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

Case No. ADJ10656776
Regular
May 06, 2019

CARMEN CHRISTINA JOHNSON vs. AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA/PLEASANT HOLIDAYS, LLC, OLD REPUBLIC INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, rescinding the sanctions and attorney fees previously imposed. The WCAB found that while the defendant's evidence was insufficient to prevail, their decision to challenge the substantiality of medical evidence did not constitute bad faith or solely intended delay. The Board also dismissed the defendant's petition for removal, determining that reconsideration was the appropriate remedy for challenging a final order. Ultimately, the WCAB affirmed the original finding of industrial injury AOE/COE to the applicant's internal system, neck, and lumbar spine.

WCABPetition for RemovalPetition for ReconsiderationFindings of Fact and OrderSanctionsAttorney FeesInjury AOE/COEHypertensionLumbar SpineThoracic Spine
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. OAK 0334529
Regular
Feb 11, 2008

IONE MCKAY vs. HOLIDAY INN, ZURICH INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the applicant's Petition for Removal in the case of Ione McKay v. Holiday Inn and Zurich Insurance Company. The WCAB adopted and incorporated the workers' compensation administrative law judge's report as the basis for their decision. Any perceived clerical error in the judge's report was noted but did not alter the outcome of denying removal.

Workers' Compensation Appeals BoardPetition for RemovalWCJ reportdenial of removalclerical erroradministrative law judgeHoliday InnZurich Insurance CompanyIone McKayOAK 0334529
References
Case No. ADJ11604315
Regular
Mar 20, 2023

JOSEPH HERNANDEZ vs. PLEASANT VALLEY STATE PRISON, CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILATION, STATE COMPENSATION INSURANCE FUND

This case concerns Joseph Hernandez's workers' compensation claim for heart trouble against Pleasant Valley State Prison. The applicant's claim was initially denied but subsequently granted after reconsideration. The defendant's Petition for Reconsideration was denied by the Appeals Board. The core issue revolved around the timing of the applicant's hypertension diagnosis, with the defense relying on a non-existent medical record to establish it as pre-existing. The Board found the defendant failed to rebut the statutory heart trouble presumption for correctional officers.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedADJ11604315Pleasant Valley State PrisonCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundJoseph HernandezCorrections Officer
References
Case No. ADJ11234735
Regular
Nov 25, 2020

BRANDEN HAMADA vs. CITY OF LOS ANGELES

This case concerns a petition for reconsideration filed by applicant Branden Hamada against the City of Los Angeles. The Workers' Compensation Appeals Board (WCAB) dismissed the petition as untimely because it was filed on September 29, 2020, after the jurisdictional deadline of September 28, 2020. Although September 28th was Yom Kippur, the WCAB offices were open, and Yom Kippur is not a legally recognized holiday that extends filing deadlines. Therefore, the Board lacked jurisdiction to consider the late petition.

Petition for ReconsiderationTimelinessDismissalWCAB Rule 10600JurisdictionalYom KippurLegal HolidayProof of FilingService by MailAdministrative Law Judge
References
Case No. ADJ11535411
Regular
Jul 19, 2019

TERRI HARRISON vs. CITY OF TORRANCE

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration, overturning a prior ruling that presumed the applicant's injury compensable due to a late denial. The Board found that the defendant's denial letter, mailed on December 26, 2018, was timely because the 90-day presumption period expired on December 25, 2018, a court holiday, making the next business day the deadline. The employer's inability to definitively prove the claim form's receipt date led the Board to infer a receipt date of September 26, 2018, thus making the December 26 denial compliant with Labor Code section 5402. Consequently, the applicant's injury is not presumed compensable.

