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

Case No. ADJ7049850 ADJ7289794 ADJ7523255
Regular
May 11, 2015

FREDDIE B. GUZMAN vs. MARTENS CHEVROLET, EMPLOYERS COMPENSATION INSURANCE COMPANY

This case involves an applicant seeking reconsideration of an order denying his petition to enforce an award for out-of-pocket medical and travel expenses. The Workers' Compensation Appeals Board granted the petition for reconsideration, finding the applicant was denied due process. The Board rescinded the prior order and returned the matter for further proceedings and a new decision, noting the applicant's right to a hearing was violated. This decision allows for a proper hearing to address the disputed reimbursement claims.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition to Enforce AwardSelf-Procured TreatmentOut-of-Pocket ExpensesDue ProcessWCJ OrderHearing DenialMedical Expenses ReimbursementTravel Expenses Reimbursement
References
Case No. ADJ1191098 (VNO 0328222)
Regular
Nov 19, 2012

EDWIN GEORGE vs. ROWLETT'S TOWING, INC., STATE COMPENSATION INSURANCE FUND

This case concerns applicant Edwin George's petition for reconsideration of a workers' compensation award. The Appeals Board denied reconsideration, affirming the administrative law judge's findings that the defendant unreasonably delayed temporary disability payments and out-of-pocket expenses, warranting penalty increases. However, the Board rejected the applicant's claims for additional penalties related to transportation issues, a single-story residence, and other requested medical services, finding the delays and denials were not unreasonable under the law. The Board also encouraged the applicant's counsel to manage the case for the client's best interest rather than solely maximizing penalties.

Workers' Compensation Appeals BoardSupplemental Findings and AwardTemporary DisabilityStipulated AwardLabor Code section 5814Labor Code section 5814.5attorney's feesout-of-pocket expensesbariatric surgeryutilization review
References
Case No. ADJ4659072 (FRE 0250287)
Regular
May 23, 2018

JIM WILLIAMS vs. INTERSTATE DISTRIBUTING, INC., ZURICH AMERICAN INSURANCE CO., ZURICH NORTH AMERICA

This case involves a defendant's petition for reconsideration of an administrative law judge's (WCJ) order awarding penalties for delayed permanent disability benefits and out-of-pocket expense reimbursement, along with attorney's fees. The Workers' Compensation Appeals Board (WCAB) granted reconsideration. The WCAB affirmed the penalty for delayed permanent disability payments, finding that the off-calendar orders did not resolve penalties accrued after the initial award. However, the WCAB amended the order to defer the issue of out-of-pocket expense reimbursement penalties, returning the matter to the WCJ for further proceedings on that specific issue.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactAdministrative Law JudgePenaltyPermanent Disability BenefitsOut-of-pocket ExpensesLabor Code Section 5814Labor Code Section 5814.5Mandatory Settlement Conference
References
Case No. ADJ9522703
Regular
Jul 04, 2018

MAYRA MENDOZA vs. SAFEWAY, INC., ALBERTSONS HOLDINGS

This case concerns whether applicant's medical mileage and self-procured medical expenses were included in a prior Compromise and Release (C&R) agreement. The applicant sought reconsideration of the WCJ's finding that these expenses were resolved by the C&R. The Appeals Board affirmed the WCJ's decision, finding that the plain language of the C&R explicitly included medical mileage and self-procured medical treatment as resolved issues within the settlement amount. Therefore, the applicant's subsequent claims for these expenses were denied.

Workers' Compensation Appeals BoardReconsiderationCompromise and ReleaseWCJLabor Code section 5813medical mileageout-of-pocket medical expensesself-procured medical treatmentindustrial injurychecker/stocker
References
Case No. ADJ1702542 (SAC 0342687)
Regular
Nov 04, 2010

EUGENE C. TREASTER vs. LAW OFFICES OF EUGENE C. TREASTER, STATE COMPENSATION INSURANCE FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The applicant seeks reconsideration of a stipulated award that limited him to 30 days to submit self-procured medical expenses. He argues he was unaware Kaiser billings and Medicare records would take longer to obtain. The Appeals Board granted reconsideration, finding the applicant's inability to meet the deadline due to unforeseen circumstances warrants further review. The case is returned to the trial level to determine if good cause exists to relieve the applicant from the stipulation.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulationsSelf-procured medical expensesGood causeRescinded awardTemporary disabilityPermanent disabilityIndustrial injuryWCJ
References
Case No. ADJ4157637
Regular
Mar 18, 2010

