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

Case No. ADJ19408921, ADJ19408487, ADJ19408920
Regular
Jun 16, 2025

Maria Vazquez vs. Holiday Inn Los Angeles Gateway, Indemnity Insurance Company of North America

Defendant filed a petition to set aside and reconsider an Order Approving Compromise & Release (OACR), claiming applicant's age and Medicare beneficiary status were overlooked in the settlement. The Appeals Board noted procedural irregularities regarding notice of case transmission and the absence of a hearing to establish a complete record concerning the Compromise and Release agreement's adequacy and Medicare interests. As a result, the Board dismissed the petition as premature and returned the matter to the trial level for a hearing to gather necessary evidence.

Order Approving Compromise & ReleaseMedicare Set AsidePetition for ReconsiderationMotion to Set AsideLabor Code Section 590960-Day RuleNotice of TransmissionWorkers' Compensation Medicare Set-Aside Arrangement (WCMSA)Good CauseMutual Mistake of Fact
References
Case No. MON 0254439
Regular
Aug 12, 2008

LEON ZAMBROWS (Deceased) SANDRA ZAMBROWS (Widow) vs. LOS ANGELES COUNTY OFFICE OF EDUCATION, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) rescinded a lower judge's order to set aside a Compromise and Release (C&R) agreement. This decision was based on the applicant's petition to set aside the C&R being filed more than five years after the date of injury, thus precluding the "good cause" standard for rescission. The WCAB remanded the case for further proceedings, noting that the applicant must prove extrinsic fraud to set aside the C&R at this stage, and also acknowledging a potential estoppel issue regarding Liberty Mutual's coverage dates.

Workers' Compensation Appeals BoardSandra ZambrowsSandra Zambrows (Widow)Los Angeles County Office of EducationLiberty Mutual Insurance CompanyPetition for ReconsiderationOrder Setting Aside Compromise & ReleasePetition to Set Aside Compromise & ReleaseMutual Mistake of FactGood Cause
References
Case No. ADJ7889661
Regular
Jan 28, 2014

CONYANILL, STATE OF CALIFORNIA, CDCR - INMATE CLAIMS vs. STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

In this case, the defendant sought to set aside an Order Approving Compromise and Release (OAC&R) due to a mutual mistake in omitting a Medicare Set-Aside (MSA) provision. The Appeals Board granted reconsideration and rescinded the OAC&R. The matter was returned to the trial level to determine the parties' intent regarding the MSA and ensure compliance with Medicare regulations. This action was taken to provide the WCJ an opportunity to properly address Medicare's interests.

Petition for ReconsiderationOrder Approving Compromise and ReleasePetition to Set AsideMutual MistakeMedicare Set-AsideMSARescindAgreed Medical ExaminerWCJAppeals Board
References
Case No. ADJ7940946 ADJ7941927
Regular
Apr 02, 2019

FAYE JENNINGS vs. TEMECULA VALLEY UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board (WCAB) dismissed the Defendant's Petition for Reconsideration because it was untimely filed, as proof of mailing is insufficient and the petition must be received within the statutory 25-day limit. The WCAB noted that the Defendant's request to set aside the Compromise and Release was premature because it had not been decided at the trial level. Therefore, the matter was returned to the trial level for further proceedings on the Petition to Set Aside.

Petition for ReconsiderationWCABworkers' compensation administrative law judgeWCJjurisdictionaluntimely petitionJoint Order Approving Compromise and ReleaseOACRdefective servicegood cause to set aside
References
Case No. ADJ3407743, ADJ4033299
Regular
May 03, 2018

KIM KELLEY vs. INTERSTATE BRANDS CORP.; SELFINSURERS SECURITY FUND, Administered by TRISTAR RISK MANAGEMENT

The applicant sought reconsideration of a Compromise and Release order, specifically challenging the inclusion of a disputed body part (right knee) in the Medicare Set Aside (MSA) calculation. The Appeals Board found the petition for reconsideration was timely filed. However, the Board determined there was insufficient evidence to rule on the applicant's claims regarding the MSA calculation. Therefore, the Board dismissed the petition for reconsideration and recommended it be treated as a petition to set aside, allowing for the presentation of evidence.

