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

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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ6995425
Regular
Apr 27, 2012

SERGIO SANCHEZ vs. LIDA KOHANSAMEH, PACIFIC SPECIALTY INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior ruling finding the applicant an employee of Lida Kohansameh. While agreeing the applicant was not an employee of Pacific Great West Construction, the Board remanded the case for further proceedings. The trial judge must now determine if the applicant is excluded from workers' compensation coverage under Labor Code sections 3351(d) and 3352(h), specifically regarding residential or casual employment and hours worked. This decision avoids a final determination on employment status and focuses on potential statutory exclusions.

Workers' Compensation Appeals BoardLida KohansamehPacific Specialty InsuranceTristar Risk ManagementSergio SanchezFindings and OrderEmployee statusPacific Great West ConstructionReport and RecommendationPetition for Reconsideration
References
Case No. B167017
Significant
Nov 18, 2004

General Casualty Insurance and Regent Insurance, Joseph A. Lane, American Home Assurance Company vs. Workers' Compensation Appeals Board and California Insurance Guarantee Association

The court has requested responses from the Workers' Compensation Insurance Rating Bureau (WCIRB) and the California Insurance Commissioner regarding the exclusion of special employees from a special employer's workers' compensation policy, specifically questioning the use and requirements of Form No. 11 for this purpose.

WCIRBForm No. 11limiting endorsementsrestricting endorsementsspecial employeesgeneral employerstemporary employeesleased employeesInsurance CommissionerCalifornia Code of Regulations
References
Case No. ADJ9473670
Regular
Nov 02, 2020

SANDRA UYAGUARI GARCIA vs. CLAUDIA MENDOZA Dba SWEET MELODY EXPRESS, UEBTF

This case concerns an applicant seeking workers' compensation benefits for an injury sustained while cleaning a defendant's residence. The primary issue was whether the applicant was an employee of the defendant's business, Sweet Melody Express, or an independent residential employee. The Board affirmed the WCJ's finding that the applicant was not an employee of Sweet Melody Express at the time of the injury, deeming her services to the defendant's home to be sporadic and casual housecleaning for the individual, not the business. Therefore, her claim for workers' compensation was denied.

Workers' Compensation Appeals BoardReconsiderationEmployee StatusResidential EmployeeCasual EmploymentLabor Code Section 3351Labor Code Section 3352(a)(8)Burden of ProofCredibility FindingEmployer Capacity
References
Case No. ADJ8190306
Regular
Jan 07, 2013

Silvestre Sanchez vs. Robert E. Town, Allied Insurance, A Nationwide Company

This case concerns whether an injured worker, Silvestre Sanchez, was an employee of Robert E. Town for workers' compensation purposes. The Board granted reconsideration to reverse the WCJ's finding of employment. The primary issue was whether Sanchez met the 52-hour work requirement within the 90 days preceding injury under Labor Code section 3352(h), which excludes certain residential employees. The Board found that based on conflicting testimony regarding a second payment, the applicant did not prove he worked over 52 hours, thus excluding him from coverage.

Workers' Compensation Appeals BoardSilvestre SanchezRobert E. TownAllied InsuranceLabor Code section 3352(h)excluded employeeresidential employee90-day perioddate of injuryFindings of Fact
References
Case No. ADJ12830624
Regular
Feb 13, 2023

RICHARD HERRERA vs. MICHAEL PAIVA, STATE FARM FIRE AND CASUALTY COMPANY, SEDGWICK CLAIMS MANAGEMENT

This case concerns whether applicant Richard Herrera was an employee or independent contractor when injured while working on defendant Michael Paiva's residence. The Workers' Compensation Appeals Board (WCAB) affirmed the finding of employee status, finding that Paiva retained sufficient control over the work and that secondary *Borello* factors, such as Paiva providing materials and the place of work, supported an employment relationship. The WCAB also found applicant's testimony credible and deemed the issue of Labor Code section 2750.5 moot due to the employee determination.

