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

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. 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. ADJ12315169
Regular
Sep 10, 2019

Gregory Williams vs. Redwood Electric Group, Travelers Property Casualty Company of America

The Appeals Board affirmed an Arbitrator's finding that an electrician's injuries, potentially from electrocution, arose out of employment. Despite the unwitnessed nature of the injury and lack of direct evidence on the precise cause, the Board applied the *Clemmens* doctrine, creating a presumption that the injury occurred in the course of employment when the employee is placed at the location by the employer. Circumstantial evidence, including entry and exit wounds and the active construction site environment, supported the industrial nature of the injury. The defendant's arguments regarding the neutral risk doctrine, burden of proof, and denial of due process were found unpersuasive or waived.

Workers' Compensation Appeals BoardRedwood Electric GroupTravelers Property Casualty Company of AmericaJourneyman Electricianupper and lower extremitiesbody systemskinkidneysheartbrain
References
Case No. ADJ4359205
Regular
Aug 07, 2013

HECTOR GONZALEZ vs. DIMAS ERNESTO RAMOS, BZZZ CONSTRUCTION, STATE COMPENSATION INSURANCE FUND, PACIFIC SPECIALTY INSURANCE COMPANY, TRISTAR RISK MANAGEMENT

This case concerns a petition for reconsideration in a workers' compensation matter where the applicant, Hector Gonzalez, claimed injury while working on a construction project. The defendant, Dimas Ernesto Ramos, contested that he was the employer, arguing Gonzalez was an independent contractor or a residential employee. The Administrative Law Judge found Ramos to be the employer based on extensive contradictions in Ramos's testimony and the credible testimony of others, establishing an employer-employee relationship. The Workers' Compensation Appeals Board denied the petition for reconsideration, upholding the WCJ's findings and giving them great weight.

WCABPetition for ReconsiderationWCJ reportcredibility findingGarza v. Workmen's Comp. Appeals Bd.construction projectbuilder-ownerlicensed general contractorBZZZ ConstructionState Compensation Insurance Fund
References
Case No. ADJ9429450
Regular
Nov 01, 2016

MARTHA SOLTERO vs. DEPARTMENT OF SOCIAL SERVICES / IHSS, YORK SERVICES

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding the administrative law judge's decision. The Board found that the employee's claim was not barred by the statute of limitations because the employer failed to provide legally adequate notice of her rights in a language she understood. Additionally, the Board affirmed that the employee's injury sustained while moving furniture at a client's request arose out of and occurred in the course of her employment. The decision emphasizes the employer's burden to prove statute of limitations defenses and the liberal construction of employment-related injury definitions in favor of the employee.

Workers Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5405Statute of LimitationsIn-home caregiverMoving furnitureClient requestSpanish language noticeUnintelligible translationTolling of statute
References
Case No. ADJ7447702
Regular
Nov 04, 2018

RONALD PANTUS, Deceased vs. GET'ER DONE TRUCKING, STATE COMPENSATION INSURANCE FUND

This case concerns a deceased truck driver whose dependent son was injured and incapacitated in the same accident. The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding the administrative law judge's award of lifetime dependency benefits to the son. The Board found that Labor Code section 3501(a) does not require pre-existing incapacity but rather incapacity at the time of the parent's death-causing injury. The Board also emphasized the liberal construction of workers' compensation laws and rejected the defendant's attempt to introduce fault-based arguments.

Workers' Compensation Appeals BoardGet'Er Done TruckingState Compensation Insurance FundRonald PantusJacob Pantuslifetime dependency benefitsLabor Code section 3501(a)incapacitated from earningtraumatic brain injuryfindings award order
References
Case No. SAL 0113062
Regular
Jan 02, 2008

, Maria LOURDES TAPIA, vs. REGENT ASSISTED LIVING, ALASKA NATIONAL INSURANCE

The Workers' Compensation Appeals Board denied reconsideration of a decision upholding a 24-visit limit for chiropractic treatment per industrial injury. The applicant argued that the statutory cap conflicted with the liberal construction mandate of Labor Code section 3202, but the Board found no ambiguity in the clear language of Labor Code section 4604.5(d)(1). The Board further clarified that the provision allowing employers to authorize additional visits in writing (LC 4604.5(d)(2)) did not remove the cap, nor did it render chiropractors meaningless within the workers' compensation system.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Section 4604.5(d)(1)chiropractic visitsoccupational therapyphysical therapyLiberal constructionLabor Code Section 3202employer authorizationFindings & Order
References
Case No. ADJ1622633
Regular
Apr 04, 2011

SALVADOR CONTRERAS vs. M&C FARM LABOR, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE PASADENA, PAULA INSURANCE

This case involved an applicant seeking to reopen his workers' compensation claim due to new and further disability. The WCAB denied reconsideration, upholding the WCJ's decision that the applicant's petition to reopen was barred by the five-year statute of limitations. This was because the petition was improperly filed in the wrong district office, violating WCAB rules requiring filing in the office with venue. Despite the applicant's pro se status and his argument for liberal construction, the majority found no alleged excusable neglect and thus upheld the dismissal. A dissenting opinion argued that the applicant's actions demonstrated mistake and excusable neglect, and that the WCAB should have excused the procedural error to allow a hearing on the merits.

Petition to ReopenStatute of LimitationsLabor Code Section 5410Labor Code Section 5804WCAB Rule 10390WCAB Rule 10450Proper VenueDistrict Office FilingMistakeInadvertence
References
Case No. ADJ9419247
Regular
Aug 09, 2016

GUADALUPE ALVAREZ vs. CITY WALL CONSTRUCTION, THE HARTFORD INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a prior order finding the applicant was not an employee of City Wall Construction. The applicant claimed a work injury to his back and foot, but the judge found his testimony regarding employment lacked credibility against the defendant's consistent testimony. The Board also rejected the applicant's request to reopen based on newly discovered evidence, as he failed to demonstrate due diligence in discovering and presenting this information at trial. Therefore, the applicant did not meet his burden of proof to establish an employer-employee relationship.

Workers' Compensation Appeals BoardGuadalupe AlvarezCity Wall ConstructionThe Hartford Insurance CompanyADJ9419247denial of reconsiderationindustrial injuryconstruction workeremployment statusnewly discovered evidence
References
Case No. ADJ10962119; ADJ11023301
Regular
Jul 10, 2018

OSCAR RENDEROS vs. SEA BREEZE CONSTRUCTION, WESCO INSURANCE, AMTRUST FINANCIAL SERVICES

The Workers' Compensation Appeals Board denied reconsideration of a decision finding the applicant's claim was not barred by the statute of limitations. The Board deferred to the Administrative Law Judge's (WCJ) credibility determination, finding no substantial evidence to reject it. The employer's letter stating they would "administratively close" the file was not deemed a denial of the claim, thus not triggering the statute of limitations. The WCJ found the employer failed to adequately inform the applicant of his rights after receiving the DWC-1 form.

WCABPetition for ReconsiderationStatute of LimitationsDWC-1 Claim FormAOE/COECredibility DeterminationLabor Code §5405Notice of RightsIndustrial InjuryClaims Administrator
References
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