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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ7166686
Regular
Jul 24, 2012

RICHARD ANDERSON vs. JAGUAR/LANDROVER OF VENTURA, COMPWEST INSURANCE COMPANY

This case involves an applicant who suffered a stroke and subsequent 100% permanent disability following surgery for an industrial shoulder injury. The defendant sought reconsideration, arguing for apportionment to pre-existing conditions and challenging the attorney's fee calculation. The Appeals Board affirmed the 100% permanent disability finding, finding no basis for apportionment as the applicant's pre-existing conditions did not cause the disability itself. However, the Board modified the attorney's fee award, requiring commutation using a specific method and a 3% cost of living adjustment, finding the previously assumed 4.6% to be speculative.

Workers Compensation Appeals BoardRichard AndersonJaguar/Landrover of VenturaCompwest Insurance CompanyADJ7166686ReconsiderationFindings and AwardIndustrial InjuryBrain InjuryNeurological System
References
Case No. VNO 0509254
Regular
Apr 17, 2008

CAROL LEVENSON vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves a claim for bilateral hearing loss and tinnitus allegedly caused by noise exposure during firearms training. The Appeals Board found the opinion of the Agreed Medical Evaluator, Dr. Grossan, to be substantial evidence, concluding that the applicant's conditions were not work-related. Consequently, the Board denied the applicant's claim for hearing loss and tinnitus, awarding only reimbursement for medical-legal liens.

Workers' Compensation Appeals BoardRemovalTemporary DisabilityFindings and AwardLicensing Program AnalystBilateral Hearing LossFirearms TrainingShooting RangeTinnitusQualified Medical Evaluator (QME)
References
Case No. ADJ1983451 (LAO 0339499)
Regular
Mar 27, 2009

JOEL ABLER vs. LOS ANGELES HARLEY-DAVIDSON, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The WCAB denied Applicant's petitions for reconsideration and granted Defendant's petition, amending the Findings and Order to include that applicant did not sustain memory loss. The original decision that Applicant did not sustain injury is affirmed.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCasualty Reciprocal Exchangeliquidationindustrial injuryupper respiratory systemlungspsychemechanicagreed medical evaluator
References
Case No. ADJ8954364
Regular
Jul 06, 2015

MARK FINNEY vs. ZURICH INSURANCE, PATRIOT RISK SERVICES

This Workers' Compensation Appeals Board case, ADJ8954364, involved applicant Mark Finney seeking reconsideration of a decision that denied permanent impairment from a left eye injury. Finney argued he had developed glaucoma and sustained vision loss due to the injury. The Workers' Compensation Judge found no substantial evidence that the glaucoma was caused by the injury, nor was there sufficient evidence of specific vision loss as defined by the AMA Guides. Therefore, the petition for reconsideration was denied, upholding the original decision that while future complications could arise, there was no current permanent impairment.

Petition for ReconsiderationDeniedPermanent ImpairmentLeft Eye InjuryGlaucomaVision LossAMA GuidesPrimary Treating PhysicianBilateral Vision LossMyopic Astigmatism
References
Case No. ADJ6692520
Regular
Jul 20, 2010

CRYSTAL VOS vs. STEVEN CHANG, DDS, ZENITH INSURANCE COMPANY

This case affirms a WCJ's decision finding the applicant sustained a 12% permanent disability. The applicant sought reconsideration, arguing the WCJ erred by limiting rebuttal evidence to "wage loss" rather than "loss of long-term earning capacity" and denying costs for a vocational expert. The Appeals Board, relying on precedent from *Ogilvie v. City and County of San Francisco*, held that the vocational expert's opinion was not substantial evidence to rebut the permanent disability rating. Therefore, the WCJ's denial of the vocational expert's costs was also affirmed.

