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

Case No. ADJ4018708 (SBA 0079160)
Regular
Apr 23, 2010

KATHY KELLERMANN vs. REGENTS OF UCSB, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves Kathy Kellermann's claim for workers' compensation benefits, where the administrative law judge initially found a cumulative trauma injury to her psyche but not to her dental, neurological, or internal systems, awarding 8% permanent disability. Ms. Kellermann sought reconsideration, arguing the judge erred by excluding dental, neurological, and internal injuries, acting in excess of powers regarding an independent medical exam, and improperly relying on certain medical reports for disability assessment. The Appeals Board granted reconsideration to clarify the scope of injury, affirming the finding of psyche injury but not other systems as a compensable consequence. The Board also upheld the 8% permanent disability award, citing precedent allowing reliance on a single physician's relevant and considered opinion even if inconsistent with others.

ADJ4018708SBA 0079160Kathy KellermannRegents of UCSBSedgwick Claims Management ServicesOpinion and Order Granting ReconsiderationDecision After Reconsiderationindustrial cumulative trauma injurypsyche injurydental injury
References
2
Case No. SBA 077625, SBA 073703, SBA 085498
Regular
Aug 04, 2008

DAVID DISANDRO vs. HAAGEN PRINTING & OFFSET, GRAPHIC ARTS, SAFECO INSURANCE COMPANY, ALLIANZ INSURANCE COMPANY, CALIFORNIA INDEMNITY

The Appeals Board granted Safeco's reconsideration, rescinding the prior award finding Safeco liable for contribution. Safeco is not responsible for benefits related to a cumulative trauma injury from Graphic Arts because it did not provide insurance coverage during that employment period. The Board clarified that the applicable statute regarding the California Insurance Guarantee Association (CIGA) does not compel contribution from solvent insurers who were not on risk during the specific period of injury.

Workers Compensation Appeals BoardReconsiderationContributionCumulative Trauma InjuryInsurance CoverageCalifornia IndemnitySafeco InsuranceAllianz InsuranceGraphic ArtsHaagen Printing
References
12
Case No. SBA 077861, SBA 083526, SBA 083527
Regular
Jul 15, 2008

JUAN GUTIERREZ vs. SANTA BARBARA SCHOOL DISTRICT, CIGA on behalf of FREMONT INDEMNITY INSURANCE CO.

The Workers' Compensation Appeals Board (WCAB) is reconsidering multiple injury claims for Juan Gutierrez against Santa Barbara School District. The WCAB is deferring a final decision on permanent disability awards and attorney fees pending the outcome of a related Court of Appeal case, *Benson*, which could impact how multiple injuries are combined. The Board has amended one finding to correct the list of injured body parts in a cumulative injury claim and affirmed that Dr. Reynolds' medical opinions constitute substantial evidence regarding chronic pain and apportionment.

CIGAindustrial injuriespsyche injurychronic pain syndromepermanent disabilityreconsiderationBenson v. Permanente Medical GroupWilkinson v. Workers' Comp. Appeals Bd.City of Santa Clara v. Workers' Comp. Appeals Bd. (Navarette)substantial evidence
References
6
Case No. SBA 84927, SBA 84928, SBA 84929
Regular
Jul 07, 2008

LAYA IRAVANI vs. SAKS FIFTH AVENUE, TRAVELERS INSURANCE COMPANY, ESTEVEZ ENTERPRISES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION by CAMBRIDGE INTEGRATED SERVICES GROUP for FREMONT COMPENSATION

The Workers' Compensation Appeals Board granted reconsideration to avoid bifurcating issues, rescinding three prior decisions. The cases are returned to the trial level to further develop the record on permanent disability apportionment, as the QME's opinion was deemed insufficient under new legal standards. Additionally, the Board agreed that Travelers should administer future medical treatment for common injuries and disallowed the EDD lien against CIGA.

CIGAFremont CompensationliquidationWilkinsonBensonapportionmentSB 899QMEDr. Weingartencumulative trauma
References
12
Case No. SBA 0077861, SBA 0083526, SBA 0083527
Regular
Apr 11, 2008

JUAN GUTERREZ vs. SANTA BARBARA SCHOOL DISTRICT, Permissibly Self-Insured; CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, on behalf of FREMONT INDEMNITY INSURANCE CO., In liquidation

This case involves an applicant, Juan Guterrez, and defendants Santa Barbara School District and the California Insurance Guarantee Association (CIGA). Both the applicant and CIGA sought reconsideration of the Workers' Compensation Administrative Law Judge's (WCJ) decisions from February 7, 2008. The Appeals Board is granting reconsideration to obtain a WCJ report on CIGA's petition, which is necessary to understand all issues before rendering a unified decision.

