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

Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
Case No. ADJ8750265
Regular
Apr 17, 2017

EDUARDO VILCHES CABRERA vs. TOWN OF SCOTIA CO. PACIFIC LUMBER, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinding a prior order that denied the defendant's request to compel the applicant's deposition. The Board found good cause existed for the deposition because a 2014 MRI showed a worsening of the applicant's knee condition, necessitating a second surgery, despite a prior QME report attributing 100% of permanent disability to the original 2006 industrial injury. This new development raised questions about potential subsequent injuries or intervening causes that could affect reimbursement. The Board permitted the deposition to gather information regarding the applicant's employment and any events between the QME's 2013 evaluation and the 2014 MRI.

Petition for RemovalSecond Order Denying Petition to CompelStipulations and AwardQualified Medical EvaluatorPetition to Compeldepositionmaterial change in medical conditionreimbursementsubsequent employmentgood cause
References
Case No. ADJ1775959 (ANA 0387306) ADJ2257120 (ANA 0386617)
Regular
May 17, 2010

SILVIA MORA vs. STEELCASE, INC., LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior decision that ordered a lien claimant to reimburse the defendant for chiropractic treatment exceeding the statutory limit. The WCAB held that Labor Code section 4604.5(d)(1) limits chiropractic visits but does not authorize restitution for voluntary payment of excessive treatment. Citing the equitable principles established in *American Psychometric Consultants, Inc. v. Workers' Compensation Appeals Board (Hurtado)*, the Board found that both parties were equally aware of the legal limits, and the defendant voluntarily paid the excess charges. The WCAB emphasized transactional stability, stating that undoing such payments would negatively impact the workers' compensation system.

Workers' Compensation Appeals BoardLien claimantReconsiderationFindings and OrderLabor Code section 4604.5(d)(1)Chiropractic visitsReimbursementPetition for ReimbursementMedical treatment lienEquitable restitution
References
Case No. ADJ4137919 (LAO 0855341) ADJ3018408 (LAO 0855344)
Regular
Dec 15, 2009

Enrique Madrigal vs. KAVLICO CORP, NOVA PRO RISK SOLUTIONS

Lien claimants' Petition for Reconsideration is granted; the Orders of Reimbursement are affirmed, but amended to delete the award of interest.

Petition for ReconsiderationOrder of ReimbursementLien ClaimantsPetition for ReimbursementAmounts Paid in ErrorInterest AwardWCJ's OrderStatutory BasisAppeals BoardDecision After Reconsideration
References
Case No. ADJ1083014 (POM 0275607) ADJ4477705 (POM 0275608)
Regular
May 29, 2009

LILIAN SOTO vs. PM GLOVES, INC., STATE COMPENSATION INSURANCE FUND

This case involved a lien claimant seeking payment for an MRI. The Workers' Compensation Judge initially disallowed the lien for failing to meet Labor Code section 5703 requirements. The Appeals Board granted reconsideration, finding the WCJ erred by strictly applying section 5703. They determined that other evidence, including the treating physician's report referenced in a settlement, established the validity of the MRI expense. Therefore, the Board allowed the lien claim for the MRI.

Lien claimantReconsiderationLabor Code Section 5703Labor Code Section 4626Finding and OrderWorkers' Compensation Judge (WCJ)Compromise and Release (C&R)MRILumbar SpineSelf-procured medical treatment
References
Case No. ADJ2185374 (LAO 0844306)
Regular
May 15, 2014

JOHN DEL PINTO vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board affirmed an arbitrator's decision regarding reimbursement between two cities for medical treatment costs. The arbitrator awarded the City of Glendale 50% reimbursement from the City of Los Angeles for medical payments made. However, the arbitrator denied Glendale reimbursement for cost-containment expenses like bill review and utilization review. Glendale's petition for reconsideration, arguing for full apportionment recovery and reimbursement of cost-containment costs, was denied. The Appeals Board adopted the arbitrator's reasoning, affirming the original award.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardLien ClaimantReimbursementApportionmentAgreed Medical EvaluatorMedical Bill ReviewUtilization ReviewCost-Containment Expenses
References
Case No. ADJ2560441 (STK 0197806) ADJ4237532 (STK 0125743)
Regular
Jan 19, 2010

