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Case Law Database

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

Case No. ADJ17819410; ADJ17819411
Regular
Jul 07, 2025

GUILHERME GUIMARAES vs. COUNTY OF LOS ANGELES, SEDGWICK

Defendant County of Los Angeles sought reconsideration of a Joint Findings and Award issued on March 18, 2025, by a Workers' Compensation Administrative Law Judge (WCJ). The WCJ had ruled that applicant Guilherme Guimaraes was entitled to separate salary continuation benefits under Labor Code section 4850 for two distinct injuries, even if some periods of disability overlapped. The defendant contended that the WCJ erred in awarding a separate period of benefits, arguing that the existence of common body parts between claims should disqualify the applicant from additional benefits once the initial 52 weeks were paid. The Workers' Compensation Appeals Board, after reviewing the arguments and the WCJ's report, denied the petition for reconsideration. The Board affirmed the WCJ's reasoning, emphasizing that entitlement to Section 4850 benefits is determined by the time period and reason for disability per claim, consistent with wage replacement policy, rather than merely by overlapping body parts.

Labor Code section 4850Salary continuation benefitsCumulative traumaSpecific injuryOverlapping disabilityConcurrent disabilityWage replacementTemporary total disabilityFoster v. Workers' Comp. Appeal Bd.Joint Findings and Award
References
4
Case No. ADJ6779197, ADJ7472140, ADJ7964720
Regular
Feb 27, 2014

ISMAEL NAVARRO vs. CITY OF MONTEBELLO, CORVEL CORPORATION

This case concerns whether an applicant must return to the same Qualified Medical Evaluator (QME) for subsequent injury claims. The defendant argued that under Rule 35.5(e), the applicant should be evaluated by the original QME due to overlapping body parts and parties. The Appeals Board granted removal, intending to hold that the Labor Code does not require return to the same QME for new claims. Furthermore, the Board proposes that Rule 35.5(e)'s requirement to use the same QME for new injuries with the same body parts is inconsistent with the Labor Code and thus invalid. The Board is seeking further input from parties and the Division of Workers' Compensation before issuing a final en banc decision.

Workers' Compensation Appeals BoardRemovalFindings of FactQualified Medical EvaluatorRule 35.5(e)Labor CodeEn Banc DecisionCumulative InjurySpecific InjuryClaim Form
References
19
Case No. ADJ14263093
Regular
Apr 12, 2023

CECILIA OJEDA vs. AMY'S KITCHEN, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

Here's a summary of the case for a lawyer: The applicant claimed cumulative injury to her neck, bilateral wrists, shoulders, and upper extremities, which the employer initially denied for all body parts except the neck. The WCJ found injury to all claimed body parts, relying on treating physicians' reports, and found the QME's reports unsubstantial due to inconsistencies and admissions of uncertainty during deposition. The defendant sought reconsideration, arguing the QME's opinion was substantial evidence regarding injured body parts and permanent disability. The Appeals Board denied reconsideration, adopting the WCJ's reasoning that the QME's testimony was too speculative and contradictory to constitute substantial evidence for the disputed body parts.

AOE/COEPetition for ReconsiderationFindings and AwardOrthopedic Qualified Medical Examiner (QME)Substantial EvidenceCumulative InjuryBilateral WristsBilateral ShouldersBilateral Upper ExtremitiesCervical Radiculopathy
References
3
Case No. 13-71700
Regular Panel Decision

Board of Trustees v. Kern (In re Kern)

The Plaintiffs, the Board of Trustees of benefit funds under ERISA, sought to declare debts owed by Defendant Richard Kern, principal owner of Cool Sheetmetal, Inc. (CSI), non-dischargeable in bankruptcy. The core issue was whether monies deducted from employee paychecks but not remitted to the benefit funds constituted non-dischargeable debts under § 523(a)(4) and (6) of the Bankruptcy Code. The Court ruled that monies deducted for a vacation fund are non-dischargeable because they were subject to a statutory trust, Kern acted as a fiduciary, and committed defalcation. However, deductions for union assessments and political action league (PAL) funds were deemed dischargeable, as no statutory trust was established for these. Furthermore, the Plaintiffs' claim under § 523(a)(6) for willful and malicious injury was dismissed. The Court granted summary judgment in part for Plaintiffs regarding the Vacation Fund deductions, with the exact amount to be determined at trial, and granted summary judgment in part for Defendant on the other claims.

BankruptcyNon-dischargeabilityERISAFiduciary DutyDefalcationSummary JudgmentEmployee ContributionsVacation FundUnion AssessmentsPolitical Action League (PAL)
References
10
Case No. ADJ10771579
Regular
Aug 08, 2018

Gabriel Ruano vs. Mayekawa USA, SOMPO JAPAN INSURANCE COMPANY OF AMERICA, BROADSPIRE

This case involved a worker claiming industrial injury to multiple body parts. The Appeals Board granted the employer's petition for reconsideration to correct the Findings of Fact. The Board amended the Findings to accurately reflect all injured body parts, including the psyche, and removed an incorrectly listed body part. Ultimately, the Board affirmed the original decision with these specified amendments.

