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

Case No. ADJ587312 (LAO 0832831)
Regular
Dec 12, 2017

RAMIRO ZAPATA JIMENEZ vs. LUIS ARAGON, MARCOS BOLANOS, UNINSURED EMPLOYERS BENEFITS TRUST FUND

The Court of Appeal overturned the Workers' Compensation Appeals Board's decision to affirm the joinder of defendant Marco Bolanos. The Court found Bolanos was a statutory employer but that his joinder was barred by the statute of limitations (Labor Code § 5405), with no grounds for tolling. Consequently, the Board amended its prior award to dismiss Bolanos as a defendant while affirming the original findings and award against Luis Aragon.

RemittiturStatute of LimitationsLabor Code section 5405Conclusive Statutory EmployerLabor Code section 2750.5Cedillo v. Workers' Comp. Appeals Bd.Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd.Reynolds v. Workmen's Comp. Appeals Bd.TollingUninsured Employers Benefits Trust Fund
References
3
Case No. 530563
Regular Panel Decision
Jan 20, 2022

In the Matter of the Claim of Luis Urena

Luis Urena, an employee of Abcal Industries, sustained injuries after falling while working on a residential renovation project in Brooklyn in July 2017 and applied for workers' compensation benefits. The Workers' Compensation Board ruled that Norguard Insurance Company, Abcal's carrier, was liable for Urena's benefits, rejecting Norguard's arguments that its policy did not cover work in New York. Norguard appealed, contending that a policy exclusion applied due to Abcal's failure to notify them of New York work within 30 days. The Supreme Court, Appellate Division, Third Judicial Department, affirmed the Board's decision, finding that Norguard failed to meet its burden of proving the exclusion applied and that the Board's interpretation of the policy language was reasonable.

Workers' Compensation InsurancePolicy ExclusionEmployer LiabilityCarrier LiabilityAppellate ReviewJurisdictionNew York Workers' Compensation LawSubcontract AgreementConstruction InjuryTimeliness
References
7
Case No. No. 13
Regular Panel Decision
Mar 26, 2020

The Matter of the Claim of Luis A. Vega v. Postmates Inc

The New York Court of Appeals addressed whether a Postmates, Inc. courier, Luis A. Vega, and similarly-situated individuals, are employees for unemployment insurance contributions. The Unemployment Insurance Appeals Board (the Board) had determined them to be employees, reversing an Administrative Law Judge's finding of independent contractor status. The Appellate Division then reversed the Board, concluding insufficient evidence of an employer-employee relationship. The Court of Appeals reversed the Appellate Division, reinstating the Board's decision, finding substantial evidence that Postmates exercised control over its couriers, rendering them employees for unemployment insurance purposes. The court highlighted Postmates' control over assignments, compensation, customer complaints, and the inability of couriers to operate as independent businesspersons.

Unemployment InsuranceGig EconomyIndependent ContractorEmployee ClassificationLabor LawApp-based DeliveryControl TestWorkers' RightsNew York Court of AppealsSubstantial Evidence
References
44
Case No. MISSING
Regular Panel Decision
Nov 13, 2002

Zurich American Insurance v. Luis Bastos Construction

Zurich American Insurance Co. initiated an action seeking a declaratory judgment that it was not obligated to defend or indemnify Luis Bastos Construction, Inc. in an underlying personal injury lawsuit filed by Hermilo Cruz. Cruz, an employee of Bastos, sustained injuries in New York while working on a job that was not related to any work being performed in New Jersey. Zurich's insurance policy provided employers' liability coverage specifically for claims arising from accidents in New Jersey or those incidental to New Jersey operations. The Supreme Court, Westchester County, granted Zurich's motion for summary judgment, ruling that Zurich had no obligation to defend or indemnify Bastos. Defendant A.E Roofing & Siding Corp. appealed this decision. The appellate court affirmed the Supreme Court's order and judgment, concluding that the terms of the policy were clear and unambiguous.

Declaratory JudgmentInsurance CoverageEmployers' LiabilityWorkers' CompensationSummary JudgmentPolicy InterpretationPersonal InjuryAppellate ReviewJurisdictionNew York Law
References
2
Case No. ADJ10259451
Regular
Sep 10, 2019

LUIS SILVA vs. CITISTAFF SOLUTIONS, OLD REPUBLIC c/o GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board granted reconsideration of a prior decision. They amended the decision to reflect that Old Republic, not a different insurer, is the liable party for Luis Silva's injury. The Board also admitted Defendant's Exhibit E into evidence. Otherwise, the original decision awarding temporary disability, permanent disability, future medical treatment, and attorney's fees to Luis Silva was affirmed.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportExhibit EOld RepublicGallagher Bassettgeneral laborerlumbar spineinternal injurytemporary disability indemnity
References
0
Case No. ADJ9409541
Regular
Aug 23, 2019

