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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. 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. ADJ2046608 (VNO 0502368)
Regular
Mar 07, 2012

NOE PEREZ vs. HERRICK CORPORATION

The Workers' Compensation Appeals Board granted Herrick Corporation's Petition for Removal, rescinding a WCJ order. The Board is now intending to dismiss Herrick's Petition for Contribution against SCIF. This is because Herrick's contribution claim is barred by the one-year statute of limitations under Labor Code section 5500.5(e). The Order Approving Compromise and Release was dated August 31, 2006, and Herrick's petition was filed over two and a half years later.

Petition for RemovalContributionCarve-out JurisdictionLabor Code Sections 3201.53201.7State Compensation Insurance Fund (SCIF)Alexander BuggyCompromise and ReleaseArbitratorJoint and Several Award
References
Case No. ADJ6671169
Regular
Oct 16, 2013

Christian Fauria vs. Carolina Panthers, Great Divide Insurance Co., Berkley Specialty Underwriting Managers, LLC, Washington Redskins, ESIS Insurance, New England Patriots, Liberty Mutual Insurance Co., Travelers Indemnity Co., Golf Insurance Co., Seattle Seahawks

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award finding California jurisdiction over Christian Fauria's claim due to lack of "regular employment" in California, as defined by Labor Code Section 3600.5(a). The case was remanded to the trial level to determine if jurisdiction exists based on injuries sustained within California or if the contract of hire was made in California, as per Labor Code Section 5305. The WCAB also instructed the judge to address all issues, including apportionment and liability periods under Labor Code Section 5500.5. The decision highlights the need for substantial evidence to establish jurisdiction and injury contribution within the state.

Workers' Compensation Appeals BoardChristian FauriaProfessional AthleteIndustrial InjuryPermanent DisabilityFurther Medical TreatmentLabor Code Section 3600.5(a)Statute of LimitationsLabor Code Section 5500.5Jurisdiction
References
Case No. LAO 0834414
Regular
Mar 03, 2008

NATASHA FANE vs. PRIME CLINICAL SYSTEMS, INC., EVEREST NATIONAL INSURANCE, ARGONAUT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted Everest's petition for reconsideration, rescinded a prior order, and remanded the case for further proceedings to determine contribution liability between Everest and Argonaut. Argonaut's petition for reconsideration was dismissed as it was not a final order, but its petition for removal was granted, rescinding an improperly issued joinder order and issuing a new order joining Argonaut as a party defendant. The Board clarified that contribution proceedings under Labor Code section 5500.5(e) can be initiated after a settlement and that Argonaut, having been notified, may not be bound by prior evidentiary records.

Workers' Compensation Appeals BoardNatasha FanePrime Clinical SystemsInc.Everest National InsuranceArgonaut Insurance CompanyContributionLabor Code section 5500.5(b)Labor Code section 5500.5(e)Compromise and Release
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. ADJ240659 (MON 0358311)
Regular
Mar 25, 2009

JOHN PELLETIER vs. CVS PHARMACY, AMERICAN HOME ASSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration regarding an industrial injury to the applicant's bilateral wrists sustained while employed at CVS Pharmacy. The Board found the date of injury, for the purpose of Labor Code sections 5412 and 5500.5, was February 11, 2008, when the applicant first knew his disability was work-related and received medical confirmation. This date was subsequent to his termination, thus negating the post-termination defense under Labor Code section 3600(a)(10) due to exceptions that applied.

Workers' Compensation Appeals BoardCVS PharmacyAmerican Home AssuranceJohn Pelletiercumulative injurybilateral wristsLabor Code section 5412date of injurycompensable disabilitymedical confirmation
References
Case No. ADJ1179569 (AHM 0099178)
Regular
Jun 10, 2011

JERRY CHASTAIN vs. COUNTY OF ORANGE, ORANGE COUNTY FIRE AUTHORITY, STATE COMPENSATION INSURANCE FUND, AMERICAN HOME ASSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, USF&G

In this workers' compensation case, the Appeals Board granted reconsideration to address USF&G's challenge to liability for an applicant's prostate cancer, who died after a prolonged period following exposure. The Board rescinded the prior decision, finding the WCJ erred by not fully addressing liability under Labor Code section 5500.5, specifically regarding the latency period and last date of injurious exposure. The matter was returned to the trial level for further proceedings and a new decision on liability, while affirming the presumption under Labor Code section 3212.1.

Workers' Compensation Appeals BoardFire Apparatus EngineerProstate CancerContinuous Trauma InjuryLabor Code Section 5412Labor Code Section 5500.5Labor Code Section 3212.1 PresumptionLatency PeriodInjurious ExposureCumulative Injury
References
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