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

Case No. ADJ9553023
Regular
Nov 02, 2016

JACQUELINE MORRIS vs. COVENANT CARE, INC. d/b/a AFFIRMA, ZURICH NORTH AMERICAN INSURANCE COMPANY

In this workers' compensation case, the defendant sought reconsideration of the denial of their petition to terminate temporary disability indemnity benefits. The applicant sustained an admitted industrial injury in 2014. The defendant improperly stopped payments and filed their termination petition significantly after the applicant's temporary disability was initially awarded and after receiving a QME report suggesting the condition was permanent and stationary. The Board denied the defendant's petition, noting procedural missteps including failing to seek reconsideration of the initial award. The Board also clarified that the applicant is not entitled to 240 weeks of temporary disability benefits, but rather a statutory limit.

Petition to Terminate LiabilityTemporary Disability IndemnityPanel Qualified Medical EvaluatorPQMEFindings of FactPetition for ReconsiderationReport and RecommendationRebuttable PresumptionLab. Code§ 4651.1
References
0
Case No. ADJ3519701
Regular
Nov 04, 2013

SHERYL SEIFERT vs. BLOCKBUSTER VIDEO, SEDGWICK RIVERSIDE

The applicant, injured in 2001, sought further temporary disability benefits more than five years after her injury date. While the Workers' Compensation Appeals Board (WCAB) generally retains jurisdiction for benefits beyond five years if no final award has been issued, this case involved a prior stipulated award of temporary disability that was subsequently terminated. Therefore, to seek additional benefits, the applicant was required to file a petition to reopen or for new and further disability within the five-year statutory period. Since no such petition was filed within the timeframe, the WCAB properly denied the applicant's petition for reconsideration, upholding the WCJ's finding of lack of jurisdiction to award further benefits.

Petition for ReconsiderationTemporary Disability BenefitsDate of InjuryJurisdictionAward TerminationPetition to ReopenNew and Further DisabilityInsidious Progressive DiseaseStated ReasonsAdministrative Law Judge
References
11
Case No. 2021 NY Slip Op 07401
Regular Panel Decision
Dec 23, 2021

Matter of Carola B.-M. v. New York State Off. of Temporary & Disability Assistance

Petitioners Carola B.-M. and Tiara M. challenged the denial of their supplemental nutrition assistance program (SNAP) benefits by the New York State Office of Temporary and Disability Assistance and the Orleans County Department of Social Services. The benefits were denied because they were deemed ineligible college students. The Appellate Division, Fourth Department, reversed this determination, holding that participation in the Adult Career and Continuing Education Services, Vocational Rehabilitation program (ACCES-VR) qualifies as a Job Training Partnership Act (JTPA) program. This status exempts the students from certain SNAP eligibility requirements. The court found that the original determination was based on an unreasonable interpretation of relevant regulations, annulled the decision, granted the petition, and remitted the case for a calculation of retroactive benefits.

SNAP benefitscollege student eligibilityJob Training Partnership ActACCES-VRvocational rehabilitationCPLR article 78regulatory interpretationpublic assistancefood stampsAppellate Division
References
28
Case No. ADJ10083989
Regular
Sep 12, 2016

LUIS PARTIDA vs. ABOVE ALL ROOFING, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's petition for reconsideration and removal of a WCJ's order deeming a prior stipulation a "continuing award" of temporary disability benefits. The defendant argued this prejudiced their right to present evidence of the applicant's employment and that the stipulation only set the rate and start date, not ongoing benefits. The Board denied both petitions, finding the defendant's subsequent payment of benefits beyond the stipulation date established it as a continuing award. Furthermore, the Board noted that under Labor Code section 4651.1, a rebuttable presumption of continuing disability exists until a petition to terminate liability is properly filed and overcome.

Petition for ReconsiderationPetition for Removalcontinuing awardtemporary disability indemnityStipulations and Awarddue processexpedited trialrebuttable presumptionterminate liabilityLabor Code
References
2
Case No. LAO 855766
Regular
Jul 16, 2007

JUAN L. FLORES vs. HEDENBERG, INC., dba IHOP, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration to address the defendant's petition to terminate temporary total disability indemnity. While the defendant's initial petition had procedural defects, including failing to adhere to filing deadlines and content requirements, the Board found that Labor Code section 4700 dictates no liability for temporary disability benefits exists beyond the date of the applicant's death. Consequently, the Board rescinded the prior order and issued a new order terminating the defendant's liability for temporary total disability indemnity as of February 20, 2007, the date of the applicant's death.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder Terminating LiabilityTemporary Total Disability IndemnityLabor Code Section 4700Applicant's DeathPermanent and StationaryPetition to Terminate LiabilityCalifornia Code of RegulationsRule 10462
References
2
Case No. ADJ3802051 (STK 0172590)
Regular
Mar 23, 2015

