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

Case No. ADJ4213823 (AHM 01440-4)
Regular
Jun 02, 2010

RODOLFO PLASCENCIA (Deceased), TERESA PLASCENCIA (Widow) vs. LOS ANGELES DODGERS, ACE USA, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board reversed a prior award, ruling that applicant Rodolfo Plascencia's neck injury sustained from a fall was not compensable. The Board found that the applicant's blood alcohol level of .187% was a material and substantial cause of his fall, thus barring compensation under Labor Code section 3600(a)(4). The majority credited expert testimony indicating the intoxication impaired judgment and physical ability, making it the probable cause of the fall in the absence of other evidence. A dissenting opinion argued the defendant failed to meet its burden of proof and that reasonable doubt should favor the employee, citing lack of evidence for intoxication being the sole cause and the possibility of other fall factors.

Labor Code section 3600(a)(4)intoxication defensematerial and substantial factorblood alcohol level.187%addiction substance abuse expertwaiver of objectioncommon knowledgeslip and fallreasonable inferences
References
25
Case No. ADJ4213823 (AHM 014404)
Regular
Aug 23, 2010

RODOLFO PLASCENCIA (Deceased) TERESA PLASCENCIA (Widow) vs. LOS ANGELES DODGERS; ACE USA, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a petition for reconsideration by a lien claimant, Rancho Los Amigos Medical Center, regarding a Workers' Compensation Appeals Board decision. The Board denied reconsideration, affirming its prior decision that benefits were barred under section 3600(a)(4) and that the lien claim was not allowed. The denial was based on the existing record and applicable law, with no new evidence considered due to procedural violations. However, one commissioner dissented, arguing that the defendant failed to prove intoxication was a substantial factor in the applicant's injury and would have reversed the decision.

Rodolfo PlascenciaLos Angeles DodgersACE USASedgwick Claims Management ServicesADJ4213823Opinion and Order Denying Reconsiderationlien claimRancho Los Amigos Medical CenterSection 3600(a)(4)intoxication
References
2
Case No. ADJ7851259
Regular
Aug 19, 2014

RODOLFO FIGUEROA NAVARRO vs. NORTH BAY LANDSCAPE MANAGEMENT, INC.

This case involves a petition for reconsideration by applicant Rodolfo Figueroa Navarro regarding injuries sustained in 2010 and 2011. The petition argues that the Workers' Compensation Judge (WCJ) improperly admitted reports from Dr. Shah, alleging the doctor asked inappropriate questions about the applicant's residency status. The Appeals Board adopted the WCJ's report, which found Dr. Shah's questions permissible as part of a personal history inquiry for medical evaluation. The Board denied reconsideration, affirming the admissibility of the medical reports and the WCJ's findings regarding the applicant's injuries and permanent disability.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJQualified Medical EvaluatorDr. ShahDr. KaplanLabor Code 1171.5Government Code 11135residency statuspersonal history inquiry
References
1
Case No. ADJ9781533
Regular
Aug 02, 2017

Rodolfo Boate vs. Truegreen Landcare, Zurich American Insurance Company

This case involves Rodolfo Boate's workers' compensation claim against Truegreen Landcare and Zurich American Insurance Company for injuries sustained during an altercation with a coworker. The defendant argued the claim was barred because Boate was the initial aggressor, citing his physical advance towards the coworker. However, the Workers' Compensation Appeals Board (WCAB) denied reconsideration of the Administrative Law Judge's (WCJ) finding that Boate's actions were in reasonable fear of bodily harm due to the coworker's prior severe threats and aggressive behavior. The WCAB adopted the WCJ's credibility determinations, finding no substantial evidence to reject them. Therefore, Boate's injury was deemed industrial.

Workers' Compensation Appeals BoardRODOLFO BOATETRUGREEN LANDCAREZURICH AMERICAN INSURANCE COMPANYADJ9781533Petition for ReconsiderationDeniedWCJCredibility determinationsGarza v. Workmen's Comp. Appeals Bd.
References
1
Case No. ADJ3157275
Regular
Jan 10, 2014

RODOLFO PONCE vs. PACIFIC MOLDED TECHNOLOGY, UNITED STATES FIRE INSURANCE COMPANY, CRUM & FORSTER

The Workers' Compensation Appeals Board (WCAB) has denied Rodolfo Ponce's Petition for Removal. The Board reviewed the petition and the administrative law judge's report, adopting the judge's reasoning for denial. This decision means the case will proceed as determined by the administrative law judge.

