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Case Law Database

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

Case No. ADJ5836855
Regular
Dec 11, 2012

Malory Wheat vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award allowing a lien for living expenses claimed by the CCPOA Benefits Trust Fund. The WCAB held that liens in workers' compensation are strictly statutory and the CCPOA's claim for reimbursement of benefits advanced did not fit within the specific provisions of Labor Code sections 4903 or 4903.1 for "living expenses" or benefits provided by a "self-insured employee welfare benefit plan." The Board clarified that liens for living expenses are intended for those who loan money or extend credit, not for contractual obligations of insurance or benefit plans.

Workers' Compensation Appeals BoardMalory WheatState Compensation Insurance FundCCPOA Benefits Trust Fundlien claimantLabor Code section 4903(c)Labor Code section 4903.1(a)(1)Labor Code section 4903.1(a)(2)Labor Code section 4903.1(a)(3)living expenses
References
Case No. ADJ7555409
Regular
Mar 04, 2014

JESUS ESCANUELA vs. CALIFORNIA DEPARTMENT OF CORRECTIONS, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the defendant's Petition for Reconsideration and dismissed the applicant's untimely petition. The WCAB found that the Agreed Medical Examiner's (AME) opinion regarding psychiatric permanent disability was not supported by substantial evidence, as it did not properly address causation under the current PDRS. Consequently, the case is remanded to the trial level for further development of the record concerning psychiatric permanent disability. The WCAB deferred the issue of permanent disability and attorney's fees pending this further development.

Workers' Compensation Appeals BoardJesus EscanuelaCalifornia Department of Correctionslegally uninsuredState Compensation Insurance FundADJ7555409Fresno District OfficeOpinion and OrderPetition for ReconsiderationFindings and Award
References
Case No. ADJ9097334
Regular
Apr 25, 2016

CHARLES GELETKO vs. CALIFORNIA HIGHWAY PATROL, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) sought reconsideration of an award granting applicant benefits, arguing the administrative law judge (WCJ) improperly calculated the applicant's permanent disability. The SIBTF contended the WCJ erred by applying a 1.4 adjustment factor and by adding individual impairments rather than combining them. The Appeals Board granted reconsideration, agreeing with the WCJ's report to affirm the award while correcting a mathematical error, ultimately awarding applicant 82% permanent disability. The Board found the 1.4 modifier applicable under the relevant statute, but upheld the prohibition against using the Combined Values Chart when assessing SIBTF eligibility due to statutory exclusions for age and occupation adjustments.

Subsequent Injuries Benefits Trust FundLabor Code section 4751permanent disability thresholdwhole-person impairmentsection 4660.11.4 modifierCombined Values ChartCalifornia Highway Patrolcumulative trauma injurycardiovascular system
References
Case No. ADJ6822166
Regular
May 27, 2011

Jackie Thompson vs. Los Angeles Unified School District

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior finding that a school district police officer was entitled to a cancer presumption for his prostate cancer. The Board found that while the applicant was a peace officer, his authority was defined by Penal Code section 830.32, not section 830.1 as initially determined. Because Labor Code section 3212.1's cancer presumption specifically lists peace officers defined under certain Penal Code sections and does not include those under 830.32, the applicant is not entitled to the presumption.

Labor Code 3212.1Penal Code 830.32Peace OfficerSchool District Police OfficerCancer PresumptionIndustrial InjuryReconsiderationWCABLaw Enforcement ActivitiesWilliam Dallas Jones Cancer Presumption Act
References
Case No. SAU2262762
Regular
Sep 17, 2019

KEVIN TUCKER vs. E.L. YEAGER CONSTRUCTION CO., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, TRISTAR RISK MANAGEMENT

This case concerns whether the California Insurance Guarantee Association (CIGA) must pay a medical lien assigned to EDS Financial Services. The Workers' Compensation Appeals Board denied EDS's petition for reconsideration, upholding a prior ruling that issue preclusion bars EDS from relitigating the lien's status as a "covered claim." The Board found that the identical issues of whether the assigned lien constituted a covered claim under Insurance Code section 1063.1 were actually litigated and decided in a previous case, *Wanda Fullylove*. EDS's arguments regarding separate statutory provisions and the nature of assignments were rejected, as prior litigation fully addressed the claim's covered status under CIGA's statutory framework, including the exclusion for assignee claims.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGACovered ClaimIssue PreclusionCollateral EstoppelInsurance Code Section 1063.1(c)(1)(F)Insurance Code Section 1063.1(c)(9)(B)AssigneeLien Claimant
References
Case No. ADJ9708192
Regular
Jul 05, 2018

