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

Case No. ADJ6939425

Regular

Oct 01, 2016

Rene Garcia vs. American Tire Distributors, Broadspire

This case concerns a worker, Rene Garcia, seeking reconsideration of a Workers' Compensation Appeals Board decision. The applicant argued that a stipulation for an Agreed Medical Examiner (AME) should bind the defendant to their recommended bi-level neck surgery. The Board denied reconsideration, affirming the judge's finding that the AME stipulation did not override the statutory requirement to resolve medical treatment disputes through the Utilization Review/Independent Medical Review process. The Board also upheld the denial of attorney fees, as no benefits were awarded under the specific 2011 stipulation.

Workers' Compensation Appeals BoardRene GarciaAmerican Tire DistributorsBroadspirePetition for ReconsiderationFindings and OrderAdministrative Law Judgeunreasonable delaypayment of compensationtemporary disability

References

Case No. ADJ7006379

Regular

Sep 04, 2014

RAMAN KUMAR vs. SEARS HOLDING CORPORATION, ACE AMERICAN INSURANCE COMPANY

Defendant Sears Holding Corporation sought to terminate liability for home healthcare services, challenging a prior WCJ order that found no good cause to do so. The original order, based on a stipulation, required reimbursement for up to 10 hours per week of home healthcare at $15/hour. The defendant's petition was denied because the prior order was deemed final and res judicata, predating SB 863's amendments to home healthcare provisions. The defendant failed to demonstrate good cause, such as a change in the applicant's medical condition, to modify or terminate the existing award. The Appeals Board adopted the WCJ's reasoning, emphasizing that the burden is on the defendant to show why the services are no longer needed, a burden not met here.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersHome Healthcare ServicesPetition to Terminate LiabilityUtilization ReviewRequest for AuthorizationFinal OrderGood CauseSB863

References

Case No. ADJ9721385

Regular

Jun 07, 2016

JUAN PABLO BELTRAN vs. STRUCTURAL STEEL FABRICATORS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, overturning a WCJ's order that disallowed settlement of a Supplemental Job Displacement Benefit (SJDB) voucher. The Board held that parties can settle an SJDB voucher claim in a Compromise and Release Agreement if a good faith dispute exists that could defeat the applicant's entitlement to all workers' compensation benefits. In this case, the applicant's failure to report the injury before termination constituted such a good faith dispute, allowing the settlement of the SJDB voucher. The Board therefore approved the parties' original Compromise and Release Agreement, including the settlement of the SJDB voucher.

Supplemental Job Displacement BenefitCompromise and ReleaseGood Faith DisputeSB863Vocational RehabilitationLabor Code Section 4658.7Petition for ReconsiderationWorkers' Compensation Appeals BoardAffirmative DefenseAOE/COE

References

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Rene Garcia vs. American Tire Distributors, Broadspire

RAMAN KUMAR vs. SEARS HOLDING CORPORATION, ACE AMERICAN INSURANCE COMPANY

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersHome Healthcare ServicesPetition to Terminate LiabilityUtilization ReviewRequest for AuthorizationFinal OrderGood CauseSB863

JUAN PABLO BELTRAN vs. STRUCTURAL STEEL FABRICATORS, STATE COMPENSATION INSURANCE FUND