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

Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
3
Case No. ADJ9551175
Regular
May 12, 2016

MANUEL ARZATE vs. WEST PICO FOODS, BARRETT BUSINESS SERVICES, INC.

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Removal and denied their Petition for Reconsideration. The defendant sought to overturn an award of temporary disability indemnity, alleging a mutual mistake of fact regarding potential EDD reimbursement. The Board found the defendant improperly filed a Petition for Removal and treated it as a Petition for Reconsideration. They denied reconsideration, adopting the WCJ's reasoning, and noted that any EDD lien issue could be addressed in future proceedings.

Workers' Compensation Appeals BoardStipulation Award and OrderPetition for RemovalPetition for Reconsiderationtemporary disability indemnitymutual mistake of factEmployment Development DepartmentEDDreimbursementfinal order
References
0
Case No. ADJ3344826
Regular
Nov 09, 2010

RONALD FRYER vs. CORNUCOPIA COMMUNITY MARKET, TRAVELERS INSURANCE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding an order to authorize medical treatment and pay bills, as well as dismissing the applicant's untimely petition for reconsideration. The defendant argued the WCJ erred in ordering reimbursement for bills not following Utilization Review, while the applicant claimed further wrongdoing and sought an award of benefits. The Board adopted the WCJ's report, denying the defendant's petition, and dismissed the applicant's petition as untimely.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderMedical Treatment AuthorizationPrimary Treating PhysicianMedical Provider NetworkGym MembershipIndustrial InjuryUtilization ReviewApplicant
References
2
Case No. AHM 90917 AHM 90918
Regular
Jul 11, 2007

ANGEL SOSA vs. D.W. FOODS, EVEREST NATIONAL INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, VILLANOVA INSURANCE

This case concerns a dispute over reimbursement between an insurer, Everest, and the California Insurance Guarantee Association (CIGA), which is handling claims for a liquidated insurer, Villanova. The Board denied Everest's petition, upholding a prior award for reimbursement from Everest to CIGA. However, the Board granted CIGA's petition to amend the award to include Villanova Insurance as a party defendant.

CIGAEverest National Insurance CompanyVillanova Insuranceliquidationreconsiderationreimbursementbill review chargesjoint and several liabilitycumulative traumadenied due process
References
0
Case No. ADJ2623515 (SJO 0244721) ADJ1776322 (SJO 0250018)
Regular
Feb 10, 2010

THU-HA TRAN vs. THERMO LASER SCIENCE, ST. PAUL TRAVELERS, MATRIX ABSENCE MANAGEMENT

This case concerns Matrix Absence Management's petition for reconsideration of a workers' compensation decision regarding cost reimbursement for applicant Thu-Ha Tran's lumbar spine treatment. The arbitrator previously found insufficient evidence to compel reimbursement between Matrix and St. Paul Travelers. Matrix's petition lacked verification, a requirement under Labor Code section 5902. The Board dismissed the petition because Matrix failed to cure this defect despite notice. Even if verified, the Board would have denied the petition based on the original arbitrator's reasoning.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalVerificationLabor Code Section 5902Lucena v. Diablo Auto BodyFindings and OrderReimbursementLumbar SpineMatrix Absence Management
References
1
Case No. ADJ3412693
Regular
Oct 13, 2010

COLINE ANTOURI vs. WARNER BROTHERS STUDIO, PSI, WARNER BROTHERS WORKERS' COMPENSATION

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, which sought to deny reimbursement for applicant's medication costs. The Board granted the applicant's petition for removal, amending the order to further develop the record. This amendment requires parties to select an Agreed Medical Evaluator (AME) within ten days, or the WCJ will appoint a regular physician to address new and further disability and apportionment, following the procedure outlined in *McDuffie*. The Board affirmed the WCJ's original findings and orders otherwise.

