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Case Law Database

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

Case No. ADJ7781989; ADJ8262771
Regular
Oct 03, 2013

MIRIAN GARCIA vs. COOPER COLD FOODS, INC., ILLINOIS MIDWEST INSURANCE AGENCY as administrator for STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) is granting reconsideration of its own prior decision and rescinding a July 23, 2013 decision that had overturned a prior finding of 2% permanent disability for applicant's right knee injury. The WCAB determined that its August 9, 2012 order granting reconsideration was improvidently granted because the applicant had already filed a successive and improper petition for reconsideration. Consequently, the prior order and the subsequent rescinded decision are vacated, and the applicant's petition for reconsideration is dismissed.

WCABReconsiderationPetition for ReconsiderationFindings and AwardAdministrative Law JudgePermanent DisabilityIndustrial InjurySuccessive PetitionImprovidently GrantedVacated
References
4
Case No. ADJ832058 (VNO 0431183) ADJ2725399 (VNO 0431180)
Regular
Jan 06, 2011

JUDITH VOLKERTS vs. JON B. ARTZ, SEABRIGHT INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION

The Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's (WCJ) order rescinding a prior decision due to improper service by the WCAB. The original decision denied the applicant's request to set aside a compromise and release agreement. Because the WCAB failed to properly serve the applicant, the WCJ retained jurisdiction and had the authority to rescind the decision. The case is remanded for further proceedings, including a new decision that must be properly served.

Workers' Compensation Appeals BoardSeabright Insurance CompanyCIGACalifornia Compensationliquidationreconsiderationadministrative law judgerescinded orderservice of processcompromise and release
References
3
Case No. ADJ1480264 (FRE 0200339) MF
Regular
Dec 29, 2015

JOSE ACOSTA vs. PETERSON FAMILY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded a prior decision concerning the retroactive application of a 2012 statutory fee reduction for ambulatory surgical centers. This decision was made after the defendant, State Compensation Insurance Fund (SCIF), and lien claimant Sierra Pacific Surgical Center (SPSC) reached a settlement agreement. The WCAB returned the case to the trial level for approval of this settlement, allowing the WCJ to reissue the rescinded decision if the settlement is not approved. The original decision had found that the fee reduction did not apply retroactively to services provided before January 1, 2004.

Workers' Compensation Appeals BoardState Compensation Insurance FundSierra Pacific Surgical Centerambulatory surgical centeroutpatient surgical centerMedicare reimbursementSenate Bill 863Labor Code section 5307.1(c)(1)retroactive applicationsettlement agreement
References
0
Case No. ADJ2218706 (VNO 0501260) ADJ1058308 (VNO 0482296)
Regular
Apr 19, 2010

DONNA DeRUSSY vs. ANTELOPE VALLEY HEALTH CARE SYSTEM, TRAVELER'S INSURANCE, SAFETY NATIONAL, FRONTIER INSURANCE

This case concerns appeals from a workers' compensation judge's decision regarding liability for cumulative trauma injury. The Appeals Board granted reconsideration to clarify the determination of the date of injury under Labor Code § 5412, which is crucial for assigning liability to the insurer covering the last year of exposure. The Board found the WCJ's decision lacked sufficient clarity and specific findings regarding disability and knowledge of causation. Therefore, the prior decision was rescinded, and the case was returned for further proceedings to make clear findings consistent with established legal principles.

Workers' Compensation Appeals BoardDonna DeRussyAntelope Valley Health Care SystemTravelers InsuranceSafety NationalFrontier Insurancecumulative traumadate of injuryLabor Code §5500.5Labor Code §5412
References
2
Case No. ADJ1210556 (AGO 0018589)
Regular
Oct 10, 2008

EDWIN MILLER vs. KEEBLER COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for removal and granted reconsideration of the WCJ's prior decisions regarding medical mileage and penalties. The Board found the WCJ failed to properly consider statutory factors in determining a "reasonable geographic area" for the applicant's medical treatment. Consequently, the WCAB rescinded the WCJ's decisions and returned the case to the trial level for further proceedings and a new decision addressing all outstanding issues, including the definition of a reasonable geographic area for treatment.

WCABPetition for RemovalPetition for ReconsiderationMedical MileageReasonable Geographic AreaLabor Code Section 4600Administrative Director Rule 9780(h)WCJBoltonRamirez
References
2
Case No. ADJ9460638
Regular

DAVID HAMALIAN vs. HANSEL FORD, SECURITY NATIONAL INSURANCE CO.

