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

Case No. ADJ1941485 (VNO 0263845) ADJ4137418 (VNO 0270976) ADJ1018222 (MON 0140131)
Regular
Dec 15, 2008

GERTRUDE CHISM vs. K-MART/SEARS HOLDING CORPORATION, Permissibly Self-Insured Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The Appeals Board dismissed the defendant's petition to remove WCJ Zarett as moot due to his retirement, and denied the request for a commissioner's hearing on sanctions as premature. The Board remanded the case to the trial level for a full evidentiary hearing on the defendant's allegations regarding the applicant's attorneys, as these factual issues are best addressed by a new Workers' Compensation Judge. The defendant's numerous petitions for removal, vacating hearings, and stays were largely dismissed or denied.

Workers' Compensation Appeals BoardGertrude ChismK-Mart/Sears Holding CorporationSedgwick Claims Management ServicesPetition for Commissioner's HearingRemoval of Judge ZarettVacate HearingStay ProceedingsImposition of SanctionsGuardian Ad Litem
References
1
Case No. ADJ4379045 (ANA 0389616)
Regular
Mar 19, 2012

FEDERICO MARTINEZ vs. ROBERTSON'S READY MIX, INC.

Defendant Robertson's Ready Mix sought to reopen a stipulated award of 81% permanent disability for Federico Martinez based on a change in law regarding life pension calculations. The Workers' Compensation Appeals Board (WCAB) dismissed the petition for reconsideration as untimely, as it was filed significantly beyond the statutory 20-day limit. However, the WCAB returned the petition to the trial level to be considered solely as a petition to reopen based on the alleged change in law. This decision allows the parties to address the legal change at the trial judge level.

Workers' Compensation Appeals BoardPetition to ReopenPetition for ReconsiderationStipulated Findings and AwardIndustrial InjuryPermanent DisabilityLife PensionLabor Code Section 4659(c)Baker v. Workers' Comp. Appeals Bd.Untimely Filing
References
5
Case No. POM 0264727POM 0267166
Regular
Aug 19, 2008

CELIA MUNOZ vs. THE TOWN CLUB, CALIFORNIA INDEMNITY INSURANCE COMPANY/GAB ROBINS

Here's a summary of the provided case excerpts: In *Fiducia*, the Appeals Board granted reconsideration and found applicant sustained industrial injuries but had failed to attend medical exams and hearings, leading to dismissal for good cause. The Board vacated the prior dismissal and remanded for further development of the record, acknowledging that the applicant's failure to attend examinations and hearings warranted dismissal. However, due to lack of current medical evidence, the Board vacated the dismissal and returned the case to the trial level to allow applicant to attend examinations and hearings. In *Munoz*, the defendant sought reconsideration of an order vacating submission and returning the case to the trial calendar to further develop the evidentiary record concerning a lien claimant's charges. The Appeals Board dismissed the petition for reconsideration as it was not from a final order and denied the petition for removal, finding no showing of irreparable harm or significant prejudice. The Board emphasized that interlocutory orders to further develop evidence are not subject to reconsideration.

WCABindustrial injurypsycheTMJnasal traumateethblood pressuredismissalgood causetemporary disability
References
12
Case No. ADJ7928198
Regular
Mar 19, 2014

FELIPE AYALA vs. CUSTOM DELUXE LANDSCAPINT, ACE USA

The Workers' Compensation Appeals Board dismissed a petition for reconsideration because it was filed against a Notice of Intention, not a final order. The Board found the petition frivolous and warned against future similar filings. The case will be returned to the trial level for further proceedings and decision.

Petition for ReconsiderationNotice of Intention (NIT)Lien ClaimDismissalTrial LevelWCJ ReportFrivolous FilingSanctionsWorkers' Compensation Appeals BoardFinal Order
References
0
Case No. ADJ441410
Regular
Oct 03, 2008

HAYDEE NUNEZ vs. FAIRMONT MIRAMAR HOTEL, COMMERCE & INDUSTRY INSURANCE COMPANY

The Appeals Board denied the lien claimant's petition for reconsideration, affirming the WCJ's denial of the remaining lien balance. The Board is returning the case to the trial level to investigate potential sanctions against the lien claimant for its actions in filing the petition for reconsideration, citing alleged procedural defects and bad faith. The WCJ's original finding was that the outpatient fusion surgery was not permitted under Medicare Guidelines and the defendant paid more than the reasonable value of the services.

