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

Case No. ADJ7110663
Regular
May 09, 2016

WILLIAM BO MATTHEWS vs. SAN DIEGO CHARGERS, ZENITH INSURANCE COMPANY, NEW YORK GIANTS, INSURANCE COMPANY OF NORTH AMERICA/ACE USA, DENVER GOLD, THE NORTH RIVER INSURANCE COMPANY

This case involves a petition for reconsideration of an arbitrator's decision regarding workers' compensation liability for a professional football player's cumulative trauma injuries. The Workers' Compensation Appeals Board (WCAB) granted reconsideration and modified the arbitrator's award, finding the applicant sustained two separate cumulative trauma injuries due to distinct periods of employment exposure. Consequently, the WCAB ruled that the petitioner, Insurance Company of North America/ACE USA (ESIS), is not liable for contribution to another insurer, The North River Insurance Company (NRIC), which had mistakenly paid a portion of a settlement. The Board affirmed the finding of two injuries, citing a significant break in employment as creating separate compensable periods, but rescinded the award to NRIC, holding NRIC should recover nothing from ESIS.

WCABPetition for ReconsiderationArbitration DecisionContributionCumulative InjuryProfessional Football PlayerInsurance Company of North America/ACE USAZenith Insurance CompanyThe North River Insurance CompanyLabor Code Section 5500.5
References
Case No. ADJ3393930 (AHM 0089017) ADJ2735537 (AHM 0094395)
Regular
May 06, 2013

DAVID CARMONA vs. BMW OF NORTH AMERICA, ZURICH NORTH AMERICA, FIREMAN'S FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration in *Carmona v. BMW of North America*, finding the Workers' Compensation Judge's (WCJ) report insufficient. The WCAB rescinded the WCJ's prior decision and returned the case for further proceedings and a new decision. While the WCJ intended to correct a clerical error regarding cumulative trauma dates, the WCAB felt further development of the record was needed on temporary total disability, but not apportionment related to Dr. Stewart. This is not a final decision on the merits.

DAVID CARMONABMW OF NORTH AMERICAZURICH NORTH AMERICAFIREMAN'S FUNDWORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONADMINISTRATIVE LAW JUDGECLERICAL ERRORCUMULATIVE TRAUMATEMPORARY TOTAL DISABILITY
References
Case No. ADJ4634338 (MON 0262377)
Regular
Jun 24, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

This case concerns a dispute over contribution claims following a cumulative injury to the applicant. The Workers' Compensation Appeals Board granted reconsideration, rescinded an arbitration finding, and remanded the matter for further proceedings. The Board found that Sedgwick, which paid over $180,000 in benefits, was not required to file a petition for contribution under section 5500.5 because it was not a signatory to the Compromise and Release (C&R). Furthermore, the Board held that even if Sedgwick had been required to file, the co-defendant CNA would be estopped from asserting the statute of limitations due to stipulations in the C&R reserving contribution rights. The Board concluded Sedgwick's claim for reimbursement was not time-barred.

Workers' Compensation Appeals BoardNina GoodrichUnilabQuest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.CNA ClaimsplusValley Health SystemsTristar Risk ManagementZurich Insurance Co.
References
Case No. ADJ9414071 ADJ10133403
Regular
Aug 13, 2018

Kevin McCoy vs. State of California - Pleasant Valley State Prison

This case involves an appeal regarding the permanent disability ratings for a correctional officer's right ankle and respiratory system (Valley Fever) injuries. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case to the WCJ for further proceedings. The Board found that the Agreed Medical Examiner's (AME) ankle impairment rating was properly calculated, but the Qualified Medical Examiner's (QME) report on the respiratory injury did not sufficiently explain its deviation from strict AMA Guides application. The Board emphasized that medical evaluators must adhere to the AMA Guides or clearly justify any deviations to ensure substantial evidence.

WCABPleasant Valley State Prisonlegally uninsuredState Compensation Insurance FundKevin McCoyADJ9414071ADJ10133403permanent disabilityright anklerespiratory system
References
Case No. ADJ4634338 (MON 02262377) ADJ614711 (MON 0288710)
Regular
Dec 07, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

Zurich's petition for reconsideration of the June 24, 2009 Opinion and Order Granting Reconsideration and Decision After Reconsideration is denied for the reasons stated in prior opinions.

