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

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ9625407
Regular
Sep 12, 2018

KEITH FIELD vs. CITY OF PINOLE

This case involves a firefighter who sustained bilateral carpal tunnel syndrome after retirement. The Appeals Board reversed the trial judge, holding that Labor Code section 4458.5 applies, entitling the applicant to permanent disability benefits calculated at the maximum indemnity rate. This applies regardless of the applicant's actual earnings or the fact that carpal tunnel syndrome is not a specifically enumerated presumptive injury. The case is remanded for determination of the precise date of injury to calculate the benefit rate.

Workers' Compensation Appeals BoardKeith FieldCity of PinolePermissibly Self-InsuredMunicipal Pooling AuthorityADJ9625407Opinion and Decision After Reconsiderationindustrial injuryfirefighterbilateral upper extremities
References
Case No. ADJ864227 (LBO 350573) ADJ1635667 (LBO 350607)
Regular
Dec 29, 2008

LUIS ECHEVARRIA vs. FALCON WEST, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and reversed the trial judge's award of attorney's fees under Labor Code section 5814.5. The Board reasoned that section 5814.5 requires an award of attorney's fees to be "in addition to" increased compensation under section 5814, which was not sought or awarded here. Furthermore, the Board found that any delay in payment was not unreasonable due to a good-faith dispute over the net settlement amount.

WORKERS' COMPENSATION APPEALS BOARDLUIS ECHEVARRIAFALCON WESTINC.STATE COMPENSATION INSURANCE FUNDADJ864227ADJ1635667OPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONFindings and Orders
References
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
Case No. MON 0311613
Regular
Aug 05, 2008

YURIKO OGAWA vs. CEDARS SINAI HEALTH SYSTEMS

This case concerns the defendant's unreasonable delay in paying a March 2007 stipulated workers' compensation award, specifically the attorney fees portion. The Appeals Board granted reconsideration, finding that attorney fees under Labor Code Section 5814.5 are permissible for enforcing the payment of penalties on delayed attorney fees. The matter is returned to the trial level for further proceedings to determine a reasonable amount of Section 5814.5 attorney fees, as the initial request was deemed potentially excessive.

Workers' Compensation Appeals BoardYuriko OgawaCedars Sinai Health SystemsFindings and AwardStipulated AwardLabor Code section 5814(b)10% penaltysection 5814section 5814.5attorney fees
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ4012402 (LAO 0862279)
Regular
Oct 20, 2011

DAVID RANGEL vs. COLE WILSON, INC.; ADMINISTAFF COMPANIES, INC.; SPECIALTY RISK PLEASANTON; CHARTIS COSTA MESA

The Workers' Compensation Appeals Board denied defendant's and applicant's petitions for reconsideration and granted the lien claimant's. The Board affirmed the original award, which found industrial injury to the applicant's right knee and back, awarded temporary and permanent disability, and imposed penalties for the employer's uninsured status and unreasonable delay in payments. However, the Board amended the award to allow the lien claimant's claim for $1,000 in living expenses.

ADJ4012402LAO 0862279Cole Wilson Inc.Adminstaff Companies Inc.Specialty Risk PleasantonChartis Costa MesaDavid RangelWorkers' Compensation Appeals BoardWCJFindings and Award & Order
References
Case No. ANA 0393385
Regular
Dec 14, 2007

JERRY MADRID vs. CITY OF ANAHEIM, Permissibly Self-Insured

The Workers' Compensation Appeals Board granted reconsideration, rescinding a prior award. The Board found that applicant's claims for penalties under Labor Code section 5814 were barred by subdivision (c) because penalties accrued prior to settlement and were not expressly excluded. Consequently, the Board also denied a section 5813 attorney fee, as there was no finding of bad faith.

Labor Code section 5814unreasonable delaypenaltymedical treatmentlien claimantStipulations With Request for AwardLabor Code section 5813attorney feestreating physicianpre-designation
References
Case No. ADJ3724129 (VNO 0414129) ADJ1154072 (VNO 0414130)
Regular
Oct 15, 2012

William Young vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied William Young's petition for reconsideration, upholding a judge's decision to deny penalties for the City of Los Angeles' delay in authorizing spinal surgery. The Board agreed that Labor Code section 5814(c) barred the penalty claim due to applicant's failure to properly preserve the issue. While a concurring opinion found the defendant's 32-month delay and failure to comply with statutory obligations sanctionable under Labor Code section 5813, the majority denied reconsideration. Therefore, the applicant's request for sanctions and attorney fees was ultimately unsuccessful.

Labor Code section 5814(c)unreasonable delayspinal surgerypenaltyLabor Code section 5813attorney feesLabor Code section 5814.5Petition for ReconsiderationJoint Findings and OrderWCJ
References
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