Independent contractorEmployee statusLabor Code sections 33513357Section 2750.5WCJPetition for ReconsiderationEmployee LedgerHourly payCash payment
References
Case No. ADJ10531850
Regular
Aug 14, 2018

JORGE MACIEL IBARRA vs. TIM CAGLE, individually, doing business as TIM CAGLE DRYWALL, GREGORY AND BROOKE BAIRD, UNINSURED EMPLOYERS BENEFITS TRUST FUND (UEBTF), ALLIED SACRAMENTO

This Workers' Compensation Appeals Board case involves applicant Jorge Maciel Ibarra's claim for an industrial injury as a drywall installer. The primary issue is whether applicant was a household employee, as the Uninsured Employers Benefits Trust Fund (UEBTF) argues for exclusion. The Board rescinded the initial findings and remanded the case for the WCJ to first determine the identity of the employer and insurance status. If Tim Cagle Drywall is uninsured, the WCJ must then decide if the applicant, as an employee of an unlicensed contractor, meets the household employee wage and hour thresholds for coverage.

UEBTFPetition for ReconsiderationHousehold EmployeeLabor Code section 3352(h)Ultimate HirerUninsured ContractorLicensed ContractorSection 2750.5(c)Section 3351(d)Workers' Compensation Appeals Board
References
Case No. SJO 0210015
Regular
Mar 04, 2008

CARLOS SALAZAR vs. JOSE VIDRIO, LIBERTY MUTUAL INSURANCE COMPANY

This case concerns whether a comprehensive personal liability policy provided by Liberty Mutual to Jose Vidrio covered applicant Carlos Salazar's workers' compensation claim for injuries sustained while working at Vidrio's residence. The Appeals Board affirmed the arbitrator's decision, finding that Insurance Code section 11590 mandates such coverage for residential employees incidental to the dwelling's use, regardless of specific policy wording. The Board also confirmed Salazar met the statutory employee criteria of working over 52 hours and earning over $100 in the 90 days prior to injury.

Workers' Compensation Appeals BoardIndustrial InjuryResidential EmployeeComprehensive Personal Liability InsuranceLabor Code section 3351(d)Insurance Code section 11590Labor Code section 3352(h)Incidental DutiesDwelling MaintenanceUninsured Employers Benefits Trust Fund
References
Case No. ADJ9099771
Regular
Apr 18, 2014

Gary Reynolds vs. Michael Thomas Connolly, Beverly Connolly

This Workers' Compensation Appeals Board decision grants reconsideration to remove Beverly Connolly as a named employer, as she was never properly joined in the proceedings. The Board affirms the original finding that Gary Reynolds was an employee of Michael Thomas Connolly, based on Labor Code § 2750.5's conclusive presumption for work exceeding $500 when the worker lacks a valid contractor's license. The employer's arguments regarding estoppel, due process, and the UEBTF's joinder were rejected. The Board found that Reynolds was not an excluded employee under Labor Code § 3352(h) as the work was for Connolly's rental business, not his personal residence.

WCABPetition for ReconsiderationFindings and AwardEmployee StatusBeverly ConnollyUninsured Employers Benefits Trust FundUEBTFContractor's LicenseEstoppelLabor Code Section 2750.5
References
Case No. ADJ10264533
Regular
Oct 07, 2017

KENNETH GOSLING vs. CALIFORNIA SECURITY AND INVESTIGATIONS ACADEMY, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision. The Board found that while the applicant was correctly identified as an employee, the issue of whether he was excluded from workers' compensation coverage is a matter for mandatory arbitration. Therefore, the case is remanded to the trial level to proceed with arbitration on the coverage issue. The WCJ's prior finding that the applicant was not excluded from coverage is superseded by this order.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactCumulative TraumaCorporate Officer ExclusionLabor Code Sections 3351(c)Labor Code Section 4151Mandatory ArbitrationInsurance CoverageEmployee Definition
References
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