Petition for ReconsiderationCompromise and ReleaseMedicare Set Aside (MSA)Joint OrderWCJ ReportPetition to Set AsideUnilateral MistakeMutual MistakeDue ProcessFair Hearing
References
Case No. ADJ8189699
Regular
Mar 27, 2013

VERONICA TREJO vs. COUNTY OF LOS ANGELES

This case involves a dispute over a workers' compensation award based on stipulations approved at a mandatory settlement conference where the applicant was not present. The defendant sought to set aside the award, alleging issues with signatures and a "mutual mistake" regarding permanent disability. The Appeals Board denied the applicant's petition for removal, upholding the judge's authority to set aside the award pending further investigation. The Board highlighted serious ethical concerns regarding potential misconduct by both parties in the filing of the stipulations. The case was remanded for a status conference to address signature validity and potential sanctions.

Petition for RemovalOrder Setting Aside AwardStipulations with Request for AwardMandatory Settlement ConferenceAgreed Medical EvaluatorPetition to Set Aside StipulationMutual MistakeFraudDue ProcessEthical Misconduct
References
Case No. ADJ8308192 ADJ11314956
Regular
Sep 12, 2019

LILY LOPEZ vs. ST PASCHAL BAYLON CATHOLIC CHURCH, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board rescinded the trial judge's decision finding mutual mistake regarding a Medicare Set Aside (MSA) and CMS approval. The Board determined that CMS does not mandate MSA review, negating the finding of mutual mistake. However, due to concerns about the applicant being adequately advised of potential future Medicare benefit impacts without CMS review, the case is returned to the trial level for further proceedings. The applicant's petition for penalties was denied.

Medicare Set AsideMSACMS approvalmutual mistakejudicial errorCompromise and Releasenull and voidPetition to Set Asiderescindedvacated
References
Case No. ADJ8873556
Regular
Jun 03, 2016

LUIS ALVARENGA vs. SCOPE INDUSTRIES, COMMERCE & INDUSTRY INSURANCE, AIG CLAIMS

The Workers' Compensation Appeals Board granted reconsideration and rescinded an order approving a Compromise and Release (C&R). The defendant argued for rescission based on a mutual mistake regarding the necessity of CMS approval for the Medicare Set Aside (MSA) amount. While CMS approval is not mandatory, the Board found the C&R inadequate as written. Specifically, the settlement did not adequately account for the MSA amount in relation to the applicant's net recovery, and the applicant was not fully advised of potential Medicare benefit denials if CMS review was bypassed. The case is returned for further proceedings to address these adequacy issues.

Compromise and ReleaseMutual MistakeMedicare Set AsideCMS ApprovalPetition for ReconsiderationOrder Approving Compromise and ReleaseRescindGood CauseFuture Medical TreatmentAdequate Consideration
References
Case No. ADJ599176 (SAC 0333692) ADJ2396484 (RDG 0122019) ADJ7950339
Regular
Mar 21, 2017

Fernando Muniz Villalpando vs. Doherty Brothers, Martin Dusters, State Compensation Insurance Fund

This case involves an applicant seeking to self-administer his Medical Set-Aside Account (MSA) after previously agreeing to third-party administration by Bridge Pointe/NuQuest. The Appeals Board granted reconsideration, rescinded the prior order, and returned the matter to the trial level. The Board found that the trial judge needs to review the original agreement to determine if it allows for a change of administration or if applicant has contractual rights to pursue this. Further proceedings will assess applicant's competency for self-administration and any opposition from the defendant.

Medical Set-Aside AccountMSAPetition for ReconsiderationJoint Findings and OrderMedical Set-Aside Account administrationself-administrationBridge PointeNuQuestState Compensation Insurance FundCompromise and Release Agreement
References
Case No. ADJ1332416 (WCK 0031685) ADJ3521523 (OAK 0322592) ADJ4017994 (WCK 0029276)
Regular
Nov 19, 2015

PAMELA ZEILSTRA vs. TARGET STORES

The Workers' Compensation Appeals Board granted defendant's petition for removal, rescinding the WCJ's order setting a mandatory settlement conference and deferring the request to set aside a prior order compelling medical examination attendance. The Board found that the issue of setting aside the two-year-old compelling order must be resolved before a settlement conference. Applicant must comply with the order or show good cause for setting it aside, and defendant may seek an order under Labor Code section 4053. The matter is returned to the trial level for further proceedings, starting with a status conference.

Petition for RemovalOrder Compelling AttendanceMedical ExaminationMandatory Settlement ConferenceWCJDiscoverySet Aside OrderLabor Code section 4053Rescind OrderTrial Level
References
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