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

Case No. ADJ2408088 (LAO 0840556)
Regular
Nov 30, 2009

, SCOTT BOWEN, vs. , TAYLOR CONTRACTING SERVICES, INC.; and TIG SPECIALTY INSURANCE COMPANY,

The WCAB denied reconsideration of the decision finding the applicant's average weekly earnings (AWE) to be $403.29. The WCJ's decision on AWE was upheld.

Workers' Compensation Appeals BoardADJ2408088LAO 0840556Scott BowenTaylor Contracting ServicesInc.TIG Specialty Insurance CompanyOpinion and Order Denying ReconsiderationFindings of Fact and OrdersWorkers' Compensation Judge (WCJ)
References
Case No. ADJ9065210
Regular
Mar 08, 2016

WILLIAM JOHNS vs. BEN F. SMITH, AIG, ZURICH NORTH AMERICA

Defendant Zurich North America sought reconsideration of a WCJ's decision awarding applicant benefits for injuries sustained as a carpenter. Zurich contested the date of injury, arguing it predated their coverage and denied due process by deferring this issue. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the case to the trial level. This action was taken because the WCJ failed to issue findings on all controverted issues, specifically the date of injury under Labor Code section 5412.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and AwardIndustrial InjuryLumbar SpineRight HipBilateral KneesLower ExtremitiesCarpenter
References
Case No. ADJ6781238
Regular
Mar 08, 2013

JORGE MORA vs. CLP RESOURCES, INC., ESIS

This case involved a carpenter, Jorge Mora, who sustained an industrial injury to his left hand while employed by CLP Resources, Inc. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's prior decision finding that the injury was proximately caused by CLP Resources' serious and willful misconduct. The WCAB also upheld the WCJ's determination that the serious and willful misconduct claim was not barred by the statute of limitations. The defendant's petition for reconsideration was denied, affirming the original award of compensation and attorney's fees.

Workers' Compensation Appeals BoardSerious and willful misconductIndustrial injuryCarpenterLeft hand injuryStatute of limitationsCompromise and ReleasePetition for ReconsiderationFindings and AwardWCJ Report and Recommendation
References
Case No. ADJ2186877 (VNO 0533117)
Regular
Jun 29, 2010

JODY LATOUF vs. STUMBAUGH & ASSOCIATES, INC., TIG SPECIALTY INSURANCE COMPANY as Administered by RISK ENTERPRISE MANAGEMENT, LTD., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an arbitrator's findings due to an incomplete record, specifically the absence of a Minutes of Hearing and Summary of Evidence. TIG Specialty Insurance Company sought reconsideration, arguing the arbitrator erred in asserting WCAB jurisdiction over a mandatory "carve out" program for carpenters. The WCAB remanded the case for the arbitrator to create a proper record and issue a new decision on the coverage dispute. Additionally, the Van Nuys District Office will consider the submitted Compromise and Release Agreement.

Workers' Compensation Appeals BoardIndustrial InjuryStumbaugh & AssociatesInc.TIG Specialty Insurance CompanyRisk Enterprise ManagementState Compensation Insurance FundLabor Code § 3201.5Carve Out ProgramAlternate Dispute Resolution
References
Case No. ADJ1434238 (SFO 0461609)
Regular
Jul 18, 2012

DANIEL PRATHER vs. CITY AND COUNTY OF SAN FRANCISCO

The Workers' Compensation Appeals Board granted reconsideration to review the administrative law judge's (WCJ) findings on permanent disability and apportionment. The Board rescinded the original award, finding that neither the applicant's treating physician nor the defense qualified medical examiner provided substantial medical evidence on apportionment. Due to complex medical issues and inadequate development of the record, the case is returned to the trial level for further proceedings, including the potential selection of an Agreed Medical Examiner or a physician appointed by the Board.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentQualified Medical Examiner (QME)Substantial Medical EvidenceLabor Code §4663Cumulative TraumaSpine Injury
References
Case No. ADJ2186877 (VNO 0522117)
Regular
Jan 07, 2011

JODY LATOUF vs. STUMBAUGH & ASSOCIATES, INC., TIG SPECIALTY INSURANCE COMPANY as administered by RISK ENTERPRISE MANAGEMENT, LTD., STATE COMPENSATION INSURANCE FUND.

