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Case Law Database

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

Case No. SJO 0227228
Regular
Nov 13, 2007

CURTIS CARUSI vs. MARKETSHARE, INC., ACE/USA

This case concerns the apportionment of permanent disability for an applicant with a cumulative trauma injury to his neck and upper extremities. The Agreed Medical Examiner (AME) determined that 60% of the applicant's permanent disability was due to non-industrial spinal stenosis and 40% was work-related. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding the AME's opinion constituted substantial medical evidence for apportionment. The WCAB rescinded the prior award and returned the case for a new award reflecting the AME's apportionment.

WCABMarketshare Inc.Curtis CarusiACE/USAESISSJO 0227228Petition for ReconsiderationFindings and AwardIndustrial cumulative traumaNeck injury
References
5
Case No. SJO 181617 SJO 181469 SJO 187564 SJO 187565
Regular
Sep 17, 2007

ANITA BLICK vs. TOWN OF ATHERTON, CITIES INSURANCE GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award because the applicant's criminal conviction, which was the basis for restitution, had been vacated. The Board determined that restitution claims are intrinsically linked to the vocational rehabilitation benefits claim. Therefore, the case is returned to the trial level for a new WCJ to decide both issues after the applicant's criminal proceedings are finally resolved.

Vocational RehabilitationVRMARestitutionPenal Code section 550(b)(3)FraudCriminal ConvictionVacated ConvictionReconsiderationAppeals BoardWCJ
References
0
Case No. SJO 238655 SJO 238656 SJO 238657
Regular
Apr 02, 2008

JAMES BEENE vs. ANDERSON CHEVROLET/AUTONATION, INC., ACE-USA, UNIVERSAL UNDERWRITERS GROUP

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award because the Agreed Medical Examiner's opinion was based on an incorrect legal theory regarding industrial causation. The Board found that the AME's opinion that the applicant's vascular condition was not industrially caused or aggravated was not substantial evidence, requiring further development of the record. Therefore, the case was returned to the trial level for the AME to provide a supplemental opinion on whether the vascular condition was industrially caused or a consequence of the admitted injury.

workers compensationindustrial injuryvascular systemagreed medical evaluatorAMEreconsiderationtemporary disability indemnityTDIlien claimsubrogation
References
15
Case No. SJO 0245864, SJO 0245865, SJO 0245866
Regular
Jul 14, 2008

ANITA REXINGER vs. ELECTROLUX CORPORATION, WAUSAU INSURANCE COMPANIES

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The Board found that the applicant waived the jurisdictional argument regarding the Rehabilitation Unit's determination by not raising it at trial. The applicant's arguments regarding the interpretation of *Gamble* were also rejected, though the Board noted a pending Supreme Court review in a similar case that may impact future proceedings.

Workers' Compensation Appeals BoardElectrolux CorporationWausau Insurance CompaniesVocational Rehabilitation Temporary Disability (VRTD)concurrent employmentDetermination of the Rehabilitation UnitLabor Code section 5804Gamble v. Workers' Comp. Appeals Bd.Medrano v. Workers' Comp. Appeals Bd.writ of review
References
2
Case No. SJO 0245865 SJO 0245864 SJO 0245866
Regular
Apr 22, 2008

ANITA REXINGER vs. ELECTROLUX CORPORATION, WAUSAU INSURANCE COMPANIES

The Appeals Board granted reconsideration to clarify vocational rehabilitation temporary disability (VRTD) benefits, holding that earnings from subsequent employment may offset VRTD if the applicant was not concurrently employed at the time of injury. The Board also directed that VRTD benefits should be reduced by unemployment insurance paid for the same period and affirmed the applicant's 1997 W-2 as the basis for calculating average weekly earnings. Finally, the Board rescinded the prior award and returned the matter for further proceedings, including potential reconsideration of the unreasonable delay penalty.

