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

Case No. ADJ11329981
Regular
Jan 14, 2019

JEFFERY DANHAUSER vs. HOWROYD WRIGHT EMPLOYMENT AGENCY, INC., ACE AMERICAN INSURANCE COMPANY, GALLAGHER BASSETT SERVICES, INC., UNITEDHEALTH GROUP, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case involved a petition for reconsideration and removal by a lien claimant disputing medical bill payments. The Appeals Board denied reconsideration and dismissed the removal petition, affirming the WCJ's findings. The Board reiterated that disputes over medical bill amounts after review must proceed to Independent Bill Review (IBR), not through the Appeals Board. A decision directing a party to IBR is a threshold determination, making reconsideration the appropriate remedy, not removal.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalAdministrative Law Judge (WCJ)Independent Bill Review (IBR)Substantive RightLiabilityQuasijurisdictionalThresholdLien Claimant
References
2
Case No. ADJ9585531
Regular
Aug 28, 2017

Andres Reyes vs. PT WELDING INC.; BERKSHIRE HATHAWAY PASADENA

The Workers' Compensation Appeals Board (WCAB) dismissed Applicant Andres Reyes's petition for reconsideration because it was filed against a non-final interlocutory discovery order. The WCAB also denied Applicant's petition for removal, finding no significant prejudice or irreparable harm, and directed the parties to resolve the discovery dispute through the Administrative Director. The original order denied Applicant's motion to quash a subpoena for his entire school records from iLearn Institute, which Applicant argued was irrelevant and invaded his privacy. Applicant's petition was dismissed as reconsideration is improper for non-final orders, and his removal petition was denied as he failed to demonstrate significant prejudice.

WACABPetition for ReconsiderationPetition for RemovalNon-final OrderInterlocutory OrderDiscovery OrderMotion to QuashSubpoena Duces TecumPrivacySignificant Prejudice
References
0
Case No. ADJ9237052
Regular
Apr 12, 2019

ANGELICA BERMUDEZ vs. JACK IN THE BOX, Administered by GALLAGHER BASSETT SERVICES

The Workers' Compensation Appeals Board granted the petitioner's (Tower Imaging) Petition for Removal, rescinded the WCJ's prior order, and returned the matter for further proceedings. The WCJ had rejected Tower Imaging's petition for non-IBR dispute resolution due to its failure to appear at a lien conference. The Board found that Tower Imaging was denied due process and a fair hearing. The Board also admonished Tower Imaging's representative for misleading statements in the petition.

Petition for RemovalOrder Rejecting Petition for Non-IBR DisputeDue ProcessFair HearingSubstantial JusticePetition for DeterminationLien ConferenceWCJWorkers' Compensation Appeals BoardCompromise and Release
References
5
Case No. ADJ9625941
Regular
Oct 15, 2015

DANIEL BORGSTROM vs. CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board dismissed both the applicant's and defendant's petitions for reconsideration, as they were taken from non-final interlocutory orders concerning a discovery dispute over deposing the Chief of Police. The applicant's petition for removal was dismissed as moot because the WCJ rescinded the order denying the deposition, thereby allowing it. Finally, the defendant's petition for removal was denied, as they failed to demonstrate substantial prejudice or irreparable harm, and liberal discovery for the fair resolution of cases was favored.

WCABPetition for ReconsiderationPetition for RemovalOrder RescindingDepositionChief of PoliceDiscovery DisputeNon-final OrderInterlocutory OrderDue Process
References
10
Case No. ADJ9101616
Regular
Feb 20, 2018

MARIA MENCITAR vs. JESUS EDGARDO PACHECO, STAR INSURANCE CO., Administered by MEADOWBROOK INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted removal and rescinded a WCJ's order that dismissed a medical-legal provider's petition for determination of non-IBR medical-legal dispute for lack of jurisdiction. The WCAB found the WCJ erred by not holding a hearing, as no procedural rule required the provider to file a lien first. This decision allows the provider to pursue its claim for medical-legal expenses at the trial level.