LUIS MEDINA BERNAL (Deceased), PATRICIA SOLANO VASQUEZ, MISAEL MEDINA SOLANO, LUCIA MEDINA SOLANO, XIMENA MEDINA SOLANO, I SAI MEDINA SOLANO, LUIS EMANUEL MEDINA SOLANO vs. REBECCA BAUTISTA dba REMAC TIRE SERVICES, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case involves a fatal industrial injury to Luis Medina Bernal, a tire changer. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to clarify death benefit payment terms. While the WCJ correctly found petitioning applicants failed to prove partial dependency, the WCAB amended the decision. The death benefit for the widow, Patricia Solano Vasquez, is to be paid bi-weekly at $297.29 until the $250,000 total is exhausted. The attorney's fee was recalculated to $34,042.54, representing 15% of the death benefit's present value.

Workers' Compensation Appeals BoardPetition for ReconsiderationDecision After ReconsiderationFatal Industrial InjuryPartial DependencyCredibility DeterminationsNet Financial BenefitDeath BenefitPresent ValueAttorney's Fee
References
4
Case No. 2016 NY Slip Op 02734 [138 AD3d 488]
Regular Panel Decision
Apr 12, 2016

Matter of Lesli R. (Luis R.)

The Family Court's order of disposition, which found that the respondent sexually abused his stepdaughters and derivatively abused his five biological children, was unanimously affirmed. The record supported the court's determination that the respondent was legally responsible for the children and that there was a preponderance of evidence of sexual abuse. The stepdaughters' out-of-court statements were sufficiently corroborated by the respondent's own statements. The court also found that the respondent derivatively abused his own children and properly exercised its discretion in quashing a subpoena to compel one of the stepdaughters to testify due to potential psychological harm.

Child AbuseSexual AbuseDerivative AbuseFamily Court ActAppellate ReviewPreponderance of EvidenceOut-of-court StatementsCorroborationParental ObligationsSubpoena Quash
References
11
Case No. VNO 0467089
Regular
Jun 20, 2008

LUIS ARAGON vs. THE CHEESECAKE FACTORY, U.S. FIDELITY AND GUARANTY, GALLAGHER BASSETT SERVICES

This case concerns a medical provider's lien claim after the applicant's workers' compensation claim was settled. The lien was initially disallowed because the provider had received payment from Medi-Cal and had not yet reimbursed the program. The Appeals Board granted reconsideration, amending the award to allow the provider to pursue its lien claim, but only after proving full reimbursement to Medi-Cal as required by Welfare and Institutions Code section 14124.791. Jurisdiction is reserved for further proceedings at the trial level.

Workers' Compensation Appeals BoardLien claimantMedi-Cal reimbursementWelfare and Institutions Code § 14124.791Industrial injuryBelow the knee amputationCompromise and releasePetition for reconsiderationReport and RecommendationFindings and Award
References
3
Case No. ADJ10521677 ADJ10945059
Regular
Dec 20, 2019

JOSE LUIS DURAN vs. COUNTY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration for Jose Luis Duran's cases to correct clerical errors and inconsistencies in prior decisions. The Board rescinded and substituted the prior findings and awards, clarifying the permanent disability percentages and the grounds for apportionment. Specifically, Case ADJ10521677 now reflects 14% permanent disability, and Case ADJ10945059 clarifies no legal grounds for apportionment regarding heart/hypertension. The revised decisions ensure accurate payment of indemnity and attorney fees.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationPetition for ReconsiderationGrantRescindSubstituteClerical ErrorsFindings of FactAwardOrder
References
1
Case No. ADJ7332228
Regular
May 04, 2016

Luis Zapanta vs. Pacific Gas & Electric Company

The Workers' Compensation Appeals Board denied Luis Zapanta's petition for reconsideration, upholding the prior ruling that his Independent Medical Review (IMR) was timely. The Board found that the IMR process, including Maximus Federal Services' review, complied with Labor Code section 4610.6(d) and relevant regulations. Applicant's arguments regarding the timeliness of the IMR determination and whether sufficient medical records were reviewed were rejected. The Board affirmed the administrative law judge's decision based on the WCJ's report and additional supporting regulations.

Workers' Compensation Appeals BoardIndependent Medical ReviewMaximus Federal ServicesPetition for ReconsiderationFindings of Fact and OrderLabor CodeCalifornia Code of RegulationsPrimary Treating PhysicianTimelinessSupporting Documentation
References
4
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