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

Case No. ADJ10013565
Regular
Nov 05, 2018

ANTONIO GUZMAN vs. KLEAN SWEEP PARKING LOT SERVICE, INC., STATE COMPENSATION INSURANCE FUND, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board (WCAB) granted Trucare Pharmacy's Petition for Reconsideration, rescinding the prior order to stay Trucare's lien. The WCAB found that the defendant failed to meet its burden of proof that Trucare was "controlled" by a criminally charged provider as defined by Labor Code section 139.21(a)(3). Specifically, there was no evidence that John Garbino, the criminally charged provider, was an officer, director, or 10% shareholder of Trucare Pharmacy. Therefore, Trucare's lien is not subject to a stay under Labor Code section 4615 and the case is returned for further proceedings.

Labor Code section 4615criminally charged providerjoint venturepartnershiplien claimantprovider statuscontrolled entitystatutory interpretationdue processadministrative director
References
Case No. ADJ4552841 (SBR 0338344)
Regular
Oct 03, 2014

ANTONIO PONCE GONZALEZ, vs. GRUMA CORPORATION; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA,

Defendant Gruma Corporation filed a Petition for Removal challenging the trial setting order and alleging applicant's fraudulent concealment of subsequent employment. However, at a subsequent hearing, the defendant withdrew its Petition for Removal. The Appeals Board dismissed the petition as withdrawn and moot. The Board also admonished defense counsel for behavior at a prior hearing that could warrant sanctions.

Petition for RemovalWCABWorkers' Compensation Appeals BoardDiscoveryTrial SettingFraudulent ConcealmentWithdrawn PetitionMoot PetitionSanctionsInsolent Behavior
References
Case No. ADJ10173387; ADJ19907358; ADJ3052978; ADJ3882676; ADJ4063239; ADJ4429907; ADJ883851; ADJ8926536
Regular
Sep 22, 2025

AURORA MUNOZ vs. FIRST GROUP AMERICA, NEW HAMPSHIRE INSURANCE COMPANY

This case concerns an applicant's petition for reconsideration of a denial of increased benefits for serious and willful misconduct by her employer. The applicant, a bus driver, was injured when a passenger lift malfunctioned. The Board denied reconsideration, affirming the WCJ's finding that the employer did not engage in serious and willful misconduct, as they reasonably relied on a mechanic's report stating the vehicle was safe to operate after an electrical short. The Board also found no basis for a presumption of serious and willful misconduct due to the employer's alleged failure to respond to discovery requests, as such procedures are not typically applicable in workers' compensation proceedings.

Serious and Willful MisconductLabor Code Section 4553Vehicle Inspection ReportPassenger LiftMechanic's Opinion"OK to Drive"Knowledge of DangerIntentional ActReckless DisregardAdverse Inference
References
Case No. ADJ8965413
Regular
Sep 02, 2015

MICHELLE DRACCO vs. ANOVA EDUCATION AND BEHAVIORAL, STATE COMPENSATION INSURANCE FUND

The Board affirmed the WCJ's finding of a compensable industrial psychiatric injury, finding that the applicant met the six-month employment requirement despite taking school breaks. However, the Board amended the decision to grant the defendant credit for temporary disability overpayment from October 18-28, 2012. This amendment was based on the employer's valid offer of modified work, made before psychiatric injury was alleged or medically established. One commissioner concurred with the psychiatric injury finding but dissented on the credit allowance.

Labor Code § 3208.3(d)psychiatric injurysix-month employment requirementcompensable consequencetemporary total disabilityoverpayment creditmodified work offeractual serviceroutine stresssudden and extraordinary event
References
Case No. ADJ8926118
Regular
Feb 01, 2018

VICTOR GUALIP SANCHEZ vs. A TO Z HOME REPAIR, INC, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted lien claimant Firstline Health's petition for removal, finding the administrative law judge (WCJ) prematurely stayed their lien under Labor Code section 4615. The WCJ's determination that the lien was stayed, based on alleged criminal indictments of individuals associated with the lien claimant, was made without admitted evidence. The Board amended the WCJ's minute order to reflect this, and the matter will return for further proceedings where evidence can be presented.