Workers' Compensation Appeals BoardNina GoodrichUnilab/Quest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.Valley Health SystemsTristar Risk ManagementZurich Insurance Co.Labor Code section 5500.5Arbitration Finding of Facts
References
Case No. ADJ3765992 (SRO 0132531) ADJ2072207 (SRO 0140061)
Regular
Apr 29, 2009

Lorraine O'Keefe vs. Surgical Staff North, Inc., CAL COMP, In Liquidation, CIGA, Adjusted by BROADSPIRE, COMMUNITY HOSPITAL OF MONTEREY PENINSULA, Permissibly Self-Insured, Adjusted by CLAIMS MANAGEMENT, INC. (ADJ3765992), QUEEN OF THE VALLEY HOSPITAL, Permissibly Self-Insured, Adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICE (ADJ2072207)

This case involves applicant Lorraine O'Keefe's workers' compensation claims for left knee injury. The Workers' Compensation Appeals Board denied reconsideration of the finding that applicant sustained an industrial injury on December 15, 1999, while employed by Community Hospital of the Monterey Peninsula (CHOMP). However, the Board granted reconsideration regarding attorney fees, rescinding the prior award against CHOMP. The issue of CHOMP's liability for applicant's attorney fees under Labor Code section 4064(c) will be returned for further proceedings due to insufficient notice.

Workers' Compensation Appeals BoardSurgical Staff NorthCal CompCIGACommunity Hospital of Monterey PeninsulaClaims Management Inc.Queen of the Valley HospitalSedgwick Claims Management ServiceFindings Award OrdersPetition for Reconsideration
References
Case No. ADJ3605789 (GOL 0101314) ADJ2387995 (GOL 0101316) ADJ460036 (GOL 0101615)
Regular
Dec 12, 2011

JORGE VIVANCO vs. NEVERLAND VALLEY RANCH, ESTATE OF MICHAEL JACKSON, MJJ PRODUCTIONS, TRAVELERS INDEMNITY, UNITED STAFFING ASSOCIATES, AMERICAN HOME ASSURANCE COMPANY, MONARCH CONSULTING dba PES PAYROLL, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation applicant claiming injuries while employed as a zookeeper for Neverland Valley Ranch and other entities. The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior findings, and returned the case for further proceedings. The Board found that the trial judge erred by excluding evidence related to employment agreements under the parol evidence rule, which is relevant to determining employer status. Further development of the record is required to properly address the applicant's employment relationships with the defendant entities.

Workers' Compensation Appeals BoardJorge VivancoNeverland Valley RanchMichael JacksonMJJ ProductionsTravelers IndemnityUnited Staffing AssociatesAmerican Home Assurance CompanyMonarch ConsultingPES Payroll
References
Case No. ADJ6652737
Regular
Nov 16, 2017

ANTRON LEE vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION, PLEASANT VALLEY STATE PRISON, legally uninsured, administered by STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration, rescinded the previous decision, and returned the case to the trial level for further proceedings. The Board found the deposition transcript of the Agreed Medical Examiner, Dr. Markovitz, should have been admitted into evidence. Crucially, the record lacked substantial evidence to determine the date(s) of injury for the applicant's Valley Fever and alleged heart condition. Additionally, the Board noted Valley Fever likely qualifies for the Labor Code Section 3212.10 pneumonia presumption.

Valley FeverCoccidioidomycosisPresumptionLabor Code Section 3212.10Date of InjuryCumulative TraumaAgreed Medical Examiner (AME)ReconsiderationPetitionPermanent Partial Disability
References
Case No. ADJ10481568
Regular
Jul 01, 2019

JUAN MARTINEZ vs. CAL CENTRAL HARVESTING, STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed Juan Martinez's petition for reconsideration because it was filed untimely. California law mandates petitions for reconsideration be filed within 25 days of the WCJ's decision being served by mail. Proof of mailing is insufficient; the petition must be received by the WCAB within the statutory timeframe. As the petition was filed more than 25 days after the April 24, 2019 decision, the WCAB lacked jurisdiction to consider it.

Petition for ReconsiderationUntimelyDismissedJurisdictionalWCAB Rule 10508WCJProof of MailingService by MailAdministrative Law JudgeFinal Decision
References
Case No. ADJ3262016
Regular
Sep 18, 2015

BETTY DYKEMAN vs. WALNUT VALLEY UNIFIED SCHOOL DISTRICT, VALLEY INSURANCE PROGRAM

This case involves Betty Dykeman's workers' compensation claim against Walnut Valley Unified School District for a 1992 back injury. The School District sought reimbursement from a lien claimant, Monrovia Memorial Hospital, for an alleged overpayment of medical services provided in 2009. The Workers' Compensation Appeals Board denied reconsideration, adopting the WCJ's report. The WCJ denied the reimbursement claim due to insufficient and conflicting evidence regarding the value of the medical services and the amount of the alleged overpayment.

Petition for ReconsiderationWorkers' Compensation Appeals BoardWalnut Valley Unified School DistrictYork Risk Services GroupLien ClaimantMonrovia Memorial HospitalPetition for ReimbursementStipulated AwardMedical TreatmentSurgery
References
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