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

Case No. ADJ2109115; ADJ3790194; ADJ4103411
Regular
Aug 01, 2013

LETICIA BENAVIDES vs. BON APPETIT DANISH; MACY'S; CHUBB GROUP OF INSURANCE CO.

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought penalties and attorney fees for the late payment of a Compromise and Release (C&R) settlement, alleging Chubb Group failed to make timely and correct payment. The Board found that the delay was due to a single instance of human error involving an incorrect address on the C&R, which was promptly corrected upon discovery. The applicant also contributed to the delay by not notifying Chubb of the non-receipt of payment for over three months. Therefore, the Board concluded there was no unreasonable delay justifying penalties.

Workers Compensation Appeals BoardPetition for ReconsiderationDeniedWCJ ReportDefective VerificationCured VerificationSupplemental PetitionCompromise and ReleaseLate PaymentChubb Group
References
Case No. POM 240908, LAO 712097
En Banc

Juan A. Rivera, Calvin Crump vs. Tower Staffing Solutions, State Compensation Insurance Fund, Los Angeles Unified School District, Helmsman Management Service

The Workers' Compensation Appeals Board holds that the 10 percent penalty for late payment under Labor Code section 4650(d) applies only to periodic indemnity payments and not to the lump sum proceeds of commutations or Compromise and Release (C&R) agreements.

En Banc DecisionLabor Code § 4650(d)CommutationCompromise and Release (C&R)Periodic Indemnity PaymentsLump SumDeath BenefitsVocational Rehabilitation Maintenance Allowance (VRMA)PenaltiesLabor Code § 5814
References
Case No. ADJ212916 (VNO 0334702)
Regular
Feb 09, 2011

PETER L. WASCHER vs. AIDS HEALTHCARE FOUNDATION INC., CIGA FOR CAL. COMP. (IN LIQUIDATION), STATE COMPENSATION INSURANCE FUND

This case involves a dispute over reimbursement for workers' compensation payments made by CIGA (California Insurance Guarantee Association) on behalf of an insolvent insurer. The arbitrator initially ordered State Compensation Insurance Fund (SCIF) to reimburse CIGA only $105,511.94, pending further proof of payment. CIGA petitioned for reconsideration, arguing it had provided sufficient evidence of payment for the full $719,238.12. The Workers' Compensation Appeals Board granted the petition, finding CIGA's payment records were reliable and unrebutted. Consequently, SCIF was ordered to reimburse CIGA the entire $719,238.12.

CIGASCIFreimbursementarbitrationreconsiderationindustrial injuryAids Healthcare FoundationCal Compmedical paymentsproof of payment
References
Case No. ADJ2005524
Regular
Apr 17, 2013

GRACIELA PONCE vs. L.W. REINHOLD PLASTICS INC., STATE COMPENSATION INSURANCE FUND, EMPLOYERS COMPENSATION INSURANCE COMPANY

This case involves a Petition for Reconsideration by lien claimants, Doctors Dini and Ehyai, whose liens were dismissed for failure to pay activation fees. The Workers' Compensation Appeals Board denied reconsideration, adopting the judge's report. The lien claimants attempted to pay the activation fee on the day of the lien conference but paid it after the conference concluded. The Board found that the payment was untimely under Labor Code § 4903.06(a)(4), which requires payment prior to the conference, and that the claimants failed to provide verifiable details for their alleged payment difficulties.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantActivation FeePublic Search ToolEAMSWCJLabor Code § 4903.06 (a)(4)Lien ConferenceDismissal with Prejudice
References
Case No. ADJ3872960
Regular
May 06, 2013

ALONZO WATKINS vs. LONG BEACH UNIFIED SCHOOL DISTRICT

This case concerns applicant Alonzo Watkins' petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying his claim for unpaid benefits totaling $14,269.10. The WCAB denied reconsideration, finding that Watkins failed to provide substantial evidence of non-payment, as the employer presented proof of payment via checks issued over 16 years prior. The WCAB also ruled that Watkins raised the issue of the employer's failure to produce payment records for the first time on appeal, which is impermissible. Furthermore, the WCAB clarified that the record retention requirements for adjusting agencies do not mandate indefinite maintenance of claim files.