Workers' Compensation Appeals BoardSupplemental Findings and Awardindustrial injurypermanent disabilityvocational expertwage lossloss of long-term earning capacitydiminished future earning capacity (DFEC)2005 Permanent Disability Rating ScheduleOgilvie v. City and County of San Francisco
References
Case No. ADJ3842696 (SAL 0105756) ADJ4430006 (SAL 0111994)
Regular
Apr 23, 2010

JOSE VILLA vs. CHALONE WINE GROUP, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ZENITH INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to allow the California Insurance Guarantee Association (CIGA) reimbursement for its bill review expenses. The Board found that bill review costs are an essential and necessary part of adjusting medical claims, akin to "incurred losses" as defined by the Uniform Statistical Reporting Plan. This decision amends a prior ruling that excluded such expenses, recognizing their role in controlling medical overpayments. The parties are now to adjust the specific amount of reimbursement for these expenses.

CIGACalifornia Insurance Guarantee Associationbill review expensesincurred lossesloss adjustment expensemedical cost containmentuniform statistical reporting planinsolvency insurancecovered claimsLabor Code
References
Case No. ADJ1643143 (SRO 0122410)
Regular
May 25, 2010

JUAN ESCUTIA vs. NICK LERAS WATER TRUCKS, et al.

The Workers' Compensation Appeals Board affirmed a prior decision holding the State Compensation Insurance Fund (SCIF) liable for reimbursement to the California Insurance Guarantee Association (CIGA). CIGA, adjusting claims for an insolvent insurer, sought reimbursement for various administrative expenses, including bill review, court reporter fees, and opposing counsel fees incurred while administering an injured worker's claim. The Board found these costs, particularly bill review expenses, were part of "incurred losses" under the California Workers' Compensation Uniform Statistical Reporting Plan and thus reimbursable. This decision establishes that CIGA can recover such administrative costs from a solvent insurer when adjusting claims for an insolvent carrier.

CIGASCIFBill ReviewIncurred LossesLoss Adjustment ExpensesInsurance Code Section 1063.1(c)(9)Labor Code Section 5500.5(e)California Workers' Compensation Uniform Statistical Reporting PlanReconsiderationFindings and Orders
References
Case No. ADJ3781289
Regular
Apr 25, 2019

MARGARET BATTEN vs. LONG BEACH MEMORIAL HOSPITAL

Here's a summary for a lawyer: The Workers' Compensation Appeals Board (WCAB) has rescinded its prior decision regarding Margaret Batten's claim against Long Beach Memorial Hospital. This action was taken because a settlement has been reached between the parties while the case was pending on reconsideration. The matter is now returned to the trial level for the Workers' Compensation Judge (WCJ) to review and approve the proposed settlement. If the settlement is not approved, the WCJ may reinstate the original decision.

Workers' Compensation Appeals BoardReconsiderationProposed SettlementRescinded DecisionTrial LevelWCJFindings and AwardOpinion of JudgeLong Beach Memorial HospitalKeenan & Associates
References
Case No. ADJ244571 (VEN 0110022) ADJ3315572 (VEN 0110023) ADJ3817980 (OXN 0145232) ADJ2004405 (OXN 0145234) ADJ4239471 (OXN 0145235)
Regular
Jan 19, 2010

DIANA HARDMAN vs. COMMUNITY MEMORIAL HOSPITAL, AIG DOMESTIC CLAIMS, INC./CHARTIS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE, CALIFORNIA COMPENSATION INSURANCE COMPANY, FREMONT COMPENSATION INSURANCE COMPANY, American Home Assurance

This case involves five workers' compensation claims by applicant Diana Hardman against Community Memorial Hospital, with American Home Assurance (AIG) as a defendant insurer. AIG seeks reconsideration of the WCJ's findings, arguing it should only be liable for permanent disability directly arising from injuries covered by its policies, not those covered by insolvent insurers now handled by CIGA. The Appeals Board granted reconsideration, rescinded the WCJ's decisions, and returned the matter for further proceedings. Key issues include the admissibility of a deposition, the apportionment of permanent disability based on recent appellate decisions, and clarification of liability for injuries that occurred during periods covered by multiple insurers, including insolvent ones.

Workers' Compensation Appeals BoardDiana HardmanCommunity Memorial HospitalAIG Domestic ClaimsCalifornia Insurance Guarantee AssociationBroads PireCalifornia Compensation Insurance CompanyFremont Compensation Insurance CompanyOpinion and Order Granting ReconsiderationDecision After Reconsideration
References
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