RHONDA THOMPSON LEE vs. SAVEMART SUPERMARKETS, PEGASUS RISK MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) granted the applicant's Petition for Reconsideration and denied the defendant's petition. The WCAB amended the original award to extend temporary disability benefits for the applicant through May 12, 2011, establishing this as the new permanent and stationary date. This decision means the defendant is not entitled to credit for temporary disability paid after September 16, 2008, against permanent disability benefits. The original award's credit for temporary disability paid from January 22, 2005, through February 25, 2005, remains.

Workers' Compensation Appeals BoardPetition for ReconsiderationTemporary DisabilityPermanent and Stationary DateIndustrial InjuryTemporary Total DisabilityAgreed Medical EvaluatorLabor Code Section 5313Medical TreatmentSurgical Candidate
References
4
Case No. ADJ10063730
Regular
May 20, 2016

WILLIE MEDRANO vs. AHERN RENTALS, OLD REPUBLIC GENERAL INSURANCE COMPANY

This case concerns a dispute over temporary disability benefits and an EDD lien following an admitted industrial injury to an applicant. The applicant claims entitlement to temporary disability from July 27, 2015, to the present, while the defendant argues against the EDD lien due to alleged double compensation and procedural issues. The Appeals Board denied the defendant's petition but granted the applicant's, remanding the matter to the trial level. This is due to insufficient medical evidence regarding the applicant's work capacity from July 27, 2015, to their termination for cause on August 25, 2015, necessitating further proceedings to clarify temporary disability, EDD lien, and attorney fees.

Workers' Compensation Appeals BoardIndustrial InjuryTruck DriverTemporary DisabilityPetition for ReconsiderationFindings and OrderEDD LienDouble CompensationTermination for CauseMedical Evidence
References
4
Case No. ADJ8810795
Regular
Jul 21, 2014

MARIA AGUIRRE vs. LOMPOC VALLEY MEDICAL CENTER

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. This decision affirmed the award of attorney's fees to the applicant under Labor Code section 4651.3. The Board found that the defendant's continued pursuit of terminating temporary disability benefits, despite medical evidence indicating ongoing disability and a subsequent withdrawal attempt, triggered the attorney fee liability. This denial upholds the principle that applicant's attorney fees are awarded for successfully resisting a petition to terminate benefits, regardless of the defendant's intent.

WCABPetition for ReconsiderationLabor Code section 4651.3attorney's feesPetition to Terminatetemporary disabilitystrict liability statutemedical reportingdepositionPTP
References
1
Case No. FRE 0220891
Regular
Mar 27, 2008

BETTY GEORGENE BAXTER vs. MARIPOSA COUNTY UNIFIED SCHOOL DISTRICT, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, affirming the original award of temporary disability benefits. The employer argued that the applicant's termination for cause negated her entitlement to benefits, but the Board found her continued inability to work stemmed from her admitted shoulder injury and subsequent surgeries, not her termination. The Board emphasized that temporary disability is paid until an applicant is medically stationary and capable of returning to work, regardless of non-industrial factors.

Workers Compensation Appeals BoardPetition for ReconsiderationTemporary Disability IndemnityPermanent DisabilityApportionmentRotator Cuff TearMedical Treatment AuthorizationAgreed Medical ExaminerPrimary Treating PhysicianModified Work
References
4
Case No. ADJ1392547 (SFO 0460414)
Regular
Aug 02, 2010

MARCO DE ANDA vs. ADECCO STAFFING AND INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

Applicant sought reconsideration of a prior award finding back, neck, and psyche injury, compensated temporary disability, and 50% permanent disability. His petition focused on a desire for temporary total disability for a later period, but this was not an issue in the prior proceedings and was stipulated as compensated. Furthermore, the petition untimely sought review of an earlier order terminating temporary disability, for which the reconsideration period had expired. Therefore, the Board denied reconsideration of the award and dismissed the petition regarding the termination order due to lack of jurisdiction.

Workers' Compensation Appeals BoardADECCO STAFFINGMARCO DE ANDAFindings and Awardforklift operatorindustrial injuryback injuryneck injurypsyche injurytemporary total disability
References
3
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