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration regarding a WCJ's order that rescinded a prior finding of no material defect in the defendant's Utilization Review (UR). This decision was based on a subsequent en banc ruling, *Dubon II*, which held that UR decisions are invalid only if untimely. Consequently, the Board rescinded the WCJ's Amended Findings & Order and remanded the case for further proceedings and a new decision consistent with *Dubon II*. The prior finding that the UR was not materially defective was rescinded, and the matter will be reheard to determine the UR's timeliness and applicant's need for surgery.

Utilization ReviewMaterial DefectDubon IDubon IIPetition for ReconsiderationFindings & OrderRescindedAdministrative Law JudgeAppeals BoardEn Banc Decision
References
3
Case No. MISSING
Regular Panel Decision
Aug 14, 1981

Claim of Schiffman v. Fugazy Continental Corp.

Claimant, a limousine driver, filed for workers' compensation benefits after sustaining an injury. Initially, a referee found an employer-employee relationship, but a board panel reversed this decision. Subsequently, the full 13-member Workers’ Compensation Board rescinded the panel’s prior decision and referred the case back for reconsideration. The panel then found an employment relationship, aligning with other similar cases involving the same employer. The employer and its insurance carrier challenged the board's action, but the court affirmed the decision, asserting the board's plenary authority to modify or rescind prior decisions to resolve inconsistencies.

Employer-Employee RelationshipBoard ReviewPlenary AuthorityInconsistent FindingsAppellate ReviewLimousine DriverInjury ClaimBoard DecisionRescissionJudicial Affirmation
References
2
Case No. MISSING
Regular Panel Decision
Jan 08, 2014

Claim of Angela Page v. Liberty Central School District

The claimant, a school librarian, sought workers' compensation benefits in July 2004 for a disability from toxic mold exposure, leading to an established claim for hypersensitivity and awards for temporary total disability. In 2006, the claim was amended to include multiple chemical sensitivity, and awards for marked disability continued. A Workers’ Compensation Law Judge (WCLJ) later classified the claimant with a permanent total disability in March 2010, but the Workers' Compensation Board rescinded this finding and referred the matter to an impartial medical specialist, Theodore Them. Them testified that multiple chemical sensitivity is not a medically recognized condition and that the claimant had no causally-related disability, which the Board credited in its December 2012 decision, finding no further causally-related disability and closing the case. The claimant's subsequent appeal of this decision was not perfected, and an application for reconsideration was denied. An April 2013 WCLJ decision to further develop the record on disability was challenged by the employer, who argued the December 2012 Board decision had resolved the issue. The Board panel agreed with the employer in January 2014, precluding further development of the record, a decision which this Court affirmed on appeal, stating the issue of causally-related disability had been decided and the claimant's remedy was a timely appeal of the prior Board decision.

References
2
Case No. ADJ476925, ADJ2247284, ADJ3324647, ADJ236582, ADJ2374280, ADJ648207
Regular
Sep 26, 2008

IRMA GUERECA vs. LSG SKY CHEFS, LIBERTY MUTUAL INSURANCE

Reconsideration granted; rescinding WCJ's July 18, 2008 decision; matter returned for further proceedings and new decision. Insufficient evidence to determine if employer provided required MPN notice.

MPNMedical Provider NetworkNotice requirementsLabor Code sections8 Cal. Code RegulationsKnight v. United Parcel Serviceemployer's burden of proofreasonable medical treatmentself-procured treatmenttimeliness of notice
References
1
Case No. MISSING
Regular Panel Decision
Feb 06, 2014

Claim of Kettavong v. Livingston County SNF

The Workers’ Compensation Board (WCB) rescinded the transfer of liability from the employer to the Special Fund for Reopened Cases, finding that the claimant's case was not truly closed when the transfer was initially requested. This was due to an unresolved issue of permanent disability, which an independent medical examination report in 2005 had raised. The employer and its workers’ compensation carrier appealed the WCB's decision. The Appellate Division affirmed the WCB's determination, concluding that substantial evidence supported the finding that the case was not closed. The Court also upheld the WCB's authority to rescind prior findings despite the lack of a timely appeal.

Workers' Compensation Law § 25-aSpecial Fund for Reopened CasesTransfer of LiabilityCase ClosingPermanent Partial DisabilityReduced EarningsIndependent Medical ExaminationMaximum Medical ImprovementSubstantial EvidenceBoard Discretion
References
10
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