BRIAN DANSKIN vs. COUNTY OF RIVERSIDE, PEMISSIDLY SELF-INSURED, CITY OF CYPRESS, PEMISSIDLY SELF-INSURED

This case involves Brian Danskin, who claimed industrial cumulative trauma in the form of skin cancer/melanoma sustained during his employment as a police officer and District Attorney's investigator. The defendant, County of Riverside, sought reconsideration of the WCJ's finding that Danskin was entitled to the Labor Code section 3212.1 cancer presumption for his investigator role. The defendant argued the investigator position didn't qualify for the presumption and that the injury predated his employment with the county. The Appeals Board denied reconsideration, adopting the WCJ's report, finding that Danskin's extensive law enforcement duties as an investigator were central to his role and qualified him for the cancer presumption under section 3212.1.

Workers' Compensation Appeals BoardBrian DanskinCounty of RiversideCity of CypressPetition for ReconsiderationFindings of FactWCJindustrial cumulative traumaskin cancermelanoma
References
Case No. ADJ4254212 (SAC 0369491) ADJ3966016 (SAC 0369493)
Regular
Jul 19, 2010

Salem Najjar vs. MEEKS BUILDING CENTER, ZURICH AMERICAN INSURANCE COMPANY

The Appeals Board granted reconsideration, finding that a payment for attending a medical-legal examination under Labor Code section 4600(e)(1) does not trigger the 104-week limit on temporary disability indemnity under Labor Code section 4656(c)(1). The Board clarified that such payments are for wage loss reimbursement, not a commencement of actual temporary disability, distinguishing it from prior cases where other benefit types functionally served as temporary disability. The case was remanded to determine the actual date temporary disability payments began to establish the correct duration of benefits. Applicant's claim for temporary disability from March 17, 2009, and continuing will be re-evaluated.

Labor Code section 4656(c)(1)temporary disability indemnity104 week limitationmedical examinationQualified Medical Evaluation (QME)wage lossreconsiderationWCJLabor Code section 4600(e)(1)aggregate disability payments
References
Case No. ADJ9349861
Regular
Aug 08, 2014

Ernest Millette vs. 81 Grand Holdings, Inc., dba California Rehabilitation, Illinois Midwest Insurance Agency, LLC on behalf of PROCENTURY INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the prior award of medical care. The Board adopted the judge's report which found the defendant's arguments regarding causation and utilization review (UR) to be unsupported by evidence. The judge admonished defendant's counsel for misstating the record and noted that the defendant failed to provide a clear basis for disputing causation or denying injury benefits within the required timeframes.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportSection 9792.9.1(b)(1)(C)Rule 9792.9.1(b)(1)(D)admonish counselmisstating evidencecausationspecific injuryoccupational therapist
References
Case No. ADJ8469531, ADJ9267403
Regular
May 02, 2019

KAREN DOUGLAS vs. STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that barred the applicant's psychiatric claim under Labor Code section 4660.1(c)(1). The WCAB rescinded the original Findings and Award for both consolidated cases. The matters are returned to the trial level for further proceedings and a new decision, guided by a subsequent WCAB en banc opinion addressing section 4660.1(c). The WCAB did not address other issues raised in the applicant's petition.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPsychiatric claimLabor Code section 4660.1(c)(1)Permanent total disabilityInjury to body partsReport and RecommendationPetition for ReconsiderationSupplemental pleading
References
Case No. ADJ8475421
Regular
Mar 30, 2017

Jessica Duncan vs. Right At Home, Travelers Diamond Bar

The Workers' Compensation Appeals Board denied reconsideration of a lien claimant's claim for medical services. The Board found that the lien, filed on June 4, 2016, was barred by the 18-month statute of limitations under Labor Code section 4903.5(a). This was because the last date of service was August 8, 2013, which fell after the July 1, 2013, implementation date of the 18-month rule. The Board also held that it lacked the authority to rule on constitutional vagueness claims.

Labor Code section 4903.5(a)Lien claimStatute of limitationsReconsiderationWorkers' Compensation Appeals BoardWCJTimelinessDate of servicesContinuous treatmentUnconstitutionally vague
References
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