Petition for RemovalWorkers' Compensation Appeals BoardAdministrative Law Judge ReportDeniedRodolfo PoncePacific Molded TechnologyUnited States Fire Insurance CompanyCrum & ForsterADJ3157275LAO 0871136
References
0
Case No. ADJ4266581 (RIV 0043684) ADJ459635 (AHM 0136605)
Regular
Aug 16, 2017

RODOLFO BARBA vs. UNIVERSAL FOREST PRODUCTS, LIBERTY MUTUAL INSURANCE COMPANY, SENTRY INSURANCE COMPANY

This case involves an applicant, Rodolfo Barba, filing a petition for reconsideration. The Workers' Compensation Appeals Board (WCAB) dismissed the petition because it was untimely. The WCAB clarified that a petition must be *received* by the board within 25 days of service (plus any applicable extensions), not just mailed. Since the petition was filed more than 25 days after the arbitrator's decision, the WCAB lacked jurisdiction to consider it.

Workers' Compensation Appeals BoardPetition for ReconsiderationUntimelyDismissalLabor CodeCalifornia Code of RegulationsJurisdictionalAdministrative ArbitratorService of DecisionMailing
References
3
Case No. ADJ12550205
Regular
Apr 06, 2020

OLGA PLASCENCIA vs. ADECCO USA, INC

This case involves a dispute over a Qualified Medical Evaluator (QME) panel request. The applicant sought a chiropractic QME panel, while the defendant later denied liability for certain injuries. The Workers' Compensation Appeals Board (WCAB) rescinded the prior ruling and returned the case to the trial judge. This decision was based on the need to further develop the record regarding the applicant's DWC-1 form filing and the effect of the defendant's partial acceptance of liability on the QME panel process. The WCAB emphasized that the validity of the QME panel needs resolution before further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderDelay LetterMedical EvaluationQME PanelChiropracticOrthopedicLabor Code Section 4060Causation Dispute
References
5
Case No. ADJ6767592
Regular
May 28, 2013

RODOLFO CHAVEZ vs. SIMMONS MANUFACTURING CO., CHARTIS SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration, rescinding an administrative law judge's order dismissing a lien claimant's lien for copy services. The lien claimant had failed to pay the required activation fee at a lien conference, which under Labor Code section 4906.03(a)(4) typically results in dismissal. However, the Board found that at the time of the dismissal, there was uncertainty regarding the application of new legislation, and the claimant's attempt to recover costs via a petition for costs under a different section was understandable. The matter was returned to the trial level for further proceedings and a new decision, requiring the lien claimant to pay the activation fee if they wish to pursue the lien.

Lien activation feeLabor Code section 4903.06Order Dismissing Lien ClaimPetition for CostsSection 5811SB 863Martinez v. TerrazasWCJWorkers' Compensation Appeals BoardCopy services
References
2
Case No. ADJ6664260
Regular
Dec 15, 2014

RODOLFO DE LA TORRE vs. DESIGNED METAL CONNECTIONS, TRAVELERS

The Workers' Compensation Appeals Board granted reconsideration of a dismissal order that had removed lien claimant Frontline Medical Associates' lien. Frontline claimed it filed a timely objection to the notice of intention to dismiss, but this objection was not recorded in the system. The Board found that the WCJ's failure to consider Frontline's objection may have violated due process. Therefore, the dismissal order was rescinded, and the case was returned to the trial level for further proceedings to determine the timeliness of the objection and its merits.

Workers' Compensation Appeals BoardPetition for ReconsiderationLien ClaimantDismissal OrderNotice of Intention to Dismiss LienDue ProcessCompromise and ReleaseLien TrialFileNetElectronic Adjudication Management System
References
3
Case No. ADJ6820997
Regular
Feb 08, 2012

RODOLFO VILLALOVOS vs. ACE BEVERAGE COMPANY, TOPA INSURANCE COMPANY

This case involves a dispute over the admissibility of medical reports from a physician outside the defendant's Medical Provider Network (MPN) and the subsequent award of temporary and permanent disability benefits. The Appeals Board rescinded the original decision due to unresolved issues regarding the proper establishment and notice of the MPN. The case is returned to the trial level for further proceedings to determine the validity of the MPN and the admissibility of the medical evidence. The WCJ must also clarify whether certain QME reports were admitted into evidence, as reliance on unadmitted evidence is improper.

MPNValdezPrimary Treating PhysicianReconsiderationMedical Provider NetworkInadmissible ReportsStipulationTemporary DisabilityPermanent DisabilityMedical Treatment
References
3
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