BEATRICE WEISS vs. TECHNOLOGY FUNDING, LUMBERMEN'S MUTUAL CASUALTY COMPANY, BROADSPIRE, a CRAWFORD COMPANY

This case involves an applicant who sustained a spinal injury in 2000 and was awarded permanent total disability and ongoing medical treatment, including assisted living. The Workers' Compensation Appeals Board (WCAB) clarified that the applicant is entitled to full reimbursement for assisted living costs incurred after exhausting long-term care insurance, as medical treatment for industrial injuries is not apportionable, even if concurrent non-industrial conditions exist. However, the WCAB reversed an award for personal duty aides, finding insufficient evidence of their necessity due to the industrial injury, and denied claims for interest on unpaid bills and guardianship costs. The WCAB affirmed reimbursement for dental expenses necessitated by medication for the industrial injury, while excluding attorney fees for enforcing treatment denials.

Workers' Compensation Appeals BoardBeatrice WeissTechnology FundingLumbermen's Mutual Casualty CompanyBroadspireCrawford CompanyADJ4157637SFO 0445495Opinion and Decision After Reconsiderationpermanent total disability
References
Case No. POM 0272006
Regular
Jun 24, 2008

ZERITA JONES vs. ALBERTSONS, Permissibly Self-Insured, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board granted reconsideration of the WCJ's decision, affirming the finding of industrial injury to the applicant's left foot. The Board amended the original findings to explicitly include an industrial injury to the applicant's lower back, finding this issue was properly litigated by the parties. While the applicant's contentions regarding penalties and out-of-pocket expenses were noted, the Board directed those issues to be resolved informally or through further proceedings if necessary.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryLeft Foot InjuryLower Back InjuryPermanent DisabilityApportionmentNon-Industrial FactorsMedical Opinion
References
Case No. ADJ218106 (VNO 0430348)
Regular
Mar 09, 2009

TODD RIGIONE vs. CINECOM COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves applicant Todd Rigione's petition for reconsideration or removal. Rigione alleged fraud or mistake in a prior order taking the matter off calendar and awarding $200 for out-of-pocket expenses. The Appeals Board dismissed the Petition for Reconsideration because the prior order was an interlocutory procedural one, not a final determination of substantive rights. The Board also denied removal, finding no evidence of substantial prejudice or irreparable harm to the applicant.

WCABRigioneCinecom CompanyState Compensation Insurance FundADJ218106Petition for ReconsiderationRemovalOff calendarJoint requestOut-of-pocket expenses
References
Case No. ADJ8061002
Regular
Oct 29, 2014

EVELYN MENCOS vs. JC PENNEY CORPORATION, INC., NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA

In *Mencos v. JC Penney Corporation*, the Workers' Compensation Appeals Board (WCAB) granted reconsideration to review a decision awarding the applicant temporary and permanent disability for a low back injury. The Board affirmed the finding that the employer was not prejudiced by the applicant's delayed reporting of the injury. However, the WCAB deferred the issue of reimbursement for self-procured medical treatment in Guatemala pending further record development regarding reasonableness and necessity, and proof of out-of-pocket expenses. The Board also amended the award to correct clerical errors regarding the date of injury and the insurer's name.

Workers' Compensation Appeals BoardEvelyn MencosJC Penney CorporationNational Union Fire Insurance CompanyPetition for ReconsiderationFindings and AwardIndustrial InjuryLow Back InjurySupervisorTemporary Disability
References
Case No. SFO 0438557 SFO 0438562
Regular
May 05, 2008

LISA BURKE vs. WINTERLAND PRODUCTIONS, HARTFORD INDEMNITY & ACCIDENT COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address whether reimbursed expenses should be included in calculating an applicant's temporary disability indemnity rate. The Board reversed the prior award, ruling that reimbursed expenses for meals, lodging, and fuel are special expenses, not remuneration, and therefore should not be included in calculating the applicant's average weekly wage. The decision clarifies that such reimbursements do not constitute "advantages received by the injured employee as part of his remuneration" under Labor Code section 4454.

Workers' Compensation Appeals BoardTemporary Disability IndemnityReimbursed ExpensesEarnings CalculationLabor Code Section 4454RemunerationSpecial ExpensesAverage Weekly WageCumulative TraumaConcert Tour Salesperson
References
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