Labor Code section 5402presumption of compensabilitytimely denialclaim form filing dateCode of Civil Procedure section 1013WCAB Rule 10507(a)court holidaybusiness day extensionPetition for ReconsiderationFindings and Order
References
Case No. ADJ13385386
Regular
Nov 17, 2020

ABRAHAM BERNAL vs. NIAGARA BOTTLING, LLC, SAFETY NATIONAL CASUALTY COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to amend the original decision regarding applicant Abraham Bernal's average weekly wage. The WCAB found the prior calculation of $\$1,383.39$ per week was erroneous as it diluted the applicant's earning capacity by using a lower hourly wage than his rate at the time of injury. The Board recalculated the average weekly wage based on actual hours worked, including overtime and holiday pay, at the applicant's established $\$27.00$ per hour rate. This resulted in an amended average weekly wage of $\$1,414.26$, increasing the temporary disability indemnity rate to $\$942.84$ per week.

ADJ13385386NIAGARA BOTTLING LLCSAFETY NATIONAL CASUALTY COMPANYVan Nuys District OfficePETITION FOR RECONSIDERATIONAVERAGE WEEKLY WAGESTEMPORARY DISABILITY INDEMNITYLABOR CODE § 4453(c)EARNING CAPACITYREGULAR WAGE
References
Case No. ADJ10553459
Regular
Feb 23, 2018

JAMES CRAIG SILLERS vs. CITY OF PLEASANT HILL, MUNICIPAL POOLING AUTHORITY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the administrative law judge's award of 47% permanent disability benefits to applicant James Sillers. The central dispute concerned whether Sillers was entitled to the maximum disability indemnity rate under Labor Code section 4458.5. The Board majority held that Sillers, a retired police officer with orthopedic injuries, qualified for the maximum rate, interpreting section 4458.5 to apply to any public safety member injured within the timeframes specified in listed presumption statutes, not solely to injuries covered by those specific presumptions. A dissenting opinion argued that only injuries falling under the explicitly enumerated presumptions in section 4458.5 qualified for the maximum rate, citing precedent that non-listed presumptions, like cancer under section 3212.1, did not grant this benefit.

Workers' Compensation Appeals BoardCity of Pleasant HillMunicipal Pooling AuthorityCumulative Trauma InjuryCervical SpineLumbar SpineBilateral Cubital TunnelsPolice OfficerStatute of LimitationsLabor Code Section 4458.5
References
Case No. ADJ7702057
Regular
Sep 11, 2012

Salome Ramirez vs. Holiday Inn Express, Illinois Midwest Insurance Agency, Benchmark Insurance Company

The Workers' Compensation Appeals Board denied Salome Ramirez's Petition for Reconsideration, upholding the Administrative Law Judge's (ALJ) finding that she failed to prove her alleged injuries arose out of and occurred in the course of employment. The ALJ found inconsistencies in Ramirez's testimony regarding the date of injury and the circumstances of the incident, particularly concerning elevator functionality and the necessity of using stairs for linen transport. Furthermore, the ALJ deemed the defense witnesses credible and found the employer's incident report admissible, concluding that Ramirez did not meet her burden of proof.

WCABPetition for ReconsiderationDeniedGarza v. Workers' Comp. Appeals Bd.ApplicantHoliday Inn ExpressIllinois Midwest Insurance AgencyBenchmark Insurance CompanyADJ7702057Housekeeper
References
Case No. ADJ9414071 ADJ10133403
Regular
Aug 13, 2018

Kevin McCoy vs. State of California - Pleasant Valley State Prison

This case involves an appeal regarding the permanent disability ratings for a correctional officer's right ankle and respiratory system (Valley Fever) injuries. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case to the WCJ for further proceedings. The Board found that the Agreed Medical Examiner's (AME) ankle impairment rating was properly calculated, but the Qualified Medical Examiner's (QME) report on the respiratory injury did not sufficiently explain its deviation from strict AMA Guides application. The Board emphasized that medical evaluators must adhere to the AMA Guides or clearly justify any deviations to ensure substantial evidence.

WCABPleasant Valley State Prisonlegally uninsuredState Compensation Insurance FundKevin McCoyADJ9414071ADJ10133403permanent disabilityright anklerespiratory system
References
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