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

Case No. ADJ3288082 (LBO 0384974)
Regular
May 09, 2013

ANDRES CRUZ vs. ALLSTATE/KOOKLANCAR PEYMAN, SPECIALTY RISK/SEDGWICK

This case, *Andres Cruz v. Allstate/Kooklancar Peyman; Specialty Risk/Sedgwick*, concerns a workers' compensation claim. The Workers' Compensation Appeals Board (WCAB) granted reconsideration of the Administrative Law Judge's (ALJ) prior decision. The WCAB rescinded the ALJ's decision and remanded the case back for further proceedings and a new decision at the trial level. This order is not a final determination on the merits of the claim.

Workers Compensation Appeals BoardReconsiderationAdministrative Law JudgeRescinded DecisionFurther ProceedingsTrial LevelFinal DecisionMeritsDental Trauma CenterSpeciality Risk
References
Case No. ADJ4634338 (MON 0262377)
Regular
Jun 24, 2009

NINA GOODRICH vs. UNILAB/QUEST DIAGNOSTICS, SEDGWICK CLAIMS MANAGEMENT SERVICES, AMERICAN CASUALTY CO. OF READING, PA, CNA CLAIMSPLUS, VALLEY HEALTH SYSTEMS, TRISTAR RISK MANAGEMENT, ZURICH INSURANCE CO.

This case concerns a dispute over contribution claims following a cumulative injury to the applicant. The Workers' Compensation Appeals Board granted reconsideration, rescinded an arbitration finding, and remanded the matter for further proceedings. The Board found that Sedgwick, which paid over $180,000 in benefits, was not required to file a petition for contribution under section 5500.5 because it was not a signatory to the Compromise and Release (C&R). Furthermore, the Board held that even if Sedgwick had been required to file, the co-defendant CNA would be estopped from asserting the statute of limitations due to stipulations in the C&R reserving contribution rights. The Board concluded Sedgwick's claim for reimbursement was not time-barred.

Workers' Compensation Appeals BoardNina GoodrichUnilabQuest DiagnosticsSedgwick Claims Management ServicesAmerican Casualty Co.CNA ClaimsplusValley Health SystemsTristar Risk ManagementZurich Insurance Co.
References
Case No. ADJ2309063, 2603988
Regular
Jun 24, 2010

RAINIE JAEGER vs. APOTHE-CARE, INC., dba OWENS PHARMACY, FIREMAN'S FUND INSURANCE COMPANY, AMERICAN AUTO INSURANCE COMPANY, RISK ENTERPRISE MANAGEMENT, WALGREEN'S, AMERICAN MOTORISTS INSURANCE COMPANY, SEDGWICK CMS, Fairmont Premier Insurance Company, American Motorist Insurance Company adjusted by Sedgwick

This case involves a dispute over a worker's compensation claim for a low back injury determined to be a compensable consequence of a prior bilateral carpal tunnel injury. The Board granted reconsideration to correct the date of the compensable consequence injury to October 5, 2004. Furthermore, Fireman's Fund was ordered to reimburse Sedgwick CMS for benefits paid after that date, with the right to seek contribution from Fairmont Premier/REM. The Board rescinded prior findings and substituted new ones, clarifying liability for medical treatment and benefits.

compensable consequence injurybilateral carpal tunnellow back injuryspinal surgeryAgred Medical Evaluator (AME)Fireman's FundSedgwick CMSjoint and several liabilityreimbursementcontribution
References
Case No. ADJ8138407
Regular
Nov 19, 2014

SCOTT LOWE vs. ADT, SEDGWICK CMS

The applicant is Scott Lowe, and the defendants are ADT and Sedgwick CMS. The defendants sought Social Security earnings records from 2005 to the present, claiming it was proper discovery. The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for removal of the judge's order denying this discovery. The WCAB found that the requested earnings information, starting seven years prior to the injury, was not relevant and removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm.

Petition for RemovalSocial Security earnings recordsdiscoverydue processtemporary total disabilitysubstantial prejudiceirreparable harmreconsiderationadministrative law judgeWorkers' Compensation Appeals Board
References
Case No. ADJ1029994 (LBO 0391256)
Regular
Sep 09, 2004

WALTER PEARCE vs. LAIDLAW EDUCATION SERVICES, SEDGWICK CMS

This order dismisses Laidlaw Education Services' and Sedgwick CMS' petition for removal. The Workers' Compensation Appeals Board adopted and incorporated the administrative law judge's report in reaching this decision. The petition for removal is therefore dismissed.

