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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ4153143, ADJ1964837 and ADJ1933860
Regular
Nov 05, 2010

JACK L. MARCUM vs. OUTSOURCE MANAGEMENT, INC. dba THE MANAGEMENT CONNECTION, SUPERIOR NATIONAL INSURANCE CO., now liquidation, administered by CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, KLEEGE INDUSTRIES, INC. dba HANDS-ON EVENT LABOR SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves an applicant who sustained shoulder injuries in 1999 and 2000, with a compensation judge awarding 4% permanent disability. The California Insurance Guarantee Association (CIGA) is appealing a decision holding it liable, arguing the applicant was not employed by a company insured by Legion Insurance (now handled by CIGA) but rather by Kleege Industries, insured by SCIF. CIGA contended there was a general/special employment relationship and that SCIF's policy should cover the applicant. The Appeals Board granted reconsideration, affirmed the previous awards, and corrected a clerical error to accurately reflect Legion Insurance as the insurer for Outsource Management, Inc. during the relevant period.

California Insurance Guarantee AssociationLegion Insurance CompanyOutsource Management Inc.The Management ConnectionKleege Industries Inc.Hands-On Event Labor ServicesState Compensation Insurance Fundcumulative traumaright shoulder injurypermanent disability
References
Case No. ADJ18217235; ADJ18217236
Regular
Apr 29, 2025

Crispin Bermudez vs. Elkhorn Packing Company, LLC; Zenith Insurance Company

The Workers' Compensation Appeals Board addressed a petition for reconsideration filed by Zenith Insurance Company challenging an arbitrator's finding that applicant Crispin Bermudez was covered by a workers' compensation policy despite signing a waiver. The Board granted the petition, rescinded the arbitrator's decision, and issued a new decision. It found that as a managing member of a limited liability company, Bermudez had executed a valid written waiver of his workers' compensation rights under Labor Code sections 3351(f) and 3352(a)(17). Consequently, the applicant was deemed excluded from the definition of an employee and thus not entitled to workers' compensation coverage.

Workers' CompensationManaging MemberWaiver of CoverageLabor Code Section 3352(a)(17)Conclusive PresumptionIndustrial InjuryPetition for ReconsiderationArbitrator's DecisionRescinded DecisionLimited Liability Company
References
Case No. ADJ9160815
Regular
Jun 10, 2014

ALMA CEDILLO vs. CEDARS SINAI MEDICAL CENTER, TRISTAR RISK MANAGEMENT

This case involves an applicant, Alma Cedillo, seeking workers' compensation benefits from Cedars Sinai Medical Center and Tristar Risk Management. The Workers' Compensation Appeals Board (WCAB) issued an order denying a Petition for Removal filed in the case. The WCAB adopted the reasoning of the workers' compensation administrative law judge (WCJ) in reaching its decision to deny removal. Therefore, the applicant's request to remove the case from the current process was rejected.

Petition for RemovalWorkers' Compensation Appeals BoardCedars Sinai Medical CenterTristar Risk ManagementAdministrative Law JudgeADJ9160815Van Nuys District OfficeAlma Cedillodenying removalworkers' compensation
References
Case No. ADJ3413739 (SAL 0120295)
Regular
Nov 26, 2013

YOLANDA OSUNA vs. MARRIOTT HOTEL, ARCHIE MAYS, M.D., RUBY LEYNES, M.D., SCOTT ROSENZWEIG, M.D., EDWARD KOMBERG, D.C.; INNOVATIVE MEDICAL MANAGEMENT and LOUIS HEARD

This case involves a sanction against Innovative Medical Management and Louis Heard for reasons outlined in a prior Notice of Intention. The Appeals Board received a $2,500 payment from them, which they deemed an acknowledgment of the undisputed reasons for the proposed sanction. Consequently, the Board ordered a $2,500 sanction, crediting the payment already made, thus settling the matter.

Workers' Compensation Appeals BoardRemovalSanctionNotice of Intention to Impose SanctionHearing RepresentativesInnovative Medical ManagementLouis HeardMedical ManagementAppeals BoardOpinion and Decision
References
Case No. ADJ13571625
Regular
Apr 12, 2023

MARITZA CANALES vs. EAST WEST EYE INSTITUTE, INC., NOVA CASUALTY COMPANY, TRISTAR RISK MANAGEMENT

This case concerns a petition for reconsideration by Nova Casualty Company, the insurer for East West Eye Institute, Inc., challenging a finding of joint employment. The applicant, Maritza Canales, worked as a nanny/housekeeper, receiving simultaneous payments from East West/Premier Practice Management (PPM) and an individual, Naomi Kurata. The Workers' Compensation Appeals Board (WCAB) denied the petition, adopting the judge's report which found sufficient connection to East West/PPM to establish employment based on payroll and benefits provided. The judge also found Naomi Kurata credible, rejecting arguments of witness contradiction and mischaracterization of facts regarding overtime pay.

