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

Case No. ADJ9078233

Regular

Sep 21, 2022

DANIEL HUNTER vs. SHREVEPORT PIRATES, DENVER BRONCOS, SAN DIEGO CHARGERS, DALLAS COWBOYS, LOS ANGELES EXPRESS, LOUISIANA WORKERS COMPENSATION CORPORATION

The Workers' Compensation Appeals Board rescinded its prior decision and returned the case to the arbitrator. The Board found that the arbitrator erred in considering whether the defendant insurer's policy, issued in Louisiana, could cover an out-of-state injury under California jurisdiction. The Board clarified that workers' compensation coverage is distinct from employer's liability coverage and that policy endorsements limiting coverage require the Insurance Commissioner's approval. The matter was returned for further proceedings and a new decision based on recent clarifying case law.

Louisiana Workers' Compensation CorporationShreveport Piratesout-of-state insuranceCalifornia jurisdictionworkers' compensation arbitratorinsurance contractLouisiana lawemployer's liability insuranceNational Counsel on Compensation InsuranceLa Jolla Beach & Tennis Club

References

Case No. ADJ10034182

Regular

Aug 02, 2017

RENATO NIEVES vs. PIRATE STAFFING, INTERCARE FOR LUMBERMEN'S UNDERWRITING ALLIANCE, In Liquidation, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The defendant sought reconsideration of the administrative law judge's (WCJ) decision to defer rulings on temporary disability benefits, credit for employment earnings, penalties, interest, and attorney's fees. The WCJ deferred these issues because the applicant's medical reports, crucial for adjudication, were excluded due to the defendant's objections. The Appeals Board denied the defendant's petition, affirming the WCJ's discretion to develop the record and find applicant's testimony sufficient to raise the issue of temporary disability. The Board also noted the defendant's stipulation to causation and failure to raise the post-termination defense at the prior hearing.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderTemporary Disability Indemnity BenefitsCredit for Employment EarningsPenalties and InterestAttorney's FeesJurisdiction ReservedAdmitted Industrial InjuryMedical Reports

References

Case No. ADJ9473303

Regular

Oct 30, 2017

PEDRO SOTELO vs. TRI-STATE EMPLOYMENT SERVICES, INC. dba PIRATE STAFFING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FOR LUMBERMEN'S UNDERWRITING ALLIANCE in liquidation, SEDGWICK

The Appeals Board granted reconsideration, finding the Agreed Medical Evaluator's (AME) reports lacked substantial evidence for permanent disability and apportionment due to unexplained DRE Category II ratings. However, the Board amended the order to not strike the AME's reports entirely, as good cause was not shown for their exclusion. The case is returned to the trial level for further development of the record regarding permanent disability and apportionment, potentially through a new AME or QME.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAgreed Medical Evaluator (AME)Permanent DisabilityApportionmentSubstantial EvidenceDRE Category IIAMA GuidesWhole Person Impairment (WPI)

References

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DANIEL HUNTER vs. SHREVEPORT PIRATES, DENVER BRONCOS, SAN DIEGO CHARGERS, DALLAS COWBOYS, LOS ANGELES EXPRESS, LOUISIANA WORKERS COMPENSATION CORPORATION

RENATO NIEVES vs. PIRATE STAFFING, INTERCARE FOR LUMBERMEN'S UNDERWRITING ALLIANCE, In Liquidation, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

PEDRO SOTELO vs. TRI-STATE EMPLOYMENT SERVICES, INC. dba PIRATE STAFFING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FOR LUMBERMEN'S UNDERWRITING ALLIANCE in liquidation, SEDGWICK