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Case Law Database

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

Case No. ADJ6973825
Regular
May 21, 2012

MONICA BENARD vs. JENNY CRAIG, SEDGWICK CMS

This case concerns a penalty imposed on Jenny Craig for unreasonably delaying authorization for applicant Monica Benard's chiropractic treatment. The WCJ found a 25% penalty for the delay, which Jenny Craig appealed, arguing the delay was due to the applicant's choice of a chiropractor outside their Medical Provider Network (MPN). The Appeals Board affirmed the unreasonable delay finding but reduced the penalty to 20% of the delayed treatment's value, citing a failure in case management rather than intentional disregard. Jurisdiction was reserved for the parties to adjust the penalty amount.

Workers Compensation Appeals BoardMonica BenardJenny CraigSedgwick CMSADJ6973825ReconsiderationFindings and AwardLabor Code section 5814Medical Provider Network (MPN)chiropractic treatment
References
Case No. ADJ8438071
Regular
Jun 07, 2013

MONICA CONTRERAS vs. KELLER WILLIAMS REALTY, SACRAMENTO METRO; TOWER NATIONAL INSURANCE IRVINE

The Workers' Compensation Appeals Board (WCAB) rescinded a prior finding that Monica Contreras was an employee of Keller Williams Realty. The WCAB determined that the initial finding was erroneously based on the legal requirement for real estate agents to be associated with a broker, rather than a factual analysis of the control exercised by the defendant. The case is returned to the Administrative Law Judge for further proceedings and a new decision considering the factual relationship and the multi-factor test for employment status. The WCAB emphasized that the right to control the means and manner of work is the primary test.

Workers' Compensation Appeals BoardMonica ContrerasKeller Williams RealtyTower National InsurancePetition for ReconsiderationFindings of FactAdministrative Law JudgeEmployee StatusIndependent ContractorReal Estate Agent
References
Case No. ADJ2007189 (LAO 0857899)
Regular
Nov 01, 2019

Monica Bernasani vs. International Filing Company, U.S. Fire Insurance Company, Crum & Forster

This case involves Monica Bernasani's workers' compensation claim against International Filing Company for cumulative trauma injury. The Administrative Law Judge (ALJ) found Bernasani permanently totally disabled due to industrial injuries to her back, neck, shoulders, wrists, knees, psyche, headaches, weight gain, hypertension, and gastrointestinal system, awarding lifetime benefits. The defendant appealed, arguing the Agreed Medical Examiner's (AME) opinion was insufficient to support total disability and that a vocational report by Enrique Vega was improperly admitted. The Appeals Board denied the defendant's petition, affirming the ALJ's decision and finding the vocational report admissible due to the defendant's waiver of objection. The Board found substantial medical and vocational evidence supported the finding of permanent total disability.

Workers' Compensation Appeals BoardMonica BernasaniInternational Filing CompanyU.S. Fire Insurance CompanyPetition for ReconsiderationFindings Award and OrderAdministrative Law JudgeWCJIndustrial Cumulative Trauma InjuryPermanently Totally Disabled
References
Case No. MON 0292635
Regular
May 20, 2008

ZENA GARCIA vs. SANTA MONICA MALIBU UNIFIED SCHOOL DISTRICT

The Appeals Board denied the lien claimant's petition for reconsideration, upholding the administrative law judge's decision that the lien claimant failed to meet its burden of proving the reasonableness of its charges for surgery. Despite prior direction to develop the record regarding rebuttal evidence, the lien claimant presented no further evidence, leaving its charges appearing disproportionate. The Board affirmed the use of the 2004 fee schedule as a guide to establish the reasonable value of the services.

KunzOutpatient Surgery Fee ScheduleReconsiderationLien ClaimantReasonable ValueRebuttal EvidenceBurden of ProofGeographic ComparablesComparative StudyIndustrial Injury
References
Case No. ADJ12393038
Regular
Mar 07, 2023

CRISTIAN AVILA GARCIA (Deceased) SINTIA YANETH GARCIA (Guardia Ad Litem) vs. BAYVIEW ENVIRONMENTAL SERVICES INCORPORATED, GREAT DIVIDE INSURANCE COMPANY, BERKELEY ENTERTAINMENT

In this workers' compensation case, the applicant's average weekly wage (AWW) was determined based on his higher earnings during the four weeks prior to his death on a special project. The defendant sought reconsideration, arguing the AWW should have been based on his entire tenure, but the Appeals Board affirmed the original award. The Board held that AWW is calculated based on earnings "at the time of injury" to reflect earning capacity, not necessarily the entire earnings history. Therefore, the calculation using the prevailing wage during the Santa Monica project was upheld.