Workers Compensation Appeals BoardFairmont Miramar HotelCommerce & Industry Insurance CompanyAIG Domestic ClaimsOutpatient Spine & Surgery CenterLien claimantIndustrial injuryLow back injuryOutpatient fusion surgeryMedicare Guidelines
References
1
Case No. ADJ426447 (RDG 0129495)
Regular
Jul 16, 2010

Shane Guest vs. Barrett Business Services

The Appeals Board dismissed the applicant's petition for reconsideration as he was not aggrieved by a final order. The applicant sought to set aside a settlement concerning the Employment Development Department's (EDD) lien, arguing it was made in error. However, the Board found that the WCJ had not yet made a final determination on the EDD lien, which is a prerequisite for the Board to have jurisdiction to approve or disapprove such a settlement. Therefore, the matter is returned to the trial level for a final determination of the EDD's lien.

WCABPetition for ReconsiderationDismissalEDD LienTrial LevelFinal DeterminationTemporary DisabilityEmployment Development DepartmentStipulationDeferred Lien
References
1
Case No. ADJ3502038 (VNO 0531200) ADJ3850322 (VNO 0531201)
Regular
Oct 21, 2010

MARIA DE LA LUZ PADILLA vs. SUNRISE SENIOR LIVING, INC., HOME ASSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration of a Stipulations and Award (S&A) regarding applicant's neck, shoulder, and chest injuries. The defendant claimed mutual mistake and delays by applicant's attorney as grounds to set aside the S&A. However, the WCAB found these allegations insufficient to overturn the executed contract. The matter is returned to the trial level for further proceedings on the defendant's separate petition to set aside the S&A, due to apparent procedural irregularities.

Stipulations and AwardPetition for ReconsiderationPetition to Set AsideMutual Mistake of FactGood CauseDelay in ApprovalService of DocumentEthical BreachesTrial Level ProceedingsWorkers' Compensation Judge
References
2
Case No. ADJ994369
Regular
Jan 19, 2014

JOSE JUAREZ vs. WATKINS MANUFACTURING CORPORATION

The Workers' Compensation Appeals Board (WCAB) is reconsidering a decision that awarded the applicant medical mileage and a penalty for unreasonable delay in compensation payments but denied attorney's fees. The WCAB believes attorney's fees are warranted under Labor Code section 5814.5 for enforcing the payment of awarded compensation. The case is being returned to the trial level for the judge to determine and award these attorney's fees.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardMedical Mileage Expense ReimbursementAttorney's FeesLabor Code Section 5814Labor Code Section 5813Labor Code Section 5814.5Cumulative Industrial InjuryPulmonary System Injury
References
0
Case No. ADJ1393892
Regular
Aug 16, 2011

JOSE NAVARRO vs. LOCKHEED

The Appeals Board denied the applicant's Petition for Reconsideration regarding an alleged March 12, 1990 injury, upholding the WCJ's finding that no industrial injury occurred. The Board granted removal on its own motion to address potential sanctions against applicant's counsel for citing medical records not present in the official record, which is a violation of WCAB rules and attorney ethics. The Board issued a Notice of Intention to impose $1,000 in sanctions jointly against the attorney and his firm, and awarded attorney's fees to the defendant. Other outstanding issues in the consolidated cases are returned to the trial level for further proceedings by the WCJ.

Petition for ReconsiderationQualified Medical EvaluatorSubstantial EvidenceCredibility DeterminationMisleading PetitionSanctionsLabor Code Section 5813WCAB RulesAttorney's DutyEvidence Outside Record
References
4
Case No. ADJ1122368 (SJO 0223390)
Regular
Mar 24, 2015

MINH LY vs. LORAL SPACE SYSTEMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY, in liquidation

The Appeals Board granted removal and rescinded the WCJ's order taking the case off calendar, holding that the applicant is entitled to an expedited hearing regarding the denial of Lyrica prescription refills. The WCJ erred by prematurely determining that utilization review (UR) was timely and jurisdictionally barred further proceedings, without allowing evidence and a hearing. The Board emphasized that the applicant has a right to an expedited hearing to contest UR decisions, challenge their applicability, or present evidence of changed circumstances. The case was returned to the trial level for an expedited hearing and a new decision based on the record.

Utilization ReviewIndependent Medical ReviewPetition for RemovalExpedited HearingOrder Taking Case Off CalendarPrescription MedicationLyricaDue ProcessLabor Code Section 5310Dubon II
References
10
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