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

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ9625407
Regular
Sep 12, 2018

KEITH FIELD vs. CITY OF PINOLE

This case involves a firefighter who sustained bilateral carpal tunnel syndrome after retirement. The Appeals Board reversed the trial judge, holding that Labor Code section 4458.5 applies, entitling the applicant to permanent disability benefits calculated at the maximum indemnity rate. This applies regardless of the applicant's actual earnings or the fact that carpal tunnel syndrome is not a specifically enumerated presumptive injury. The case is remanded for determination of the precise date of injury to calculate the benefit rate.

Workers' Compensation Appeals BoardKeith FieldCity of PinolePermissibly Self-InsuredMunicipal Pooling AuthorityADJ9625407Opinion and Decision After Reconsiderationindustrial injuryfirefighterbilateral upper extremities
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. SAC 0316687
Regular
May 20, 2008

STEVE OLSON vs. DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address whether Labor Code section 4663(e), effective January 1, 2007, applies retroactively to a 2002 injury regarding apportionment of permanent disability for heart trouble. The Board rescinded its prior decision and the trial judge's decision, returning the case to the trial level to await a Court of Appeal ruling on this identical issue in the *Alexander* case. The outcome will depend on whether the court finds section 4663(e) retroactively applicable to pre-2007 injuries.

Labor Code section 4663section 4663(e)heart trouble presumptionapportionmentcumulative industrial injurycorrectional lieutenantpermanent disabilityreconsiderationrescindedretroactive application
References
Case No. ADJ6766619 (MF) ADJ6766620
Regular
Feb 28, 2018

MARIA DURAN vs. FOREVER 21 RETAIL, INC., CHUBB GROUP

This case involves Maria Duran's request for home health care services, which was initially denied by utilization review (UR) and upheld by Independent Medical Review (IMR). The applicant argued that her need for assistance with household chores and personal hygiene fell outside the scope of the Medical Treatment Utilization Schedule (MTUS) guidelines as applied. While the Board acknowledges that the specific MTUS guideline used in this case was later found to be an invalid regulation in a related case, it affirmed the original decision. This affirmance was based on the finding that the initial request for services was too vague, lacking specific details on the type, frequency, and duration of care, and that a revised request could be made.

Workers' Compensation Appeals BoardMaria DuranForever 21 RetailInc.Chubb GroupOpinion and Decision After ReconsiderationIndependent Medical ReviewIMRUtilization ReviewUR
References
Case No. ADJ10021120 ADJ8949346
Regular
Apr 14, 2017

ANTHONY BERNARD EDWARDS (Dec'd), CANDACE EDWARDS (Widow), ASHLEY EDWARDS (Daughter), ANTHONY EDWARDS, JR. (Son) vs. CITY OF LOS ANGELES; LOS ANGELES WORLD AIRPORTS, Permissibly Self-Insured

This case involves a workers' compensation death benefit claim for Anthony Bernard Edwards, who died in the course of his employment. The dependents seek death benefits and burial expenses, which were initially awarded by the WCJ. The employer, City of Los Angeles, sought reconsideration, arguing it should receive credit for a third-party settlement the dependents obtained from Kaiser Permanente. The Board agreed to reconsider the issue of credit, specifically whether Civil Code section 3333.1 bars such credit. The Board ultimately deferred the credit issue, affirming the death benefit award and returning the matter for further proceedings to determine the applicability of Civil Code section 3333.1 and potential employer negligence.

Workers' Compensation Appeals BoardADJ10021120ADJ8949346death benefitsLabor Code section 4702burial expensesCivil Code section 3333.1Medical Injury Compensation Reform ActMICRAthird-party settlement
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ3817836 (SJO 0250881)
Regular
May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability
References
Case No. ADJ2425610 (STK 0180003), ADJ3704258 (STK 0181637), ADJ6883666
Regular
Aug 27, 2012

STATE ADAMS vs. STATE OF CALIFORNIA, CALIFORNIA YOUTH AUTHORITY, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board affirmed prior findings awarding applicant cumulative industrial injuries to his circulatory and respiratory systems, and subsequent psychiatric injury. Applicant sought to reopen a stipulation for a 5% non-industrial apportionment based on a claimed change in law or mutual mistake of fact regarding Labor Code section 4663(e). The Board found no good cause to reopen, as section 4663(e) was declaratory of existing law and the defendant did not share applicant's asserted mistake. Therefore, the previous awards and stipulations, including the apportionment, remain valid.

Workers' Compensation Appeals BoardPetition for ReconsiderationSupplemental Findings and AwardCorrectional Youth CounselorCumulative Industrial InjuryCirculatory SystemRespiratory SystemPsychiatric InjuryPetition to ReopenNew and Further Disability
References
Case No. ADJ6743994
Regular
Jan 24, 2011

STANLEY HOLDER vs. COUNTY OF NEVADA

The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for reconsideration and denied the defendant's. The WCAB found the applicant's heart condition to be industrially caused based on the presumption under Labor Code section 3212.5, overriding the AME's fluctuating opinion. Permanent disability was increased from 4% to 20% and apportionment was disallowed under Labor Code section 4663(e). Finally, the defendant was denied a 15% reduction in permanent disability payments under Labor Code section 4658 because they failed to strictly prove an offer of regular work in the statutorily prescribed form and manner.

Industrial injuryDeputy SheriffCirculatory systemHeart diseasePermanent disabilityApportionmentAgreed Medical Evaluator (AME)ReconsiderationLabor Code section 3212.5Heart trouble presumption
References
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