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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ2711930 (OAK 0251340) ADJ1889959 (OAK 0318838)
Regular
Jul 21, 2015

MARK BAXTER vs. WASTE MANAGEMENT, INC., RELIANCE INSURANCE COMPANY, GALLAGHER BASSETT, PASCO SANITATION COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, FREMONT

This case involves complex workers' compensation claims with multiple defendants and insurers, including CIGA, regarding injuries in 1998 and 1999. The appeals board granted reconsideration, rescinded the WCJ's decision, and returned the matter to the trial level. Key issues include the proper application of Insurance Code section 1063.1, the apportionment of liability between successive injuries, and the clarity of the liable entity for the 1999 injury. Further proceedings are needed to address these disputed issues.

Workers' Compensation Appeals BoardReconsiderationFremont Indemnity Insurance CompanyLiquidationCalifornia Insurance Guarantee Association (CIGA)Self-insurance deductibleTransient exacerbationJoint and several liabilityApportionment of liabilitySuccessive injury
References
Case No. ADJ3910048 (VNO 0417016)
Regular
Jul 30, 2010

NAHID JAVADI vs. SIMI VALLEY HOSPITAL, ADVENTIST HEALTH SYSTEMS WEST

This case involves an employer, Simi Valley Hospital/Adventist Health Systems West, seeking to prevent the joinder of AIG as a defendant in a workers' compensation claim. The employer argues it is permissibly self-insured and self-administered, and joining AIG, an excess carrier, would cause irreparable harm. The Appeals Board found that since there is no third-party administrator involved, the precedent relied upon for joinder is inapplicable. Consequently, the Board rescinded all orders joining AIG and returned the case to the trial level.

Workers' Compensation Appeals BoardPetition for RemovalJoinder of DefendantReinsurance CarrierExcess CarrierPermissibly Self-InsuredSelf-AdministeredIndustrial InjuryFindings and AwardPetition to Reopen
References
Case No. ADJ3588884 (FRE 0222309) ADJ4330880 (FRE 0223217)
Regular
Feb 22, 2011

ENEDELIA LUNA vs. FRESNO UNIFIED SCHOOL DISTRICT, UNITED ARTISTS THEATRE CIRCUIT; AMERICAN MOTORISTS INSURANCE COMPANY, Administered By BROADSPIRE

This case concerns American Motorists Insurance Company's petition for reconsideration of a Joint Findings and Award. The original award addressed two admitted industrial injuries sustained by the applicant, one against Fresno Unified School District (FUSD) and another against United Artists Theatre Circuit, insured by American Motorists. The petition specifically challenges the WCJ's failure to incorporate a stipulated liability apportionment between the defendants into the award. The Appeals Board denied the petition, ruling that the WCJ correctly deferred the issue of contribution between co-defendants, as they remain jointly and severally liable to the applicant.

Petition for ReconsiderationJoint Findings and AwardSpecial Education Teacher's AideCumulative InjuryBilateral Upper ExtremitiesPermanent DisabilityFurther Medical TreatmentPermissibly Self-InsuredStipulated Percentage of LiabilityContribution Between Co-Defendants
References
Case No. ADJ6949453
Regular
Sep 27, 2012

MARIA LAZARTE vs. AMERICAN HONDA

The Workers' Compensation Appeals Board rescinded an order approving a compromise and release because the judge improperly added a handwritten provision withholding settlement proceeds pending determination of non-MPN lien claimants' liability. The Board clarified that while it has jurisdiction over liens for treatment provided under Labor Code section 4600, treatment procured at the employee's own expense under section 4605 falls outside its jurisdiction and is the employee's personal liability. The case was remanded for further proceedings to determine the adequacy of the settlement and the parties' rights, particularly concerning the applicant's potential personal liability for self-procured medical treatment.

Workers' Compensation Appeals BoardCompromise and ReleaseMedical Provider NetworkLabor Code Section 4605Self-Procured TreatmentLien ClaimantsJurisdictionDue ProcessAdministrative Law JudgePetition for Reconsideration
References
Case No. ADJ4629950
Regular
Dec 21, 2012

JOHNNY BETTENCOURT vs. DONALD WILLIAMS, SAFECO INSURANCE COMPANY, UNINSURED EMPLOYERS' BENEFIT TRUST FUND DEPARTMENT OF INDUSTRIAL RELATIONS

The Uninsured Employers' Benefit Trust Fund (UEBTF) sought reconsideration, arguing Safeco's policy covered the applicant's injury. The Arbitrator previously ruled Safeco had no liability as its policy with Donald Williams did not include "comprehensive personal liability" insurance as required by Insurance Code section 11590. The Appeals Board affirmed this decision, finding the Safeco policy explicitly limited coverage to premises liability and lacked the necessary language for comprehensive personal liability coverage. Therefore, Safeco was correctly found not liable for the applicant's injury.