Petition for ReconsiderationFindings and OrderIndustrial InjuryBack InjuryLower ExtremitiesTeacherCompromise and ReleasePayment RecordsProof of PaymentNon-Payment
References
Case No. SAL 0107814
En Banc
Jun 13, 2007

VALERI HAWKINS vs. AMBERWOOD PRODUCTS, STATE COMPENSATION INSURANCE FUND

The Appeals Board held that the two-year limitation on temporary disability payments under Labor Code section 4656(c)(1) begins from the date the first payment is actually made, not the date for which the benefit is first owed.

Workers' Compensation Appeals BoardEn Banc DecisionTemporary Disability PaymentLabor Code Section 4656(c)(1)Commencement of PaymentDate of InjuryCompensable WeeksAggregate Disability PaymentsSB 899Legislative Intent
References
Case No. ADJ6604427, ADJ8192308
Regular
Jul 31, 2014

CHERRICE MORRIS-GAINES vs. AC TRANSIT, SEDGWICK CLAIMS MANAGEMENT SERVICES

In this workers' compensation case, the applicant initially stipulated to a lower average weekly wage, which the Board found to be a final determination that could not be revisited due to lack of good cause and the five-year statute of limitations. The Board affirmed the employer's credit for payments made to the Employment Development Department (EDD) to prevent double recovery. Furthermore, the Board found no unreasonable delay by the employer in payments to EDD, thus denying the applicant's penalty claim. Finally, the Board rescinded the order requiring the applicant's attorney to repay fees voluntarily paid by EDD, as such repayment was not mandated by law.

Workers' Compensation Appeals BoardAC TransitSedgwick Claims Management ServicesADJ6604427ADJ8192308bus drivercumulative traumatemporary disability indemnityLabor Code section 4656(c)(2)mandatory settlement conference
References
Case No. ADJ2759696 (VNO 0492027)
Regular
Oct 11, 2010

WOON YOUNG PARK vs. FILM PAYMENT SERVICES, INC., CHARTIS INSURANCE

The Board granted reconsideration, rescinding the WCJ's decision on the defendant's credit for overpaid temporary disability. The defendant is allowed credit for temporary disability payments made from March 26, 2009, to June 3, 2009, at the temporary disability rate. Further credit is granted for payments made from June 4, 2009, to December 7, 2009, at the permanent disability rate of $185.00 per week. The Board denied further credit due to insufficient evidence regarding post-AME report overpayments.

Petition for ReconsiderationPermanent DisabilityTemporary DisabilityCreditStipulated AwardAgreed Medical ExaminationPermanent and StationarySection 4909Abuse of DiscretionDue Process
References
Case No. ADJ1454740 (SRO 0135848)
Regular
Mar 09, 2009

ROSA HUEY DE VARGAS vs. PETALUMA POULTRY PROCESSORS, ZURICH AMERICAN INSURANCE COMPANY

This case involves a defendant's petition for reconsideration of an award of penalties for late payment of workers' compensation benefits and attorney fees. The defendant argued the penalties were improperly calculated, excessive for a brief, inadvertent delay, and duplicated another penalty. The Appeals Board granted reconsideration, rescinded the original award, and returned the matter for further proceedings. The Board agreed that a section 4650 penalty should be ordered and that late EDD reimbursements should not be included in penalty calculations.

Labor Code section 5814(a)Joint Findings Award and Orderpenaltylate paymentpermanent disability indemnityattorney's feesLabor Code section 4650(a)unreasonable delayinadvertenceinterest paid
References
Case No. ADJ2699076 (LBO 0367787)
Regular
Aug 22, 2014

JOSE MORAN vs. LOS ANGELES REGIONAL FOOD BANK, STATE COMPENSATION INSURANCE FUND

This case involves a defendant seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision imposing sanctions for late payment of interpreter costs. The WCJ found sanctions were warranted under Labor Code section 5813, ordering the defendant to pay both the lien claimant and the General Fund. However, the WCAB granted reconsideration, rescinded the decision, and returned the matter to the trial level. The WCAB found the WCJ failed to establish bad faith required for sanctions and incorrectly ordered payment directly to the lien claimant instead of the General Fund.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderSanctionsInterpreter CostsLate PaymentsLien ClaimantCompromise and ReleaseBad FaithNegligence
References
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