Workers' Compensation Appeals BoardCristan Avila GarciaSintia Yaneth GarciaBayview Environmental Services IncorporatedGreat Divide Insurance CompanyBerkeley EntertainmentAdjudication NumberFindings and AwardAverage Weekly WageTemporary Disability Indemnity
References
Case No. ADJ9445540
Regular
Sep 04, 2018

MONICA DENOFRA vs. COUNTY OF VENTURA

This case involves a dispute over the extent of applicant Monica Denofra's industrial injury. The Administrative Law Judge (ALJ) awarded 43% permanent disability based on an orthopedist's opinion, but disregarded the Agreed Medical Evaluator (AME). The defendant seeks reconsideration, arguing the ALJ should have followed the AME's findings of injury only to the neck and 5% permanent impairment. The Appeals Board granted reconsideration, rescinded the ALJ's decision, and returned the case for a new decision based on the AME's findings and to determine credit for overpayments.

Petition for ReconsiderationAgreed Medical EvaluatorPrimary Treating PhysicianIndustrial InjuryPermanent DisabilityOrthopedic Permanent ImpairmentNeurological Permanent ImpairmentPermanent and Stationary DateCredit for OverpaymentFindings and Award
References
Case No. ADJ2140810 (OAK 0294314) ADJ1780104 (WCK 0046461)
Regular
Jan 29, 2010

Monica Meadors vs. Oakland Unified School District

The Workers' Compensation Appeals Board dismissed Monica Meadors' petition for reconsideration and removal. The petition was untimely, seeking reconsideration of a December 2008 order to attend a QME exam, which was outside the statutory filing period. Furthermore, the petition failed to address any specific order, finding, or award subject to review. The Board also remanded the matter to the trial level for consideration of declaring the applicant a vexatious litigant due to her history of filing repetitive and unsubstantiated complaints.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationPetition for RemovalPanel QMEVexatious litigantLabor Code section 5903Government Code Section 905(d)Permanent disabilityDate of injuryLiability denied
References
Case No. ADJ10533211, ADJ10547118
Regular
Dec 26, 2018

MONICA NURSE (COOK) vs. COUNTY OF SAN DIEGO

This case involves Monica Nurse's claim for psychological injury due to alleged sexual harassment. The Workers' Compensation Appeals Board denied her petition for reconsideration of a prior ruling. The Board found that Nurse failed to provide objective evidence of harassment, a requirement for establishing a compensable psychiatric injury under Labor Code section 3208.3(b)(1). The judge's credibility determination of witnesses, who testified against harassment, was given significant weight. Therefore, her claims were denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings of Fact and Orderpsyche injuryemploymentsexual harassmentobjective evidenceactual events of employmentWCJsubstantial evidence
References
Case No. ADJ10206021
Regular
Feb 26, 2018

Monica Roe vs. Trinity Property Consultants, Travelers Casualty Company of America

The Workers' Compensation Appeals Board denied Monica Roe's petition for reconsideration, upholding the Administrative Law Judge's (ALJ) decision. The ALJ found Roe's testimony lacked credibility regarding her alleged work-related neck and right upper extremity injury, and relied on the more credible testimony of employer witnesses. Furthermore, the ALJ determined that the medical reports submitted by Roe's physicians did not constitute substantial evidence to support her claim, particularly regarding cumulative trauma. Consequently, the Board adopted the ALJ's reasoning and denied reconsideration of the original order.

AOE/COEPetition for ReconsiderationWCJ credibilitysubstantial medical evidencecumulative traumaspecific injurymedical opinionprior injuriesemployment dutieswitness testimony
References
Case No. ADJ6571874, ADJ7967746
Regular
Oct 21, 2013

DARYL BRISTOL vs. CITY OF SANTA MONICA, CITY OF SANTA MONICA RISK MANAGEMENT

The Board denied the applicant's reconsideration regarding his claimed cumulative trauma injury of multiple myeloma, agreeing with the WCJ that employment exposure to benzene was insufficient to establish causation. The Board granted the defendant's reconsideration regarding a specific arm/shoulder injury, affirming it was not due to horseplay. However, the Board amended the award for this specific injury to limit temporary disability benefits to August 26, 2008, finding subsequent disability was due to the applicant's non-industrial cancer. All other issues related to the specific injury remain deferred.

Workers Compensation Appeals BoardCumulative TraumaInternal SystemCancerMultiple MyelomaLabor Code Section 3212.1Presumption of Compensable InjurySpecific InjuryRight Arm and ShoulderHorseplay
References
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