Petition for ReconsiderationFindings of Factsubstantial evidencemedical reportsprimary treating physicianBal S. Grewal Ph.D.Report and Recommendationinjured body partspsychecervical spine
References
0
Case No. ADJ9312928
Regular
Sep 11, 2019

Jeffrey DaVanon vs. Oakland Athletics, ACE Insurance Company, Sedgwick Claims Management

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration. The applicant, a former professional athlete, claimed cumulative trauma injury to multiple body parts, including gastrointestinal issues, neurological problems, and a sleep disorder not initially identified. The Board found that the WCJ erred by excluding medical evidence for these later-identified body parts, as they were included in the parties' stipulations and could have arisen or worsened after the applicant's deposition. The case is returned for further proceedings, allowing admission of relevant medical records and deferring final decisions on disputed body parts and permanent disability.

Mandatory Settlement ConferencePetition for ReconsiderationCumulative TraumaProfessional AthleteStatute of LimitationsLabor Code Section 5405Labor Code Section 5412Discovery CloseBifurcationIndependent Medical Evaluator
References
6
Case No. ADJ7288330
Regular
Oct 03, 2016

GLORIA BENITEZ vs. NEWPORT SUBACUTE HEALTH CARE CENTER, ALASKA NATIONAL INSURANCE COMPANY

The applicant, Gloria Benitez, sought to reopen her workers' compensation claim to include injury to additional body parts beyond her cervical spine and psyche. The original award found injury only to the cervical spine and psyche, with a 19% permanent disability rating for the cervical spine. While the WCJ's initial decision denied injury to additional body parts, the Board granted reconsideration. The Board amended the original findings to defer the issue of injury to the alleged additional body parts, while affirming other aspects of the WCJ's order, including the appointment of a regular physician to evaluate new and further disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderNew and Further DisabilityAgreed Medical ExaminerRegular PhysicianLabor Code Section 5410Petition to ReopenIndustrial InjuryCervical Spine
References
4
Case No. ADJ18492736
Regular
Sep 30, 2025

MARIA HERNANDEZ vs. VALLARTA FOOD ENTERPRISES, INC.; SAFETY NATIONAL CASUALTY CORPORATION

The Workers' Compensation Appeals Board reviewed a petition for reconsideration filed by Safety National Insurance, challenging a WCJ's finding that Maria Hernandez sustained injury to multiple body parts. The Board found the treating physician's report lacked substantial medical evidence due to inadequate records and a flawed job description. Additionally, the Qualified Medical Evaluator's (QME) reports were incomplete and inconsistent regarding all body parts except the left hand. Consequently, the Board granted reconsideration, rescinded the original decision, and substituted new findings, determining that Hernandez sustained a cumulative injury only to her left hand while deferring the issue of injury to other body parts for further development of the record.

WCABPetition for ReconsiderationFindings of Fact and Ordersubstantial medical evidenceQualified Medical Evaluator (QME)cumulative traumabilateral shoulderswristshandsleft hand injury
References
19
Case No. MON 313615; MON 312443; MON 315655; MON 315656
Regular
Sep 11, 2007

BRUCE BALBIRNIE vs. CITY OF LONG BEACH

The Workers' Compensation Appeals Board denied reconsideration, upholding the finding of 74% permanent disability for the applicant fire captain. The Board found that the defendant employer failed to meet its burden of proof to demonstrate overlap with prior awards, citing that prior awards lacked specific work restrictions and applied to different body parts. The Court affirmed that the employer must prove the extent of overlap between prior and current disabilities to justify apportionment.

Workers' Compensation Appeals BoardReconsideration DeniedFire CaptainIndustrial InjuryInternal OrgansHypertensionCervical SpineLumbosacral SpineRight KneeHearing Loss
References
4
Case No. ADJ9767947
Regular
Jan 18, 2017

GILBERT PEREZ vs. ABC SHEET METAL, LIBERTY MUTUAL INSURANCE

This case involves an applicant who sustained industrial injury to his left knee and abdomen. The trial judge initially found injury to these parts but also found no injury to back, psyche, lower extremities, and stress, which the applicant appealed. The appellate court annulled the denial of reconsideration, finding the trial judge improperly ruled on body parts not fully at issue. The Appeals Board rescinded the negative finding, deferred the issue of additional injured body parts, and remanded for further proceedings to determine if injury to other parts occurred.

WCABindustrial injurywelderleft kneeabdomenbackpsychelower extremitiesstressCourt of Appeal
References
0
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