VOCATIONAL REHABILITATIONRECONSIDERATIONSTIPULATIONSPERMANENT DISABILITYREHABILITATION UNITDELAY RATEAVERAGE WEEKLY WAGEATTORNEY FEESCREDIT FOR EARNINGSUNREASONABLE DELAY
References
2
Case No. SJO 0258370; SJO 0258371; SJO 0264287
Regular
Oct 22, 2007

SHERI COSBY vs. M. E. FOX & CO., ACCLAMATION INSURANCE MANAGEMENT SYSTEMS [AIMS]

The Appeals Board dismissed the applicant's petition for reconsideration of a denial to withdraw from a QME due to it not being a final order. However, the Board granted removal and rescinded the judge's order, allowing the applicant to withdraw from the QME due to the defendant's improper submission of non-medical information post-examination, violating Labor Code section 4062.3. While acknowledging the applicant's delay in raising the issue, the Board found no waiver or laches, ordering a new QME evaluation.

QME withdrawalLabor Code 4062.3improper communicationnon-medical informationpro per applicantattorney representationpetition for reconsiderationremoval motionAppeals Boardstatutory violation
References
3
Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
3
Case No. ADJ1825244 (SJO 0218090) ADJ409934 (SJO 0218091) ADJ2092501 (SJO 0243094) ADJ2437045 (SJO 0226020)
Regular
Feb 04, 2011

FESSAHAIE TESFAGIORGIS vs. LIFESCAN/JOHNSON & JOHNSON, OLD REPUBLIC Adjusted By BROADSPIRE

This case involves applicant Fessahaine Tesfagiorgis seeking reconsideration of a workers' compensation award. The defendant, Lifescan/Johnson & Johnson, also petitioned for reconsideration. The Appeals Board granted the defendant's petition and denied the applicant's, amending the original award. Specifically, the psychiatric impairment rating was reduced, resulting in a lower overall permanent disability award of 60% totaling $58,862.50. The applicant's attorney's fee was adjusted to 20% of this revised award, totaling $11,772.50, which the Board found to be reasonable given the case's complexity and the attorney's efforts.

WCABReconsiderationFindings and AwardIndustrial InjuryBilateral FeetRight ShoulderRight WristNeckPsychePermanent Disability
References
0
Case No. ADJ1740444 (SJO 0799313) ADJ2189376 (SJO 0785376) ADJ506041 (SJO 0866217)
Regular
May 13, 2011

EDUARDO JIMINEZ vs. DSL TRANSPORTATION, ARGONAUT INSURANCE

The Workers' Compensation Appeals Board denied the applicant's petitions for reconsideration regarding findings of industrial injury and permanent disability ratings. However, the Board granted the lien claimant's petition, reversing the dismissal of its attorney's fee lien. The case is remanded to the trial level for further proceedings to determine the value of the lien claimant's services, with defendants ordered to withhold 15% of the applicant's awards for potential attorney's fees.

Workers' Compensation Appeals BoardOpinion and Orders DenyingGranting ReconsiderationDecision After ReconsiderationIndustrial InjuryPermanent DisabilityBenson v. Workers' Comp. Appeals Bd.Permanent Disability Rating ScheduleIndependent Medical Examiners132a Claim
References
3
Case No. ADJ1781751 (SJO 0264172) ADJ4460330 (SJO 0264178) ADJ3361342 (SJO 0266633)
Regular
Jan 14, 2010

SARA MARTINEZ-RODRIGUEZ vs. TARGET STORES, Permissibly Self-Insured; SEDGWICK CMS, TPA

The Workers' Compensation Appeals Board denied Target Stores' petition for reconsideration, affirming the WCJ's award to Sara Martinez-Rodriguez. The Board found Target's argument that the applicant's 2002 absence from work was for personal reasons unsubstantiated, upholding the temporary disability finding. The Board also affirmed the WCJ's use of the 1997 permanent disability rating schedule for the 1998 and 2002 injuries, primarily because Target failed to issue the required Section 4061 notice due to its own misconduct in not paying temporary disability benefits. The Board disagreed with the WCJ's secondary rationale for applying the older schedule based on the AME's post-2005 report, finding it insufficient on its own.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardTemporary DisabilityPermanent DisabilityRating ScheduleLabor Code Section 4061Agreed Medical Examiner (AME)Pre-2005 Injuries1997 Rating Schedule
References
2
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