Uninsured Employers' Benefit Trust Fundcomprehensive personal liability insuranceLabor Code section 3351(d)Labor Code section 3352(h)Insurance Code section 11590premises liability insuranceSafeco Insurance CompanyDonald WilliamsJohnny Bettencourtworker's compensation coverage
References
Case No. ADJ2708349 (SBR 0339433)
Regular
Oct 06, 2008

MELVIN LANE vs. BIG LOTS STORES, INC., ZURICH INSURANCE, SEDGWICK CLAIMS MANAGEMENT SERVICES

The applicant sought reconsideration after being ordered to treat within the employer's Medical Provider Network (MPN). The Appeals Board granted reconsideration, finding that while the employer provided adequate notice of its MPN, the applicant has the right under Labor Code section 4605 to self-procure medical treatment at his own expense. Therefore, the applicant cannot be forced to treat within the MPN and the employer is not liable for self-procured treatment.

MPNself-procureLabor Code section 4605Labor Code section 4600Medical Provider Networkworkers' compensationWCJreconsiderationfindings and orderstatutory obligation
References
Case No. ADJ2497883 (SFO 0450940) ADJ3261393 (SFO 0504693)
Regular
Apr 30, 2010

JANETTE HARDIN vs. COUNTY OF ALAMEDA, SEDGWICK CLAIMS MANAGEMENT SERVICES, CHARTIS INSURANCE, TRISTAR RISK MANAGEMENT

This case involves Chartis Insurance seeking reconsideration of an arbitrator's decision setting the date of cumulative trauma injury for Janette Hardin's breast cancer as May 28, 1997, not the previously stipulated date of May 16, 2001. Chartis argued the stipulated date was res judicata and could not be altered, especially in a contribution proceeding. The Workers' Compensation Appeals Board denied the petition, affirming that contribution proceedings allow for a relitigation of liability and the determination of the true date of injury based on facts, not prior stipulations between the applicant and one defendant. The Board reasoned that findings of liability in the primary case are not binding in supplemental contribution proceedings.

Cumulative traumaDate of injuryContribution proceedingsRes judicataStipulated awardLabor Code section 5500.5Apportionment of liabilityCase-in-chiefSupplemental proceedingsGreenwald v. Carey Distribution Company
References
Case No. MON 0255472
Regular
Mar 17, 2008

MARIA RODRIGUEZ vs. LOS ANGELES COUNTY METROPOLITAN TRANSPORTATION AUTHORITY, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a previous award, rescinding the arbitrator's decision that equally divided liability between the County and Travelers Insurance. The Board found the arbitrator improperly determined the date of injury and confused initial liability proceedings with apportionment. The case is remanded to the trial level for specific findings on the date(s) of injury and last injurious exposure, followed by a reconsidered liability apportionment based on proportionate coverage during the relevant one-year period.

Cumulative injuryDate of injuryInjurious exposureApportionment of liabilityContributionTravelers Insurance CompanyLos Angeles County Metropolitan Transportation AuthoritySection 5500.5Section 5412Permissibly self-insured
References
Case No. ADJ4415679 (OAK 0259031) ADJ2701101 (WCK0050594)
Regular
May 10, 2010

Stanley Sanders vs. REMEDY INTELLIGENT STAFFING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INSURANCE COMPANY, OREGON STEEL MILLS, INC. dba NAPA PIPE

The Workers' Compensation Appeals Board reversed a judge's decision, ruling that Napa Pipe, a self-insured special employer, is liable for applicant Stanley Sanders' workers' compensation benefits. Despite an agreement between the general employer (Remedy Temp) and Napa Pipe attempting to limit liability to Remedy Temp's insurer (Reliance), Napa Pipe's joint and several liability as a special employer cannot be contractually eliminated. Because Napa Pipe's self-insurance was not excluded for special employees and constitutes "other insurance" under Insurance Code § 1063.1(c)(9), CIGA is relieved of its obligation to provide benefits following Reliance's insolvency. Therefore, Napa Pipe must now provide all workers' compensation benefits and administer the claim.

Workers' Compensation Appeals BoardStanley SandersRemedy Intelligent StaffingCalifornia Insurance Guarantee AssociationReliance National Insurance CompanyOregon Steel MillsNapa PipeADJ4415679ADJ2701101Opinion and Decision After Reconsideration
References
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