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

Case No. ADJ8252128
Regular
Nov 30, 2015

HILARY RHONAN vs. COUNTY OF LOS ANGELES, INTERCARE INSURANCE SERVICES

The Workers' Compensation Appeals Board granted the defendant's petition for reconsideration to correct mathematical and clerical errors in an award approving stipulations. While the defendant sought to amend the award to include a credit, the Board affirmed the award with specific corrections to the retroactive temporary disability, self-imposed penalty, attorney's fees, and the permanent disability rate. The final award reflects these adjustments as agreed upon and recommended by the WCJ.

Petition for ReconsiderationAward Approving Stipulationsretroactive temporary disabilityself-imposed penaltyattorney's feepermanent disabilityLabor Code section 4658(d)mathematical errorsclerical errorWCJ
References
Case No. ADJ7054442
Regular
Jan 11, 2013

JARRAD JELSMA vs. WINE GROUP, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Board denied the defendant's petition for reconsideration of the WCJ's award of temporary disability indemnity. The defendant failed to demonstrate due diligence in producing a wage statement discovered after trial, which it claimed would lower the indemnity rate. While denying reconsideration of the retroactive award, the Board allowed the defendant to petition to reopen the award to prospectively adjust the temporary disability indemnity rate based on the disputed wage statement. The Board also denied credit to the defendant for any retroactive overpayment of temporary disability indemnity.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAverage Weekly EarningsTemporary Disability IndemnityWage StatementDue DiligenceNewly Discovered EvidenceReopen AwardRetroactive Overpayment
References
Case No. SAC 0316687
Regular
May 20, 2008

STEVE OLSON vs. DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address whether Labor Code section 4663(e), effective January 1, 2007, applies retroactively to a 2002 injury regarding apportionment of permanent disability for heart trouble. The Board rescinded its prior decision and the trial judge's decision, returning the case to the trial level to await a Court of Appeal ruling on this identical issue in the *Alexander* case. The outcome will depend on whether the court finds section 4663(e) retroactively applicable to pre-2007 injuries.

Labor Code section 4663section 4663(e)heart trouble presumptionapportionmentcumulative industrial injurycorrectional lieutenantpermanent disabilityreconsiderationrescindedretroactive application
References
Case No. ADJ8386503
Regular
Feb 15, 2019

KENNETH MORRIS vs. COUNTY OF RIVERSIDE

This case involves a deputy sheriff seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The applicant was awarded an increased permanent disability rating of 83% from his prior 50% award. The defendant sought reconsideration arguing the increased disability payments were not retroactive to the original permanent and stationary date. The WCAB granted reconsideration, amending the findings to acknowledge two maximum medical improvement dates but affirming the applicant's entitlement to increased permanent disability payments retroactive to the earlier date. The WCAB also upheld the penalty for unreasonable delay in payments.

Workers' Compensation Appeals BoardCounty of Riversidedeputy sheriffpermanent disabilitypermanent and stationary datelife pensioncost of living adjustmentCOLALabor Code section 5814agreed medical evaluator
References
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
Case No. SAC 360490
Regular
Jul 07, 2008

VICKI WASIELEWSKI vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMP. INS. FUND

The Workers' Compensation Appeals Board granted reconsideration to address whether the 2007 amendment to Labor Code section 4663, regarding apportionment, applies retroactively to injuries predating the amendment. The Board rescinded the previous award and returned the case to the trial level pending a definitive appellate decision on this issue. This action was taken because the issue mirrors that before the Court of Appeal in *Department of Corrections v. Workers' Compensation Appeals Board (Alexander)*.

ApportionmentLabor Code 4663Cumulative TraumaHypertensive Cardiovascular DiseaseCorrectional SergeantAgreed Medical ExaminerRetroactivityAlexander caseReconsiderationRescinded
References
Case No. ADJ9854457
Regular
Jun 29, 2018

MARIO YBARRA vs. REED'S INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns CIGA's petition for reconsideration of an arbitrator's decision finding it liable for applicant Mario Ybarra's workers' compensation benefits. The core issue is whether an endorsement excluding coverage for leased employees on a Travelers policy issued to Reed's Inc. was valid. The Board granted reconsideration, rescinding the arbitrator's decision and finding the Travelers policy provided coverage. The Board determined the exclusion endorsement was invalid because it was not countersigned as required by the regulation in effect at the time the policy was issued, and the amendment to the regulation was not retroactive.

CIGAReed's Inc.Travelers Property Casualty Company of Americaleased employeescountersignatureRule 2259retroactiveLabor Code Section 3602(d)endorsement WC 04 03 17special employer
References
Case No. ADJ3015152 (MON 0351308)
Regular
Oct 06, 2016

MARIA DE LA LUZ GARCIA vs. MORTON MANUFACTURING, WASAU INSURANCE, LIBERTY MUTUAL

The Appeals Board granted reconsideration to Sepulveda Plaza Medical Center, Inc. (Sepulveda), a lien claimant, reversing the WCJ's decision. The Board found the WCJ improperly applied a new statute of limitations retroactively to Sepulveda's lien filed in 2012. Furthermore, the Board determined the WCJ erred by not fully addressing Sepulveda's burden of proof regarding the reasonableness and necessity of treatment under Labor Code § 5402(c). The case is returned to the trial level for further proceedings on the timeliness of the lien filing and Sepulveda's proof of entitlement.

WCABLien claimantPetition for ReconsiderationStatute of LimitationsLabor Code Section 4903.5(a)SB 863RetroactivityAOE/COEMedical Treatment Utilization Schedule (MTUS)Burden of Proof
References
Case No. ADJ8457565
Regular
Sep 22, 2015

MELANIE HATHAWAY vs. COUNTY OF FRESNO, AMERICAN ALL RISK LOSS ADMINISTRATORS

In Hathaway v. County of Fresno, the Workers' Compensation Appeals Board granted reconsideration and deferred issues of temporary disability and self-procured medical treatment. The Board found that the applicant's pre-designated physician status may have rendered the defendant's denial of an out-of-network specialist improper under then-existing regulations. Therefore, the case was remanded to determine if the defendant's authorization denial was erroneous before assessing liability for the applicant's self-procured surgery and associated temporary disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardTemporary DisabilitySelf-Procured Medical TreatmentSpinal Fusion SurgerySecond Opinion Spinal SurgeryMedical Provider Network (MPN)Predesignation of Personal PhysicianLabor Code § 4062(b)
References
Case No. ADJ4334434 (RIV 0047774) ADJ1332571 (VNO 0485919)
Regular
Sep 02, 2010

TARIK JUSUFBEGOVIC vs. FIESTA FORD LINCOLN MERCURY, STATE COMP. INS. FUND

This case concerns retroactive temporary disability payments for an admitted industrial injury. The applicant argued for higher retroactive payments based on an increased average weekly earnings determination and Labor Code section 4661.5, which mandates payment rates in effect at the time of payment if made more than two years after the injury. The Board reversed the WCJ, ruling that section 4661.5 applies even if some prior payments were made, as long as the payments are for temporary disability and occur more than two years post-injury. Therefore, the award was amended to reflect the higher indemnity rate in effect at the time of the Board's decision. A dissenting opinion argued against this interpretation, favoring the WCJ's narrower application of the statute.

Workers' Compensation Appeals BoardReconsiderationTemporary Total DisabilityAverage Weekly EarningsLabor Code Section 4661.5Hofmeister v. Workers' Comp. AppealsBd.Permanent DisabilityRetroactive Temporary DisabilityMaximum Rate
References
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