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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ14015513
Regular
Feb 15, 2023

BRADEN NANEZ vs. 3 STONEDEGGS, INC., TECHNOLOGY INSURANCE COMPANY, AMTRUST NORTH AMERICA

The Appeals Board rescinded the initial Findings and Order, finding the applicant's petition for reconsideration was timely due to defective service. The Board applied the commercial traveler rule, determining the applicant's injury arose out of and in the course of employment. The claim is not barred by the going and coming rule or intoxication, and the applicant sustained a fractured right femur. Issues of traumatic brain injury and bruised lung are deferred for further proceedings.

Workers' Compensation Appeals BoardReconsiderationOpinion and DecisionFindings and OrderApplicantEmployerAdjustedAdjudication NumberRedding District OfficeInjury Arising Out of and In the Course of Employment (AOE/COE)
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ8410459
Regular
Oct 22, 2019

DIETRA WALKER vs. YMCA METROPOLITAN LOS ANGELES

The Workers' Compensation Appeals Board (WCAB) granted the applicant's Petition for Reconsideration, overturning the trial judge's decision to strike a Qualified Medical Evaluator's (QME) report. The WCAB found no disqualifying conflict of interest for Dr. Gabriel, despite co-authored articles and past professional association with another dentist, Dr. Schames. Furthermore, the Board deemed the defendant's motion to strike Dr. Gabriel untimely due to a nearly three-year delay after his deposition. The case is affirmed with an amendment finding Dr. Gabriel free of conflict, and the defendant's motion is denied.

QMEconflict of interestdisqualifying conflict of interestlachesestoppelpetition for reconsiderationremovalmotion to strikeAOE/COEdeposition
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. ADJ271462 (SJO 0255768)
Regular
Apr 03, 2017

SHAWN LEWIS vs. TANEJA, INC dba PASSAGE TO INDIA, UNINSURED BENEFITS TRUST FUND OF THE STATE OF CALIFORNIA

This case involves an appeal of a $\$1,000$ sanction imposed on applicant's attorney for failing to appear at a hearing. The attorney argued he had arranged alternate representation, but the substitute attorney had a prior conflict with the applicant. The Workers' Compensation Appeals Board rescinded the sanction, finding the circumstances made imposition unjust, especially given opposing counsel's agreement to a continuance. The Board noted that while the attorney's planning was flawed, the judge should have granted the continuance due to these unusual circumstances.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOrder Imposing SanctionsWCJAttorney SanctionsFailure to AppearAlternate RepresentationPersonal ConflictContinuance RequestWCAB Rule 10561
References
Case No. ADJ7332384
Regular
Jul 19, 2011

DEBORAH CULP vs. UNITED HEALTH GROUP, U.S. FIDELITY & GUARANTY INSURANCE, Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied reconsideration of the applicant's claim. The applicant argued her injury during an extended break en route to a PTA meeting was compensable. The Board adopted the judge's report, which found the injury did not arise out of and occur in the course of employment. This conclusion was based on stipulated facts indicating the accident occurred during more than a lunch break, for a personal errand unrelated to employment.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedStipulated FactsAOE/COEGoing and Coming RulePersonal Comfort DoctrineCompensable InjuryNon-compensable InjuryPaid Lunch Break
References
Case No. ADJ10864843
Regular
Nov 15, 2018

YOLANDA PLASCENCIA vs. HYUNDAI CAPITAL AMERICA, SOMPO AMERICA INSURANCE COMPANY

This case involves an applicant who sustained injuries after falling into a pothole on her employer's premises during a break. The applicant was in the process of switching vehicles with her daughter when the incident occurred. The defendant argued the injury was not AOE/COE, as the personal vehicle exchange served no employer benefit and the personal comfort doctrine did not apply. The Board denied reconsideration, adopting the WCJ's report which found the injury compensable under the personal comfort doctrine. The Board reasoned that it's reasonably contemplated for employees to access the employer's parking lot during breaks, and moving a personal car is a personal convenience incidental to employment.

AOE/COEPersonal Comfort DoctrineIndustrial InjuryCourse of EmploymentWorkers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactWCJEmployer's PremisesPaid Break
References
Case No. ADJ7091667
Regular
Jan 31, 2013

THOMAS HERRERA vs. AMERI-COLD LOGISTICS, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board reconsidered a decision allowing the applicant to treat outside the defendant's Medical Provider Network (MPN). The Board found the employer failed to notify the applicant of his right to predesignate a personal physician as required by law. However, the remedy for this failure is limited to treatment with that specific personal physician, not any physician outside the MPN. Therefore, the original order was rescinded, and the applicant is now entitled to treatment from his identified personal physician, Dr. Aceves, provided he meets the statutory criteria, and not outside the MPN otherwise.

ADJ7091667Americo LogisticsLiberty Mutual InsuranceMedical Provider Network (MPN)Petition for Reconsiderationcumulative injurypsyche injuryinternal injuryheadachessleep disorder
References
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