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

Case No. LAO 0795696
Regular
Jul 09, 2007

DULCE MONTES vs. NATIONWIDE PAGING, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The applicant sought reconsideration of a decision mandating transfer into the defendant's Medical Provider Network (MPN) for treatment. The Workers' Compensation Appeals Board denied reconsideration, affirming that MPNs, as established by SB 899, allow for transfer of care regardless of prior treatment relationships or awards. The Board found no evidence applicant met exceptions to MPN transfer rules and rejected arguments based on pre-SB 899 law or MPN rule unconstitutionality.

MPNMedical Provider NetworkPrimary Treating PhysicianReconsiderationFindings of FactLabor Code Section 4616Appeals Board Rule 9767.9Transfer of CareSB 899Babbitt v. Ow Jing
References
7
Case No. MON 0261251 MON 0315082
Regular
Mar 17, 2008

RICHARD HICKS vs. BRAND & HILL PRODUCTIONS, LEGION INSURANCE, CALIFORNIA INSURANCE GURANTEE ASSOCIATION

The Workers' Compensation Appeals Board granted reconsideration and rescinded the previous award because the Administrative Law Judge's decision on permanent disability was based on a medical report predating SB 899, which failed to address apportionment as required by current law. The court found inconsistencies in the apportionment of disability, particularly regarding pre-existing conditions and subsequent cumulative trauma. The case was returned to the trial level for further development of the record on apportionment to comply with post-SB 899 legal standards.

CIGALegion InsuranceSB 899apportionmentDr. Charles SadlerDr. Thomas SheryLabor Code section 4663cumulative traumapermanent disabilitymedical treatment
References
7
Case No. ADJ4146224 (SBR 0296668) ADJ1272169 (SBR 0296667)
Regular
Oct 28, 2013

KATHLEEN ZAMANJAHROMI vs. KAISER FOUNDATION HOSPITAL

This case involves Kathleen Zamanjahromi seeking increased permanent disability benefits for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied Kaiser Foundation Hospital's petition for reconsideration. The WCAB affirmed the finding of good cause to reopen a prior stipulated award for new and further disability, resulting in a 96% permanent disability rating. The defendant's argument that SB 899's apportionment provisions applied to the original award was rejected. The WCAB clarified that SB 899's apportionment applies to new and further disability but cannot retroactively alter prior findings.

Petition for ReconsiderationNew and Further DisabilityLabor Code Section 5410Senate Bill 899ApportionmentStipulated AwardReopeningFinal OrderWorkers' Compensation Appeals BoardAgreed Medical Examiner
References
7
Case No. ADJ1438639 (GRO 0024593) ADJ3262777 (GRO 0025366)
Regular
Sep 20, 2011

Dennis Timmons vs. CALIFORNIA MENS COLONY, STATE COMP. INS. FUND, SUBSEQUENT INJURIES BENEFITS TRUST FUND

This case concerns applicant Dennis Timmons' petition for reconsideration of a denial of Subsequent Injuries Benefits Trust Fund (SIBTF) benefits. The Appeals Board reversed a prior award, finding applicant failed to prove a pre-existing permanent partial disability from a 1991 cervical fusion surgery prior to his 2000 industrial injury. Applicant argued the fusion itself constituted a previous impairment and that SB 899's apportionment changes should apply, but the Board affirmed its decision. The Board reiterated that contemporaneous medical evidence is required for SIBTF eligibility, and that SB 899 did not alter SIBTF's established requirements.

Subsequent Injuries Benefits Trust FundSIBTFpermanent disabilitypre-existing disabilitycervical fusionApril 132000 industrial injurySB 899apportionment to causationLabor Code section 4751
References
2
Case No. SRO 0132302 SRO 0137260 SRO 0137261
Regular
Apr 25, 2008

ROMAN BELTRAN vs. PIEDMONT LUMBER & MILL COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns the application of Labor Code section 4658(d) to an injury occurring on May 10, 2004, after Senate Bill 899's enactment. The Appeals Board affirmed the WCJ's finding that because the employer did not offer a return-to-work plan for at least 12 months, the permanent disability indemnity payable from 60 days after the P&S date must be increased by 15%. This ruling clarifies that SB 899's provisions apply prospectively from its enactment date to injuries not specifically excluded by the legislation.

