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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. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ2038785 (VNO 0426080), ADJ900602 (VNO 0426045), ADJ2562931 (VNO 0494371), ADJ7032939, ADJ7045667
Regular
Aug 01, 2019

JOSEPH PROTHRO vs. STATE COMPENSATION INSURANCE FUND as administered by ACCLAMATION INSURANCE MANAGEMENT SERVICES

This Workers' Compensation Appeals Board case, involving multiple claim numbers for Joseph Prothro against State Compensation Insurance Fund, has been granted reconsideration. The Board rescinded the prior WCJ's decision because a settlement has been proposed. The case is now returned to the WCJ to evaluate the settlement, with the option to reinstate the original decision if the settlement is not approved. This decision is not a final determination on the merits.

Workers' Compensation Appeals BoardPetition for ReconsiderationGrant ReconsiderationRescind DecisionReturn to Trial LevelWorkers' Compensation Administrative Law JudgeProposed SettlementApproval of SettlementReinstating Original DecisionFinal Decision
References
Case No. ADJ3346924
Regular
Oct 02, 2013

JORGE RAMIREZ vs. BOARD FORD, PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of the Administrative Law Judge's (ALJ) prior decision. The WCAB rescinded the ALJ's decision and remanded the case back to the trial level for further proceedings and a new decision. This action means the original decision is nullified, and the case will be re-evaluated by the ALJ. The parties retain the right to seek further reconsideration of any future ALJ ruling.

WORKERS' COMPENSATION APPEALS BOARDOPINION AND ORDER GRANTING RECONSIDERATIONDECISION AFTER RECONSIDERATIONPetition for Reconsiderationworkers' compensation administrative law judgeWCJgrant reconsiderationrescind WCJ's decisionfurther proceedingstrial level
References
Case No. ADJ9398863
Regular
Mar 03, 2016

JULIA GALICIA vs. CHRISTOPHER AND JAIME SIMON, STATE FARM INSURANCE

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration because it was filed late and sought review of an interlocutory, procedural decision, not a final order. The WCAB also denied the petition for removal, finding no showing of substantial prejudice or irreparable harm that reconsideration could not remedy. The WCJ's report, which the WCAB adopted, correctly determined that the applicant was not entitled to a QME panel in chiropractic, as the primary treating physician was an M.D. and the applicant failed to provide sufficient documentation for a different specialty, thus a QME panel in orthopedics was appropriate. The WCJ's decision was based on regulations requiring documentation for requests outside the treating physician's specialty and the medical nature of the injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for Removalfinal ordersubstantive right or liabilitythreshold issueinterlocutory procedural decisionevidentiary decisionsubstantial prejudiceirreparable harm
References
Case No. ADJ7199986 ADJ7399845
Regular
Oct 03, 2011

ELMIRA SMITH vs. PACIFIC AUTISM CENTER FOR EDUCATION, TRI- STAR RISK MANAGEMENT

The applicant sought removal to challenge a finding that defendant's requested Qualified Medical Evaluator (QME) panel was properly assigned. The Appeals Board granted removal, rescinded the finding, and determined that *neither* panel was properly assigned. Both panel requests were found to be premature as they were made before the statutory 10-day period for agreeing on an Agreed Medical Evaluator had expired, plus an additional five days for mail service. This decision clarifies the timing requirements for QME panel requests following an unsuccessful attempt to select an AME.

Petition for RemovalQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Labor Code section 4062.2(b)WCAB Rule 10507Messele v. Pitco FoodsInc.Premature RequestPanel AssignmentMedical Unit
References
Case No. ADJ7532290
Regular
Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

This case involves a dispute over obtaining a Qualified Medical Evaluator (QME) panel. The applicant requested a new panel because a QME on the initial panel could not provide an appointment within 60 days. However, the applicant failed to properly strike a physician from the original panel after the defendant did. As a result, the defendant was authorized to schedule an appointment with a remaining physician, and the applicant was not entitled to a new QME panel. The Appeals Board granted removal to amend the prior order to reflect a rescheduled appointment with the original QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment
References
Case No. ADJ11154163
Regular
Jan 09, 2019

FAUSTO DIAZ vs. C OVERAA & COMPANY, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded its prior decision and returned the case to the trial level. This action allows the workers' compensation administrative law judge to review a proposed settlement reached between the applicant and defendant. If the settlement is not approved, the original decision can be reinstated, and either party may seek reconsideration. This is not a final ruling on the merits of the case.

ReconsiderationWithdrawal without prejudicePetition for ReconsiderationProposed settlementRescinded decisionReturned to trial levelWCJ approvalReinstating original decisionFinal decision on meritsFindings of Fact
References
Case No. ADJ11144491
Regular
Nov 19, 2018

RALPH CONWAY vs. COUNTY OF SANTA CLARA/ PARKS AND RECREATION

This case involves a petition for reconsideration of a workers' compensation decision. The Appeals Board dismissed the petition because it was filed from an interlocutory procedural order, specifically the denial of a replacement QME. Such orders are not considered "final" as they do not determine substantive rights or liabilities. The Board also noted that the petition did not demonstrate substantial prejudice or irreparable harm, even if considered for removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationFinal OrderSubstantive RightLiabilityThreshold IssueInterlocutory DecisionProcedural DecisionEvidentiary DecisionQualified Medical Examiner
References
Case No. ADJ8522308
Regular
Jul 21, 2014

ROBERT GRANT vs. US AIRWAYS GROUP, INC.; NEW HAMPSHIRE INSURANCE by AMERICAN HOME ASSURANCE. Administered by CHARTIS CLAIMS INC.

The Workers' Compensation Appeals Board dismissed the Petition for Reconsideration because it was not taken from a "final" order, but rather an interlocutory procedural decision. Furthermore, the petition for removal was denied as no substantial prejudice or irreparable harm was demonstrated. Even if the order were considered final, reconsideration would have been denied based on the record indicating the applicant's attorney did not intend to waive objections to the substantive admission of Dr. Blau's reports without an opportunity for cross-examination. Therefore, the petition was dismissed and removal was denied.

Petition for ReconsiderationRemovalFinal OrderInterlocutory DecisionSubstantive RightProcedural DecisionEvidentiary DecisionWCJ ReportProvisional AdmissionDivision of Workers' Compensation
References
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