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Case Law Database

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

Case No. ADJ7196811
Regular
May 17, 2012

ROBERTO LEDESMA vs. U.C. BERKELY, SEDGWICK CMS

Here's a summary for a lawyer: The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding a discovery order compelling production of non-privileged claims file notes from a specific prior period. The Board found these notes relevant to the time medical reports influencing the current Agreed Medical Evaluator were obtained. While one Commissioner concurred with allowing physician depositions, he dissented on the claims file notes, arguing their relevance and probative value were outweighed by undue consumption of time and questioning their necessity for the present admitted claim.

Petition for RemovalWorkers' Compensation Appeals BoardDiscovery OrderClaims File NotesAgreed Medical EvaluatorApportionmentFraudulent MeansDeposition of PhysiciansWCJ Report and RecommendationEvidence Code Section 352
References
Case No. ADJ3711842 (ANA 0409880)
Regular
Jun 21, 2013

SEAN GILBERT vs. OAKLAND RAIDERS, ACE USA

This case concerns disputed attorney fees in a workers' compensation claim. The applicant seeks to correct a clerical error in the award regarding the distribution of permanent disability benefits between himself and his counsel. The defendant challenges the calculation of attorney fees, arguing they should be based on the present value of the award, not its full value, and claims improper ex parte communication by a DEU rater. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings to address these issues and ensure proper calculation and distribution of fees.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability IndemnityAttorney's FeesPresent ValueEx Parte CommunicationDEU RaterCross-examinationClerical ErrorLife Pension
References
Case No. ADJ2506800 (VNO 0481347) ADJ2668930 (VNO 0540303)
Regular
May 10, 2010

CANDIDA MONTIEL vs. THOR OF CALIFORNIA, Permissibly SelfInsured, Administered by CAMBRIDGE INTEGRATED SERVICES

The Workers' Compensation Appeals Board granted reconsideration for lien claimant Bloch Medical Clinic. The Board found the WCJ erred by deeming Bloch's medical-legal reports duplicative and worthless. The Board determined these reports were properly obtained as rebuttal to defendant's evaluations, and their value, not entitlement, was the issue. Therefore, the defendant is liable for the expense of Bloch's medical-legal reports, with the exact reimbursement amount to be adjusted by the parties or determined by the WCJ.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrderMedical-Legal ReportDuplicative ServicesLabor Code Section 4062(a)Permanent and Stationary ReportCompromise and ReleaseThomas Finding
References
Case No. ADJ823138 (OXN 0142604)
Regular
Oct 25, 2010

CHERYL PEET vs. COUNTY OF VENTURA, Permissibly SelfInsured, Administered By CORVEL CORPORATION

The Workers' Compensation Appeals Board is reconsidering a prior decision that found a deputy probation officer sustained industrial injuries resulting in 78% permanent disability. The defendant sought reconsideration, arguing the Qualified Medical Examiner's (QME) opinion, which formed the basis of the award, was ambiguous and unsubstantiated. The Board agrees that the QME's assessment of 60% whole person impairment is not adequately supported by the record, particularly in light of the applicant's own testimony regarding her daily activities. Therefore, the case is returned to the trial level for further evidence development and a new decision, with consideration for cost of living adjustments if a life pension is awarded.

Workers Compensation Appeals BoardCheryl PeetCounty of VenturaCORVEL CORPORATIONADJ823138OXN 0142604Opinion and Decision After Reconsiderationdeputy probation officerindustrial injuryright upper extremity
References
Case No. ADJ4292283 (SRO 0134365)
Regular
Dec 24, 2012

SYLVIA MILES vs. WAL-MART, INC., Permissibly Self-Insured

The Appeals Board granted reconsideration to re-evaluate an interim attorney's fee awarded in a permanent total disability case. Initially, the WCJ awarded $49,286.16, but the applicant's attorney argued it was unreasonably low and should account for Cost of Living Adjustments (COLAs). The Appeals Board rescinded the WCJ's decision, finding the attorney entitled to a 15% fee on the commuted present value of the lifetime award, including COLAs. This revised fee, calculated with a 3% COLA effective January 1, 2008, totals $94,985.91, commuted using the "uniformly increasing reduction method."

Workers' Compensation Appeals BoardPermanent Total DisabilityAttorney FeeReconsiderationCost of Living Adjustment (COLA)Labor Code Section 4659(c)Commuted ValuePresent Value CalculationsUniformly Increasing Reduction MethodLodestar Calculation
References
Case No. ADJ6996303
Regular
Mar 23, 2023

JOHN DAVIES vs. COUNTY OF SAN DIEGO PROBATION DEPT., COUNTY OF SAN DIEGO

The Workers' Compensation Appeals Board affirmed a prior award of 84% permanent disability for a Probation Officer with heart/hypertension and hip injuries. The Board found that Labor Code section 3212.10's heart presumption and section 4663(e)'s non-attribution clause prohibit apportionment of the applicant's new and further disability. The defendant's contention that prior stipulations required apportionment was rejected, citing precedent that such presumptions take precedence. The Board clarified that the 84% represents the applicant's total permanent disability, not solely the new and further disability.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPetition for ReconsiderationPermanent DisabilityApportionmentHeart PresumptionLabor Code Section 3212.10Non-Attribution ClauseLabor Code Section 4663(e)
References
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. ADJ9052447
Regular
Oct 13, 2018

JACQUELINE FINDLER vs. WALMART, AVIZENT, YORK INSURANCE

The Workers' Compensation Appeals Board denied the petition for reconsideration in *Findler v. Walmart*. The WCAB adopted the findings of the WCJ, who found that the lien claimant failed to provide sufficient evidence of the reasonable value of services rendered. This was because the applicable fee schedule did not control for services provided before its effective date. Therefore, the lien claimant was required to present evidence of reasonable value, which they did not adequately do.

Jacqueline FindlerWalmartAvizentYork InsuranceADJ9052447Petition for ReconsiderationWorkers' Compensation Appeals BoardWCJOpinion and Order DenyingAdministrative Director Rule 9983
References
Case No. ADJ4243140 (OXN 0130418)
Regular
Sep 23, 2009

ALMALILIA MARTINEZ vs. TRACEY VILLA, NATIONAL FIRE INSURANCE OF HARTFORD, CNA CLAIMS PLUS

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award concerning a lien claimant's fees for medical interpreting services. The amended award clarifies that certain specific medical sessions are valued at the greater of the stipulated market rate or the billed amount. Other medical interpreting services are awarded at one-half of the greater of the market rate or billed amount, with the total value of the lien affirmed as previously decided.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationJoint Findings and AwardWorkers' Compensation JudgeMedical Interpreting ServicesMarket RateAdministrative Director RulesReasonable ValueWCAB Appearances
References
Case No. ADJ9668315
Regular
Jan 10, 2020

MARTIN AMADOR vs. CAL CENTRAL HARVESTING, STAR INSURANCE COMPANY

This case concerns a lien claimant, Citywide Scanning, seeking payment for medical-legal discovery services. The Workers' Compensation Appeals Board (WCAB) affirmed the initial award but deferred the issue of the reasonable value of services. The WCAB found the defendant waived objections to the invoices by failing to provide timely explanations of review, thus incurring a penalty and interest. However, the WCAB returned the matter for further proceedings to establish a reasonable value, as the initial evidence was insufficient.

WCABReconsiderationLien ClaimantCitywide ScanningFindings of FactAward and OrderMedical-Legal Discovery ServicesCopy ServicesExplanation of Review (EOR)Labor Code Section 4622
References
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