Labor Code section 4658(d)SB 899permanent disability awardpermanent and stationary datereturn to workjob offerweekly conversion schedulemedical-legal reporttreating physician's reporttemporary disability indemnity
References
11
Case No. SAC 0326274
Significant

JANELLE SCHEFTNER, Applicant vs. RIO LINDA SCHOOL DISTRICT, Permissibly Self-Insured

The Appeals Board affirmed the WCJ's decision, holding that the new apportionment statutes enacted by SB 899 do not apply to cases where an order of submission for decision existed prior to the new law's enactment on April 19, 2004.

SB 899apportionmentexisting ordersubmission orderreconsiderationJanelle ScheftnerRio Linda School DistrictWCJDr. NijjarDisability Evaluation Unit
References
35
Case No. ADJ11795460
Regular
Oct 17, 2019

GABRIEL MORA vs. SB ENTERTAINMENT VENTURES INC. dba 340 RESTAURANT AND NIGHTCLUB, EMPLOYERS PREFERRED INSURANCE COMPANY

This case involves a workers' compensation claim where the applicant alleges injury during an altercation at work. The employer, SB Entertainment Ventures Inc., denied the claim, asserting the applicant was the initial aggressor. The applicant sought a video of the incident, which the employer failed to produce despite a subpoena and court order. The WCJ issued a finding that the video showed the applicant was not the initial aggressor, implying the employer's non-production led to this conclusion. The Appeals Board treated the employer's petition as a request for reconsideration, rescinded the WCJ's finding, and remanded the case. This action was taken because the prior hearing lacked sufficient admitted evidence to support the finding, and due process requires a proper evidentiary record before determining such a threshold issue as initial aggressor status.

WCABRemoval PetitionReconsiderationInitial AggressorDue ProcessSubpoena Duces TecumAdverse InferenceWillful SuppressionBad Faith ActionsSanctions
References
13
Case No. OAK 0297895, OAK 0326228
En Banc
Dec 13, 2007

Dianne Benson vs. The Permanente Medical Group, Athens Administrators

The Appeals Board holds that the rule from Wilkinson v. Workers’ Comp. Appeals Bd., allowing a combined disability award for successive injuries, is no longer generally applicable after SB 899 reforms, mandating that apportionment must be based on causation for each separate injury.

SB 899Wilkinson ruleApportionmentCausationPermanent disabilityCumulative traumaSpecific injurySuccessive injuriesAgreed Medical ExaminerEn banc decision
References
7
Case No. SAC 323226
Significant
Feb 01, 2005

Marilyn Simi vs. SAV-MAX FOODS, INC; Springfield Insurance Company

The Appeals Board held that for injuries occurring prior to January 1, 2005, Labor Code section 4062, as it existed before its amendment by SB 899, continues to provide the procedure for obtaining AME and QME medical-legal reports in cases involving represented employees.

Workers' Compensation Appeals BoardEn BancRemovalDefense Qualified Medical ExaminationSB 899Labor Code Sections 40614062Pre-2005 InjuriesAgreed Medical EvaluationMedical-Legal Reports
References
9
Case No. SAC 0326274
En Banc
Oct 04, 2004

Janelle Scheftner vs. Rio Linda School District

The Appeals Board holds that orders closing discovery and submission orders issued prior to the enactment of SB 899 on April 19, 2004, are existing orders that cannot be reopened to apply the new apportionment statutes. The decision affirms the WCJ's findings on permanent disability and apportionment under the old law.

SB 899ApportionmentExisting orderSubmission orderReconsiderationPermanent disabilityLabor Code section 4663Mandatory settlement conferenceCausationProspective application
References
35
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