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

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The Workers' Compensation Appeals Board (WCAB) rescinded a prior finding that Monica Contreras was an employee of Keller Williams Realty.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. ADJ7707093
Regular
Oct 22, 2013

PORFIRIO CONTRERAS vs. GIBSON FARMS, ZENITH INSURANCE

In this Workers' Compensation Appeals Board case, applicant Porfirio Contreras' Petition for Removal was denied. The Board adopted the reasoning of the Workers' Compensation Administrative Law Judge, finding no basis to grant the removal. The decision indicates the case will proceed without further intervention from the Appeals Board at this stage.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportdeny removalADJ7707093San Jose District OfficeGibson FarmsZenith InsurancePorfirio Contrerasadministrative law judge
References
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. 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. ADJ9782943
Regular
Jan 20, 2016

Felix Contreras vs. County of Fresno

The Workers' Compensation Appeals Board denied Felix Contreras' petition for reconsideration. The Board adopted the judge's report, which found that Contreras' injury did not arise out of and in the course of employment due to the "Going and Coming Rule." The judge found Contreras' testimony regarding his actions at the time of the accident lacked credibility, citing conflicting accounts and evidence that the stated work purpose was already completed. The Board gave great weight to the judge's credibility determinations due to observing the witness demeanor.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJGarza v. Workmen's Comp. Appeals Bd.Going and Coming RuleCourse and Scope of EmploymentCredibility DeterminationsApplicant TestimonyEmployer TestimonyPrior Findings of Fact
References
Case No. ADJ1622633 (VEN 0115623)
Regular
May 15, 2012

SALVADOR CONTRERAS vs. M&C FARM LABOR, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, INTERCARE PASADENA, PAULA INSURANCE

This case involves Salvador Contreras's petition to reopen his workers' compensation claim for new and further disability. The original claim was venued in Ventura/Oxnard, but Contreras filed his reopen petition in Los Angeles. The WCJ denied the petition based on former WCAB Rule 10390, which required filing in the proper district office and did not excuse non-compliance for filing in an incorrect office. The Court of Appeal, however, reversed this decision, holding that current WCAB Rule 10397, which allows filing in any office, applied as a procedural change. The Court also found that even under former Rule 10390, Contreras demonstrated excusable neglect, thus compelling the WCAB to grant reconsideration and return the case for a decision on the merits.

RemittiturPetition to ReopenStatute of LimitationsLabor Code 5410Labor Code 5804WCAB Rule 10390WCAB Rule 10397Excusable NeglectNew and Further DisabilityCourt of Appeal
References
Case No. ADJ7386376, ADJ7096591
Regular
Oct 16, 2015

Jesse Contreras vs. United Airlines

The applicant sought reconsideration of an approved Compromise and Release (C&R) settlement for $73,172.00. Subsequently, both applicant and defendant jointly notified the Board that the applicant wished to withdraw his Petition for Reconsideration and proceed with the original C&R. The Board vacated its previous order granting reconsideration and dismissed the applicant's petition. The case is now returned to the trial level for finalization of the C&R.

Workers' Compensation Appeals BoardJesse ContrerasUnited AirlinesADJ7386376ADJ7096591San Diego District OfficeOpinion and Decision After ReconsiderationOrder Approving Compromise and ReleasePetition for ReconsiderationCompromise and Release Agreement
References
Case No. ADJ7949362
Regular
Dec 14, 2015

DANIEL CONTRERAS vs. GHILOTTI BROTHERS INCORPORATED, ZURICH

This case involves a petition for reconsideration filed by a petitioner that was subsequently withdrawn. The Workers' Compensation Appeals Board has issued an order dismissing the petition due to its withdrawal. Therefore, the appeal proceeding is terminated as per the petitioner's request.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissedWithdrawnGhilotti Brothers IncorporatedZurichDaniel ContrerasADJ7949362San Francisco District OfficeMarguerite Sweeney
References
Case No. ADJ7091661
Regular
Apr 02, 2014

JOSE CONTRERAS vs. SPECIALTY MEATS, INC., TRAVELERS CASUALTY & SURETY COMPANY, COMPWEST INSURANCE COMPANY

This case involved Jose Contreras alleging a continuous trauma injury to multiple body parts while employed as a butcher. The Workers' Compensation Appeals Board denied his Petition for Reconsideration, adopting the findings of the administrative law judge (WCJ). The WCJ found no industrial injury, relying on Qualified Medical Evaluator (QME) reports that attributed the conditions to pre-existing or degenerative issues. The WCJ also found Contreras to be not credible due to inconsistencies and similarity to prior claims, and denied his attempt to elect against a specific defendant on the trial date.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJIndustrial injuryFinal orderRemovalSpecialty MeatsInc.Travelers Casualty & Surety CompanyCompWest Insurance Company
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
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