnership. The WCAB also affirmed the finding that the defendant willfully failed to maintain workers' compensation insurance, rejecting the defendant's claims of good faith belief they had no employees. The WCAB gave significant weight to the judge's credibility determinations regarding witness testimony.

Workers' Compensation Appeals BoardEmployee vs. PartnerUninsured EmployerLabor Code Section 4554Willful Failure to InsureCredibility DeterminationFindings and AwardPetition for ReconsiderationAdministrative Law JudgeWCJ Report
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. ADJ8134312
Regular
Sep 15, 2016

ERNIE GALLEGOS vs. GROTH BROTHERS CHEVROLET, AUTO DEALERS COMPENSATION OF CALIFORNIA, CORVEL

The applicant sustained a right knee injury, leading to a total knee replacement. The original award granted permanent disability without apportionment, which the defendant appealed. The Appeals Board granted reconsideration, finding that apportionment to pre-existing knee conditions was legally permissible even after total knee replacement. The case is remanded for a new award based on the Qualified Medical Evaluator's 50% apportionment to pre-existing pathology. A dissenting opinion argues the medical evidence lacked sufficient reasoning to support apportionment.

WORKERS' COMPENSATION APPEALS BOARDERNE GALLEGOSGROTH BROTHERS CHEVROLETAUTO DEALERS COMPENSATION OF CALIFORNIACORVELADJ8134312PETITION FOR RECONSIDERATIONFINDINGS AND AWARDPERMANENT DISABILITYAPPORTIONMENT
References
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