BONNIE GRAVES (FREITAS) vs. ALMOND TREE RESTAURANT, CALIFORNIA GUARANTEE INSURANCE ASSOCIATION, For FREMONT INSURANCE COMPANY, In Liquidation, STATE COMPENSATION INSURANCE FUND

This case involves two cumulative injury claims for shoulder injuries sustained by the applicant waitress. Fremont Insurance Company, initially the insurer, became insolvent, and CIGA subsequently took over its obligations. CIGA sought reimbursement from SCIF, the subsequent insurer, for medical treatment provided to the applicant. The WCJ initially denied CIGA full reimbursement, finding the issue of 100% reimbursement for non-permanent disability benefits was not properly raised at trial. However, the Appeals Board granted reconsideration, finding CIGA sufficiently raised the issue of full reimbursement in its petitions and supporting documents, and remanded the case for further proceedings.

California Insurance Guarantee AssociationCIGAState Compensation Insurance FundSCIFFremont Insurance Companyliquidationindustrial injurybilateral shouldersleft shoulderpermanent disability
References
Case No. ADJ9282902
Regular
Oct 10, 2017

JUAN CARRILLO vs. ASKEW INDUSTRIAL CORPORATION, TWIN CITY FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the Employment Development Department's (EDD) petition for reconsideration. The EDD sought interest on reimbursement awarded for disability benefits, but the original Findings and Award did not specify the reimbursement amount or rule on interest. The Board found the EDD was not aggrieved by the initial award, as the parties were instructed to adjust the amount themselves. Therefore, the EDD must first seek a final order on the reimbursement amount before pursuing reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardtemporary disability indemnityreimbursementEmployment Development Department (EDD)lienUnemployment Insurance Code section 2629.1interestadministrative law judge (WCJ)
References
Case No. ADJ2279830 (LBO 0290929) ADJ3851198 (LBO 0362934)
Regular
Sep 05, 2008

SUSAN ORTLOFF vs. ANAHEIM GENERAL HOSPITAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT COMPENSATION, ARGONAUT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted CIGA's reconsideration, affirming the denial of contribution for Fremont's pre-insolvency benefits due to untimeliness under Labor Code §5500.5(e). However, the Board reversed the denial of CIGA's reimbursement claim for post-insolvency benefits, finding that Argonaut provided "other insurance" and is therefore liable for reimbursement. The Board ordered Argonaut to reimburse CIGA for benefits paid after Fremont's insolvency.

CIGAFremont CompensationArgonaut Insurancecontributionreimbursementinsolvencycumulative traumastipulated awardstatute of limitationsLabor Code 5500.5(e)
References
Case No. ADJ8069196 ADJ7219457
Regular
Jan 19, 2017

MICHELLE RIDDLE vs. LAS FLORES CONVALESCENT HOSPITAL, CIGA by its servicing facility INTERCARE INSURANCE SERVICES, ULLICO CASUALTY CO.

This case involves CIGA's petition for reconsideration regarding reimbursement for nonpermanent disability benefits paid to an applicant. CIGA sought reimbursement from Travelers Insurance Company, arguing Travelers' earlier policy constituted "other insurance." The Appeals Board denied CIGA's petition, adopting the WCJ's reasoning. The Board found that Travelers had no further liability for the applicant's benefits due to a prior approved Compromise and Release agreement, thus Travelers' policy was not "other insurance" for the purpose of reimbursement.

California Insurance Guarantee AssociationCIGAreimbursementTravelers Insurance Companyjoint and several liabilitynonpermanent disability benefitsother insurancecompromise and releasecovered claimscumulative injury
References
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