JOINT EMPLOYMENTALTER EGOEMPLOYMENT FOLLOWS PAYROLLCORPORATE ENTITIESRESIDENTIAL EMPLOYEEHOMEOWNER'S INSURANCEWITNESS CREDIBILITYCOMPENSATION JUDGEPETITION FOR RECONSIDERATIONWORKERS' COMPENSATION APPEALS BOARD
References
Case No. STK 0192198, STK 0192199(M)
Regular
Mar 27, 2008

DAVID FONSECA vs. ALAMEDA COUNTY SHERIFF'S DEPARTMENT, TRISTAR RISK MANAGEMENT, SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration and removal, rescinding the finding of no cumulative trauma injury and amending the finding regarding the applicable rating schedule for a 1992 knee injury. The case is returned to the trial level for further development of the record on cumulative trauma, permanent disability, and apportionment. Medical evaluators should be provided with the applicant's deposition transcript and a job description.

Workers Compensation Appeals BoardPermissibly Self-InsuredTristar Risk ManagementSedgwick Claims ManagementRemovalReconsiderationFindings Award and OrdersSchedule for Rating Permanent DisabilitiesCumulative Trauma InjuryFuture Medical Treatment
References
Case No. ADJ3614029 (STK 0192198) ADJ1670728 (STK 0192199)
Regular
Jan 09, 2009

DAVID FONSECA vs. ALAMEDA COUNTY SHERIFF'S DEPARTMENT, TRISTAR RISK MANAGEMENT, SEDGWICK CLAIMS MANAGEMENT

Reconsideration granted; rescinds prior Findings, Award and Orders; returns matter to trial level to determine applicable permanent disability rating schedule and Section 4850 benefits; and to determine defendant's insurance status at time of 1992 injury.

Workers' Compensation Appeals BoardDavid FonsecaAlameda County Sheriff's DepartmentTristar Risk ManagementSedgwick Claims Managementpermanent disabilitycumulative traumadate of injuryrating scheduleLabor Code section 4061
References
Case No. ADJ6814425
Regular
Apr 23, 2012

JIMMY WILLIAMS vs. SAN FRANCISCO 49ers; TIG INSURANCE COMPANY Administered By RISK ENTERPRISE MANAGEMENT LIMITED; SUCCESSOR IN INTEREST BY MERGER TO GULF INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY; BERKELEY SPECIALTY UNDERWRITING MANAGERS, LLC; NEW ORLEANS SAINTS; LOUISIANA WORKERS' COMPENSATION CORPORATION; SEATTLE SEAHAWKS; PSI; HOUSTON TEXANS; BERKELEY SPECIALTY UNDERWRITING MANAGERS, LLC.

In this Workers' Compensation Appeals Board case, applicant Jimmy Williams' Petition for Removal has been denied. The order signifies the Board's decision not to further review or remove the case from its current proceedings. The specific grounds for denial are not detailed in this excerpt. The decision was issued by the Workers' Compensation Appeals Board on April 23, 2012.

Petition for RemovalWorkers' Compensation Appeals BoardSan Francisco 49ersTIG Insurance CompanyRisk Enterprise Management LimitedGulf Insurance CompanyThe Travelers Indemnity CompanyBerkeley Specialty Underwriting Managers LLCNew Orleans SaintsLouisiana Workers' Compensation Corporation
References
Case No. ADJ6857384
Regular
Dec 07, 2009

KATHLEEN BACA vs. COUNTY OF MARIN, TRI STAR RISK MANAGEMENT

"The appeals board granted defendant's petition to remove the finding that Jeffrey Amheiter was a managing agent. The board affirmed the order, except for amending it to reflect that Amheiter is not a managing agent."

Petition for RemovalManaging AgentCode of Civil Procedure section 1987(b)DepositionSupervisory ClassificationIndustrial InjuryNerves and PsycheClass SpecificationWCJ Report and RecommendationWorkers' Compensation Appeals Board
References
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