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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ1952983
Regular
Mar 15, 2018

JUAN RIVERA vs. IMPORT EXPORT CACTUS, STATE COMPENSAITON INSURANCE FUND

In this workers' compensation case, the defendant sought reconsideration of a prior ruling that deemed them to have waived objections to a specific invoice from lien claimant Scandoc Imaging. The WCAB denied reconsideration, finding that the defendant's objection, if any, was untimely, having been filed approximately four years after the invoice was submitted. California regulations require objections to medical-legal billings within 60 days to avoid waiver. Therefore, the defendant waived their objections to the reasonableness of the services and charges for invoice #234447-3.

WCABPetition for ReconsiderationFindings and Orderslien claimantinvoice objectionwaiver of objectionreasonableness of servicesLabor Code section 4622Scandoc ImagingImport Export Cactus
References
Case No. ADJ6884625
Regular
Jun 19, 2012

JASON PETERSON, KIRSTIE MCCRAINE-PETERSON vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

This case concerns the death of Jason Peterson, a correctional officer, from a pulmonary embolism after injuring his calf in a kickboxing class. The applicant, his widow, claimed the injury and death were work-related, arguing the kickboxing class was a reasonable expectancy of employment due to a general fitness requirement and incentive program. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's decision, finding the claim barred by Labor Code Section 3600(a)(9) because the decedent's belief that kickboxing was required was not objectively reasonable, as mere general assertions of fitness expectations are insufficient. Commissioner Brass dissented, believing the decedent's participation was both subjectively and objectively reasonable given its likely benefit to his job performance as a correctional officer.

Labor Code Section 3600(a)(9)Pulmonary EmbolismCorrectional OfficerKickboxingOff-duty Recreational ActivityReasonable Expectancy of EmploymentSubjective BeliefObjective ReasonablenessEzzy testCity of Stockton v. Workers' Comp. Appeals Bd. (Jenneiahn)
References
Case No. ADJ6669630
Regular
Jul 23, 2018

ROBERT SAXTON vs. SELECT A SERVICE RETAIL, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision regarding a lien claim by Western Imaging Services for copying services. The WCAB found that for most invoices, the defendant waived objections to reasonableness due to untimely and invalid objections. However, the WCAB noted potential issues with two specific invoices (82003-7 and 82003-8) and deferred the final determination of reimbursement for these and other contested invoices. The matter was returned to the administrative law judge for further proceedings on the validity of those specific invoices.

Workers' Compensation Appeals BoardLien ClaimantPetition for ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeReimbursementFee ScheduleObjectionsInvoicesReasonable and Necessary
References
Case No. ADJ8334555
Regular
Apr 05, 2013

JOSE HERNANDEZ vs. BRYAN MIMAKI dba PACIFIC RIMS, PALMS; ZENITH INSURANCE COMPANY

This case concerns whether a knee injury sustained by an employee, Jose Hernandez, while playing basketball on company premises during lunch is compensable. The defendant argued the injury did not arise out of employment, as it stemmed from voluntary participation in an athletic activity not required by the employer. The Appeals Board denied reconsideration, affirming the finding that the injury was industrial. The majority found the employee's subjective belief of employer expectation was objectively reasonable, given the employer provided a court and balls and supervisors encouraged participation. Commissioner Lowe dissented, arguing the applicant failed to demonstrate an objectively reasonable belief of employer expectation, as he could opt out and faced no repercussions.

Workers' Compensation Appeals BoardIndustrial InjuryRight KneeField WorkerBasketball GameOff-Duty Recreational ActivityLabor Code Section 3600(a)(9)Reasonable Expectancy of EmploymentSubjective BeliefObjective Reasonableness
References
Case No. ADJ4225434 (LAO0864755)
Regular
Dec 10, 2008

CHING YEN vs. C & C INTERNATIONAL GROUP, STATE COMPENSATION INSURANCE FUND

This case involves an applicant injured in a car accident while traveling to a wedding with her employer. The applicant claimed her participation in the trip was a reasonable expectancy of her employment as an account assistant, which involved driving and travel. The Board denied reconsideration of the workers' compensation judge's finding that the injury was industrial, determining the applicant's subjective belief of being required to attend the trip was objectively reasonable given her job duties and her employer's direction.

Workers' Compensation Appeals BoardIndustrial InjuryReasonable ExpectancyOff-duty recreational activitySubjective beliefObjectively reasonableMotor vehicle accidentAccount assistantCommercial travelSpecial mission
References
Case No. ADJ7348520, ADJ7343936, ADJ7321306
Regular
Oct 25, 2016

Mauricio Arciniega vs. Santa Monica Seafood Company, Compwest Insurance Company

This case involves a lien claimant, Med-Legal Photocopy, seeking payment for subpoenaed medical records. The defendant objected to the lien on grounds of unreasonable necessity, but their objections were untimely and inadequately raised. The Appeals Board rescinded the prior decision disallowing the lien and remanded the case. This will allow the trial judge to determine the amount due to the lien claimant, as the defendant is precluded from objecting to the reasonableness and necessity of the expenses due to their procedural failures. However, the cost of a consultative rating obtained by the lien claimant is not a recoverable medical-legal expense.

Med-Legal PhotocopyReconsiderationDisallowed LienContested ClaimLabor CodeMedical-Legal ExpensesSubpoenaReasonablenessNecessityObjection
References
Case No. ADJ1543782 (VNO 0540728)
Regular
May 27, 2009

Richard E. Knudsen vs. CITY OF BEVERLY HILLS

The Workers' Compensation Appeals Board granted reconsideration, reversing a previous decision that denied benefits for a police officer's shoulder injury. The Board found the injury sustained in the on-duty gym was industrial because the applicant's belief that working out was expected was objectively reasonable, given the employer provided gym facilities and allowed officers to stay overnight for safety and duty readiness. The injury is now considered a compensable industrial injury.

Workers' Compensation Appeals BoardCity of Beverly Hillspolice officeroff-duty injuryindustrial injuryreasonable expectancypersonal comfort doctrineexertional injurygym workoutpremises
References
Case No. ADJ9244317
Regular
May 01, 2017

RAMON FRANCO vs. VERIZON/FRONTIER COMMUNICATIONS, NATIONAL UNION FIRE INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior decision disallowing a lien claim for imaging services. The WCAB found that the trial judge erred by prematurely determining the services were not reasonable or necessary without first fully addressing whether a "contested claim" existed when services were rendered. The Board remanded the case for further proceedings to determine if the claim was contested and if proper objection procedures were followed by the defendant. The WCAB also clarified that the fee schedule for copying services does not apply to services rendered before July 1, 2015.

Contested claimMedical-legal expenseLien claimantPetition for reconsiderationFindings and OrderLabor Code section 4620Labor Code section 4622Reasonableness of servicesNecessity of servicesObjection timeliness
References
Case No. ADJ7850439
Regular
Oct 15, 2012

Edgar Tabo vs. CITY AND COUNTY OF SAN FRANCISCO POLICE DEPARTMENT

The applicant, a police officer, injured himself in an off-duty bicycle crash. The Board denied compensation because the applicant failed to establish that his subjective belief of needing to train for an optional bicycle patrol course was objectively reasonable. His off-duty recreational activity did not meet the requirements for an exception to the exclusion for such injuries under Labor Code section 3600(a)(9). Therefore, the applicant takes nothing by way of his claim.

Workers' Compensation Appeals BoardEdgar TaboCity and County of San Francisco Police DepartmentPermissibly Self-InsuredADJ7850439Oakland District OfficeOpinion and Order Granting ReconsiderationFindings and AwardWCJindustrial injury
References
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