WCABPetition for RemovalPetition for ReconsiderationPetition for Determination of Non-IBR Medical-Legal DisputeWCJMinute OrderFinal OrderInterlocutory OrderMedical-Legal ExpensesLien Claimant
References
12
Case No. ADJ8824674
Regular
Mar 15, 2018

MIGUEL MONTES vs. KOLE, INC. DBA QUALITY TUNE UP #8, ILLINOIS MIDWEST INSURANCE AGENCY, LLC, PROCENTURY INSURANCE COMPANY

This case concerns a Petition for Removal that the Workers' Compensation Appeals Board (WCAB) dismissed as untimely. The petitioner failed to file their removal petition within the prescribed 20-day period plus additional mailing time, submitting it one day late. Even if timely, the WCAB would have denied it on the merits, agreeing with the WCJ that the billing dispute was subject to Independent Bill Review (IBR) and not the WCAB's jurisdiction. The WCAB emphasized that if the sole dispute is the amount of payment and a second review failed, IBR is the proper avenue under Labor Code section 4603.6.

Petition for RemovalWorkers' Compensation Appeals BoardUntimely FilingService of OrderLegal MailingIndependent Bill ReviewLabor Code Section 4603.2Labor Code Section 4603.6Medical Provider NetworkJurisdiction
References
1
Case No. No. 95 Civ. 5338 (JGK)
Regular Panel Decision
Dec 11, 1995

Petition of Home Ins. Co.

The Home Insurance Company (Home) filed a petition to compel arbitration against Svedala Industries Inc. (Svedala) under the Federal Arbitration Act concerning disputed retrospective premiums. Svedala cross-moved to dismiss, arguing the dispute arose under an insurance policy without an arbitration clause and that Home had previously invoked federal jurisdiction in a Wisconsin action. The court clarified that only the Southern District of New York could compel arbitration, as specified in the agreement. The court granted Home's petition, concluding that the broad arbitration clause in the Retrospective Premium Agreement covered the dispute, and denied Svedala's cross-motion, thereby ordering the parties to proceed with arbitration.

ArbitrationFederal Arbitration ActRetrospective Premium AgreementWorkers Compensation PolicyMotion to Compel ArbitrationStay of ProceedingsFirst-Filed RuleContract InterpretationScope of Arbitration ClauseBad Faith Claim
References
15
Case No. ADJ6799204
Regular
Nov 03, 2010

MANUEL ZAMORA vs. DEL MAR FOOD PRODUCTS, Inc., ZENITH INSURANCE COMPANY

This case involves a dispute over the proper medical panel for a workers' compensation applicant. The defendant sought reconsideration of the Administrative Law Judge's (ALJ) order directing a chiropractic QME panel. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration because the ALJ's order was a non-final, interlocutory discovery ruling. The WCAB also denied the petition for removal, adopting the ALJ's reasoning in their report.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and OrdersQualified Medical EvaluatorQME PanelChiropractic QMEInternal Medicine QMEInterlocutory OrderNon-Final Order
References
5
Case No. ADJ15495436
Regular
Feb 18, 2025

Calvin Grigsby vs. Grigsby and Associates, State Farm Fire and Casualty Company

The Workers' Compensation Appeals Board considered two petitions from the applicant, Calvin Grigsby: a December 9, 2024 Petition for Reconsideration and/or Removal, and a December 24, 2024 Petition for Removal. The Board dismissed the reconsideration aspect of the December 9th petition as it pertained to non-final orders and denied removal, finding no demonstration of irreparable harm. The subsequent December 24th petition was also dismissed as it challenged the same December 4, 2024 orders. The Board also noted the applicant's failure to comply with page limits for the petition.

Petition for ReconsiderationPetition for RemovalNonfinal OrdersLabor Code Section 5909Electronic Adjudication Management SystemFinal OrderInterlocutory DecisionsSubstantial PrejudiceIrreparable HarmSupplemental Pleadings
References
15
Case No. ADJ7038469
Regular
Sep 17, 2014

AZIZA SAYED vs. GIORGIO ARMANI, FEDERAL INSURANCE COMPANY

The defendant's petition to appeal an Administrative Director's Independent Bill Review (IBR) determination was dismissed. The Board found the petition premature as it was not first heard by a trial level Workers' Compensation Judge (WCJ). Additionally, the petition failed to comply with numerous procedural requirements, including proper captioning, verification, service, and stating specific grounds for appeal. Consequently, both the petition for reconsideration and the petition appealing the IBR determination were dismissed.

Workers' Compensation Appeals BoardIndependent Bill ReviewPetition for ReconsiderationAdministrative DirectorLabor Code section 4603.6MAXIMUS Federal ServicesInc.Lien claimantOfficial Medical Fee ScheduleWCAB Rules of Practice and Procedure
References
0
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