Workers' Compensation Appeals BoardCIGAFremont Indemnity Insurance Co.liquidationReconsiderationWCJReport and RecommendationDecision After ReconsiderationSanta Barbara School DistrictPermissibly Self-Insured
References
0
Case No. SBA 0083894; SBA 0099253
Regular
Jul 29, 2008

RAFAEL LOPEZ vs. SAN YSIDRO RANCH, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For HIH AMERICA, In Liquidation

This case concerns an applicant's petition to amend a prior workers' compensation award to include the right shoulder as an injured body part. The Appeals Board denied reconsideration, holding that the omission of the right shoulder was not a clerical error and that Labor Code section 5804, which limits amendments to awards after five years from the date of injury, barred the requested modification. Since the applicant sought to add a new injury rather than enforce an existing award and the five-year jurisdictional limit had passed, the Board lacked the authority to grant the relief sought.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulated Awardclerical errorLabor Code § 5804continuing jurisdictiondate of injuryAgreed Medical Examiner (AME)permanent disabilitymedical treatment
References
4
Case No. SBA 0069195 SBA 0069196
Regular
Apr 18, 2008

MOLLY PANIAGUA vs. FISHER FARMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Adjusted By BROADSPIRE for SUPERIOR NATIONAL, In Liquidation, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, Adjusted By INTERCARE INSURANCE for PAULA INSURANCE, In Liquidation

The Workers' Compensation Appeals Board granted reconsideration and affirmed the WCJ's finding of unreasonable delay in permanent disability payments by the defendant. While initially a 25% penalty was awarded, the Board reduced it to 10% as recommended by the WCJ, acknowledging a reasonable legal doubt regarding the start date of benefits prior to a specific WCJ decision. The Board also affirmed the denial of the defendant's credit for prior payments and the imposition of penalties for unilateral credit-taking and attorney fees.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee Associationliquidationunreasonable delaypermanent disabilityattorney feesinterestLabor Code section 5814creditnew and further disability
References
1
Case No. SBA 0083167, SBA 0086539
Regular
Nov 08, 2007

KAREN R. SEGROVES vs. ONEIDA, LTD.; and THE HARTFORD

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior order, remanding the case for further proceedings. The original decision denied the applicant reimbursement for out-of-state medical travel expenses due to an inadequate trial record. However, the Board noted that the applicant's claim for reimbursement appears legally sound, referencing relevant precedent.

SegrovesOneida Ltd.The HartfordWorkers' Compensation Appeals Boardreconsiderationtravel expensesmedical treatmentout-of-state physicianBraewood Convalescent Hospitaltrial record
References
2
Case No. SBA 0083738, SBA 0084753
Regular
Dec 04, 2007

MAGDALENA PINEDA vs. INAMED CORPORATION aka MCGHAN MEDICAL, CIGA by CAMBRIDGE INTEGRATED SERVICES, SAFECO

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration of a previous award. The applicant had sought reconsideration of findings that she sustained industrial injury to her bilateral upper extremities, neck musculature, shoulders, and upper back, but not to her psyche or cervical spine. The Board adopted the WCJ's report and recommendations, denying the petition and noting a potential clerical error in the award regarding medical treatment for the cervical spine and psyche.

Workers' Compensation Appeals BoardMagdalena PinedaInamed CorporationMcGhan MedicalCIGACambridge Integrated ServicesSafecobilateral upper extremitiesneck musculatureshoulders
References
0
Case No. ADJ3668486 (SBA 0081243) ADJ2866077 (SBA 0073112) ADJ3676183 (SBA 0082815) ADJ3511801 (GOL 0090292) ADJ2318677 (GOL 0095094) ADJ658495 (SBR 0193676)
Regular
Jul 09, 2009

FRANCINE KOBLICK vs. PALM SPRINGS UNIFIED SCHOOL DISTRICT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ACE/ESIS

This case concerns ACE/ESIS seeking reconsideration of a WCJ's decision that CIGA was not responsible for a Blue Cross lien. ACE/ESIS and CIGA had settled the applicant's multiple injury claims via a Compromise and Release agreement which included an addendum obligating both parties to pay 50% of adjusted liens. CIGA argued it was not liable for the Blue Cross lien due to Insurance Code § 1063.1(c) excluding "covered claims" related to insurers, similar to the *Gorgi* case. The Appeals Board granted reconsideration, finding the WCJ erred by distinguishing this case from *Gorgi* due to CIGA's voluntary contractual agreement to pay 50% of liens, making it analogous to the *Carter* case. The Board rescinded the WCJ's finding and returned the matter for further proceedings, holding that CIGA's contractual promise overrides the statutory exclusion for liens.

CIGAACE/ESISCompromise & ReleaseLienBlue CrossInsurance Code § 1063.1(c)Contractual ObligationCovered ClaimReconsiderationWorkers' Compensation Appeals Board
References
2
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