Petition for RemovalDismissalReconsiderationWorkers' Compensation Appeals BoardAdministrative Law Judge ReportLAIDLAW EDUCATION SERVICESSEDGWICK CMSADJ1029994LBO 0391256
References
Case No. ADJ2655171 (LAO 0886561) ADJ1429155 (LAO 0862514)
Regular
May 22, 2012

GUILLERMO HERNANDEZ vs. MCKESSON CORPORATION, SEDGWICK CMS, INC.

This case involves reconsideration sought by both applicant Guillermo Hernandez and defendant McKesson Corporation/Sedgwick CMS, Inc., regarding prior decisions. The Workers' Compensation Appeals Board (WCAB) granted reconsideration because an initial review indicated the need for further study of the factual and legal issues to ensure a just and reasoned decision. Pending the decision after reconsideration, all communications must be filed in writing with the WCAB Commissioners in San Francisco, not with any district office or e-filed.

Workers' Compensation Appeals BoardReconsideration GrantedMcKesson CorporationSedgwick CMSInc.Guillermo HernandezStatutory Time ConstraintsFactual IssuesLegal IssuesJust and Reasoned Decision
References
Case No. ADJ13310557
Regular
Oct 14, 2020

BRENDA TURNER vs. MERCY HOSPITAL OF FOLSOM, DIGNITY HEALTH, SEDGWICK CLAIMS

This Workers' Compensation Appeals Board case involves Brenda Turner as the applicant and Mercy Hospital of Folsom, Dignity Health, and Sedgwick Claims as defendants. The Board is issuing an Opinion and Order dismissing the Petition for Removal. This dismissal is solely because the petitioner voluntarily withdrew their petition.

Petition for RemovalWithdrawn PetitionDismissal OrderWorkers' Compensation Appeals BoardMercy Hospital of FolsomDignity HealthSedgwick ClaimsADJ13310557September 1 2020 decisionRatto Law Firm
References
Case No. ADJ10663212
Regular
Dec 18, 2017

Applicant vs. Sedgwick CMS, Sedgwick CMS

This case concerns a Petition for Removal filed by an applicant. The Workers' Compensation Appeals Board (WCAB) denied the petition, finding that the applicant failed to demonstrate substantial prejudice or irreparable harm. The WCAB also determined that reconsideration would be an adequate remedy should an adverse final decision be issued. Therefore, the Board adopted the WCJ's report and denied removal as an extraordinary remedy.

Petition for RemovalExtraordinary RemedySubstantial PrejudiceIrreparable HarmReconsiderationAdequate RemedyWCJ ReportAdopt and IncorporateDenial of RemovalAppeals Board
References
Case No. ADJ2296442 (VNO 0518441)
Regular
May 29, 2013

ENRIQUE DE LA TORRE vs. NESTLE USA, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case concerns a Petition for Reconsideration filed by an applicant against Nestle USA, Inc. and Sedgwick Claims Management Services, Inc. The Workers' Compensation Appeals Board (WCAB) dismissed the petition because it was not taken from a final order. However, the WCAB returned the matter to the trial level for further proceedings, including dismissal of a lien and potential sanctions.

Petition for ReconsiderationDismissedNot from Final OrderReturned to Trial LevelLien DismissalNotice of IntentSanctionsNestle USASedgwick Claims ManagementWorkers' Compensation Appeals Board
References
Case No. ADJ7874883
Regular
Apr 10, 2013

ENRIQUE ESPINOZA vs. MARTIN PROPERTIES, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board dismissed Enrique Espinoza's Petition for Reconsideration against Martin Properties and Sedgwick Claims Management Services. The dismissal was primarily due to the petition not being timely filed. Even if it had been timely, the Board would have denied it on the merits, adopting the reasoning of the administrative law judge. Therefore, the petition is dismissed.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalTimely FiledWCJ ReportAdministrative Law JudgeSedgwick Claims Management ServicesMartin PropertiesEnrique EspinozaAnaheim District Office
References
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