Workers' Compensation Appeals BoardReconsiderationRemovalAgreed Medical EvaluatorRegular PhysicianLabor Code Section 5701Labor Code Section 4062.2(c)Utilization ReviewOut-of-Pocket ExpensesNew and Further Disability
References
1
Case No. ADJ1350924 (VNO 0092908)
Regular
Jan 27, 2014

DAVID SMITH vs. GENERAL MOTORS, SEDGWICK CLAIMS MANAGEMENT

This case involved a dispute over reimbursement for self-procured medical expenses. While the WCJ initially awarded applicant an additional $2,154.91, the Appeals Board granted defendant's petition for reconsideration. The Board found that defendant's bill review expert's testimony, which indicated no further reimbursement was due under the Official Medical Fee Schedule, was unrebutted. Consequently, the Board rescinded the WCJ's award, denied applicant's claim for further reimbursement, and also denied applicant's belated claims for penalties and attorney's fees as they were not raised at trial.

Workers' Compensation Appeals BoardSelf-procured medical expensesPetition for ReconsiderationFindings and AwardLabor Code section 5814Labor Code section 5814.5Bill review expertOfficial Medical Fee SchedulePermanent disabilityCumulative trauma
References
1
Case No. ADJ8069196 ADJ7219457
Regular
Jan 19, 2017

MICHELLE RIDDLE vs. LAS FLORES CONVALESCENT HOSPITAL, CIGA by its servicing facility INTERCARE INSURANCE SERVICES, ULLICO CASUALTY CO.

This case involves CIGA's petition for reconsideration regarding reimbursement for nonpermanent disability benefits paid to an applicant. CIGA sought reimbursement from Travelers Insurance Company, arguing Travelers' earlier policy constituted "other insurance." The Appeals Board denied CIGA's petition, adopting the WCJ's reasoning. The Board found that Travelers had no further liability for the applicant's benefits due to a prior approved Compromise and Release agreement, thus Travelers' policy was not "other insurance" for the purpose of reimbursement.

California Insurance Guarantee AssociationCIGAreimbursementTravelers Insurance Companyjoint and several liabilitynonpermanent disability benefitsother insurancecompromise and releasecovered claimscumulative injury
References
10
Case No. ADJ2425191 (LAO 0775944) ADJ3230477 (LAO 0775943) ADJ3919134 (LAO 0793799)
Regular
Apr 05, 2010

MARTHA ARIAS vs. CUSTOM FOODS PRODUCTS, INC., FIREMAN'S FUND, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE SERVICES, INC., SUPERIOR NATIONAL INSURANCE COMPANY

This case concerns CIGA's petition for reconsideration of a denial of reimbursement from Fireman's Fund for workers' compensation benefits paid to Martha Arias. CIGA sought reimbursement, arguing Fireman's Fund's coverage for other injuries constituted "other insurance." However, the WCAB denied CIGA's petition, adopting the WCJ's reasoning that CIGA failed to prove applicant's injuries in the other cases contributed to the benefits CIGA paid. CIGA had the burden of establishing entitlement to reimbursement under the "other insurance" provision, which it did not meet.

CIGAreimbursementFireman's Fundindustrial injurymeat packerlow backleft handhipcumulative injuryspecific injury
References
3
Case No. ADJ9943316 ADJ9558081
Regular
Dec 01, 2017

WING QUAN vs. BARRETT BUSINESS SERVICES

This case involves competing petitions for reconsideration from lien claimants Joyce Altman Interpreting and Orthomed. The Workers' Compensation Appeals Board (WCAB) denied Orthomed's petition, upholding the finding that they failed to meet their burden of proof for reimbursement. However, the WCAB granted Joyce Altman's petition, remanding the issue of sanctions and costs against the defendant for delaying payment of interpreting services. The WCAB affirmed the original finding that Joyce Altman failed to establish the market rate for her services.

Workers' Compensation Appeals BoardLien ClaimantsPetition for ReconsiderationFindings and OrdersMedical Provider NetworkOrthomedJoyce Altman InterpretingFrivolous ActionsSanctionsCosts
References
4
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