Labor Code section 4615Petition for RemovalLien claimantWCJAutomatic stayCriminal chargesFraudMedical treatment servicesMedical-legal servicesIndictment
References
Case No. ADJ991157 (GRO 0032393)
Regular
Jun 07, 2010

RANDY SHOOK (Deceased) GLENDA STAFFORD vs. ARMORED TRANSPORT, ESIS SOUTHFIELD

The Workers' Compensation Appeals Board denied a petition for reconsideration in the case of Randy Shook's suicide. Applicant argued the employer's investigation was conducted in bad faith, thus invalidating the "good faith personnel action" defense. However, the Board found the investigation met the objective reasonableness standard and was undertaken in subjective good faith. The Board distinguished this case from those involving criminal false imprisonment and affirmed its authority to reject a WCJ's findings when substantial evidence supports its own. Therefore, compensation remains barred under Labor Code section 3208.3(h).

Labor Code section 3208.3(h)good faith personnel actionindustrial suicidepsychiatric injurydeceit and coercionpreliminary investigationcriminal misconductsubjective good faithobjective reasonablenesscriminal false imprisonment
References
Case No. ADJ685961 (VEN 0120428) ADJ3005615 (PAS 0035964)
Regular
Aug 06, 2018

STEPHANIE CURRY vs. PACIFIC CARE BEHAVIORAL HEALTH CARE, INC., THE TRAVELERS INSURANCE COMPANY, ROSEMARY COTTAGE, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, FREMONT INDEMNITY COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

Applicant Stephanie Curry suffered industrial injuries from employment with Pacific Care Behavioral Health Care, Inc. and Rosemary Cottage, leading to disputes regarding the scope of injury and compensation. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of prior awards against CIGA and Travelers Insurance Company. Ultimately, the parties entered into a Compromise and Release agreement, which the WCAB approved, resolving all claims for a settlement payment of $1,363,071.00 from Travelers to applicant, thereby rescinding the prior findings and awards.

Workers' Compensation Appeals BoardStephanie CurryPacific Care Behavioral Health CareInc.Fremont Indemnity CompanyliquidationSedgwick Claims Management Servicesconsequential injurynew and further disabilitytemporary partial disability
References
Case No. SJO 181617 SJO 181469 SJO 187564 SJO 187565
Regular
Sep 17, 2007

ANITA BLICK vs. TOWN OF ATHERTON, CITIES INSURANCE GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award because the applicant's criminal conviction, which was the basis for restitution, had been vacated. The Board determined that restitution claims are intrinsically linked to the vocational rehabilitation benefits claim. Therefore, the case is returned to the trial level for a new WCJ to decide both issues after the applicant's criminal proceedings are finally resolved.

Vocational RehabilitationVRMARestitutionPenal Code section 550(b)(3)FraudCriminal ConvictionVacated ConvictionReconsiderationAppeals BoardWCJ
References
Case No. ADJ9693986
Regular
Dec 10, 2018

CLAUDIA SIBRIAN vs. THE KROGER COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to lien claimant Firstline Health, Inc. The prior decision had stayed Firstline's lien based on allegations in a criminal indictment, which the Board found was improperly relied upon without proper notice or evidence. The Board held that allegations in a criminal indictment alone do not constitute sufficient evidence to impose a Labor Code section 4615 stay. Therefore, the case was returned to the trial level for further proceedings.

Labor Code Section 4615Labor Code Section 139.21Petition for ReconsiderationFindings of FactCriminal IndictmentDIR ListDIR Potential Stay ListEAMS NotationDue ProcessBurden of Proof
References
Case No. ADJ9379743 ADJ9133071
Regular
Dec 10, 2018

SHERRY ARELLANES vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board granted Firstline Health's Petition for Reconsideration, rescinding the prior order that Firstline's liens were subject to a stay under Labor Code section 4615. The Board found the original decision improperly relied on criminal indictment allegations as evidence and lacked substantial evidence to prove Firstline was "controlled" by a criminally charged individual as defined by statute. Consequently, the cases are returned to the trial level for further proceedings to properly address the evidentiary basis for any potential stay.

Labor Code Section 4615Labor Code Section 139.21Lien ClaimantPetition for ReconsiderationJoint Findings of FactWorkers' Compensation Administrative Law Judge (WCJ)Criminal IndictmentDepartment of Industrial Relations (DIR)Electronic Adjudication Management System (EAMS)Dirt potential stay list
References
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