The Workers' Compensation Appeals Board denied TIG Specialty Insurance Company's petition for reconsideration. TIG claimed its policy only covered non-carpenter employees at the LAUSD site. However, TIG failed to present the policy as evidence at either arbitration hearing. Therefore, the Board inferred the policy did cover the applicant's employment, upholding the arbitrator's decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationArbitrator's ReportSite-Specific PolicyEvidenceCoverage IssueInferenceTIG Specialty Insurance CompanyStumbaugh & AssociatesInc.
References
Case No. ADJ2239874 (STK 0170112) ADJ472994 (STK 0198041) ADJ3391005 (STK0208641)
Regular
Dec 15, 2008

MITCHELL PACHECO vs. INNOVATIVE STEEL SYSTEMS and CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT COMPENSATION INSURANCE COMPANY, in liquidation, LENNAR CORPORATION and OLD REPUBLIC INSURANCE COMPANY, RICHMOND AMERICAN HOMES and AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to the trial level. The Board found that the WCJ erred by applying the wrong disability rating schedule and by issuing a combined award for three separate successive injuries. The matter is remanded for separate determinations of permanent disability for each injury, with the 2005 and 2006 injuries to be rated under the 2005 Schedule.

CIGAFremont Compensation Insurance CompanyliquidationInnovative Steel SystemsLennar CorporationOld Republic Insurance CompanyRichmond American HomesAmerican Home Assurance Companyindustrial injuriesneck
References
Case No. ADJ473373 (ANA 0406381)
Regular
Feb 10, 2012

FERNANDO GUTIERREZ vs. SOCAL FRAMING aka BMHC; ACE AMERICAN INSURANCE, administered by ESIS, INC.

This case concerns applicant's claim for extended temporary disability (TD) benefits beyond 104 weeks due to a left eye injury. The Appeals Board affirmed the WCJ's denial of the "amputation" exception, ruling that the surgical removal of an eye does not fit the statutory definition. However, the Board remanded the case for further development of the record on the "high-velocity eye injury" exception, as the velocity and force of the object that struck the applicant's eye were unclear. The applicant's Petition for Removal was dismissed as reconsideration was the appropriate remedy.

Workers' Compensation Appeals BoardFernando GutierrezSoCal FramingBMHCACE American InsuranceESISInc.ADJ473373ANA 0406381Opinion and Decision
References
Case No. ADJ3357383 (LAO 0845427)
Regular
Nov 26, 2013

LARRY ALVES vs. PANELIZED STRUCTURES, STATE COMPENSATION INSURANCE FUND

This case concerns Larry Alves' claim for psychiatric injury following a physical injury sustained while employed for less than six months. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior ruling favoring the applicant. The WCAB found the psychiatric claim barred under Labor Code § 3208.3(d) because the applicant's employment was too short and the injury was not caused by a "sudden and extraordinary" employment condition. The Board concluded that an injury from a falling truss, though unfortunate, is not extraordinary in construction work.

Labor Code section 3208.3(d)psychiatric injurysudden and extraordinary employment conditionsix-month employment requirementfalling trusscarpenterconstruction workerpanelized structuresState Compensation Insurance FundWorkers' Compensation Appeals Board
References
Case No. ADJ119070 (SAL 0106616)
Regular
Oct 27, 2008

JOSE ESCALANTE vs. JOHN MANNINGER ELECTRIC, STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration and increased applicant's permanent disability rating from 50% to 56%, with indemnity payments commencing November 12, 2007. The Board affirmed the application of the 1997 Permanent Disability Rating Schedule based on defendant's failure to provide required notice after a hiatus in temporary disability payments. Additionally, the Board admitted applicant's medical reports into evidence and affirmed the WCJ's amended award.

Permanent Disability Rating ScheduleLabor Code Section 4061Mandatory Settlement ConferenceTreating PhysicianMedical-Legal ReportTemporary Disability IndemnityAmerican Medical Association GuidesAgreed Medical EvaluatorReconsiderationCommutation of Attorney Fees
References
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