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

Case No. ADJ268422 (MON 0326162) ADJ1140304 (MON 0329012)
Regular
Jan 10, 2020

Dawn Leah Guritzky vs. Regents of the University of California, UCLA Medical Center, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a registered nurse seeking workers' compensation for industrial injuries sustained on two separate dates, leading to a finding of 100% permanent disability without apportionment. The defendant sought reconsideration, arguing against the 100% disability rating and the lack of apportionment. The Appeals Board found that the WCJ properly applied the "cannot parcel out" exception for apportionment based on psychiatric disability. However, the Board rescinded the award and returned the matter for a new decision to consider the recent *Fitzpatrick* decision regarding permanent total disability findings under Labor Code section 4662(b).

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuriesPermanent DisabilityApportionmentCausationCannot Parcel OutBenson ExceptionLabor Code Section 4663Labor Code Section 4664
References
Case No. ADJ2609190
Regular
Jul 19, 2019

DEBORAH ORTIZ vs. KAISER PERMANENTE HOSPITAL/ SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

The Workers' Compensation Appeals Board granted reconsideration of a lien claimant's petition, rescinding the original order and remanding the case for further proceedings. The Board found that the lien claimant failed to demonstrate "extraordinary circumstances" to justify payment above the Official Medical Fee Schedule, as those provisions were repealed in 2004. Furthermore, the Board clarified that lien claimants now bear the burden of proof for injury arising out of and occurring in the course of employment (AOE/COE), a principle established by recent legislative amendments and case law. The WCJ must now make findings on AOE/COE and other evidentiary issues.

Petition for ReconsiderationLien ClaimantFindings of Fact and OrderOfficial Medical Fee ScheduleExtraordinary CircumstancesLabor Code Section 3202.5Burden of ProofPreponderance of the EvidenceInjury AOE/COECompromise and Release
References
Case No. FRE 0226474
Regular
Aug 10, 2007

FRANCISCO CAMPOS vs. MOYA FARM LABOR, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of an award finding a $2\%$ permanent disability rating for an orange picker injured in 2004. The Board held that the revised rating schedule applied as there was no pre-January 1, 2005 medical report indicating permanent disability, and the parties stipulated to temporary disability payments which negated the notice exception. The Board relied on the published appellate decision in *Costco Wholesale Corp. v. Workers' Compensation Appeals Board (Chavez)*.

Workers Compensation Appeals BoardFrancisco CamposMoya Farm LaborState Compensation Insurance FundFindings of Fact and Awardpermanent disabilityrating scheduleLabor Code 4660(d)Baglione IIAMA Guides
References
Case No. ADJ1541863 (SBR 0317921) ADJ1955130 (SBR 0318072)
Regular
Oct 24, 2008

CAROL TELIZYN vs. BRASWELL'S COLONIAL CARE, STATE COMPENSATION INSURANCE FUND

The Appeals Board dismissed Arrowback Medical Group's (AMG) petition for reconsideration because it was successive and not taken from a final order, as the prior decision remanded the case for further proceedings. The Board also corrected the caption of its August 8, 2008 decision nunc pro tunc to include both relevant case numbers. AMG's core argument regarding the applicability of an expired fee schedule was previously addressed and found to be without merit.

Nunc Pro TuncPetition for ReconsiderationSuccessive PetitionFinal OrderInterim OrderRemandCaption CorrectionRepackaged PharmaceuticalsOfficial Medical Fee ScheduleLien Claimant
References
Case No. ADJ739610 (SAC 0333601)
Regular
Jun 19, 2009

MAXIMILIANO RAMIREZ vs. MB BUILDING CONTRACTORS, STATE COMPENSATION INSURANCE FUND INSURED RIVERSIDE

Applicant sought reconsideration to be relieved of a stipulation regarding the start date for permanent disability indemnity increases, arguing a subsequent panel decision justified it. The Board denied applicant's petition, holding that a change in legal interpretation post-stipulation does not constitute good cause to set aside negotiated agreements. The Board granted defendant's petition to correct a clerical error in the attorney's fee amount, amending it from $113,451.03 to $111,029.13. The original Findings and Award were otherwise affirmed.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and AwardStipulationGood CausePermanent DisabilityAttorney's FeeClerical ErrorLabor CodeWCJ
References
Case No. SAL 0110868
Significant
Apr 06, 2007

Josh Pendergrass vs. Duggan Plumbing, State Compensation Insurance Fund

The Appeals Board, in an en banc decision, holds that the 2005 Schedule for Rating Permanent Disabilities applies to pre-2005 injuries if the last payment of temporary disability indemnity, which triggers the notice requirement under Labor Code section 4061, occurred on or after January 1, 2005.

Labor Code section 4660(d)1997 Schedule2005 Scheduletemporary disability indemnitypermanent disabilitynotice requirementsection 4061en banc decisionreconsiderationstatute of limitations
References
Case No. ADJ4194347 (SRO 135724) ADJ8065537
Regular
Feb 11, 2013

JONATHAN GREEN vs. T.J. and DENI MARRONE, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The Appeals Board granted reconsideration on an attorney's fee dispute arising from a $150,000 compromise and release settlement. The applicant's attorney sought an $18,000 fee, but the administrative law judge initially awarded less, leading to a petition for reconsideration. The Board ultimately rescinded the judge's order and awarded the full $18,000 fee, finding it reasonable based on factors including the attorney's success in securing the settlement, even though it included funds for a Medicare Set Aside. A dissenting opinion argued that the attorney failed to properly notify the applicant of adverse interests and right to independent counsel as required by board rules and a subsequent Notice of Intention.

Workers' Compensation Appeals BoardCompromise and ReleaseAttorney's FeeReconsiderationRule 10778Medicare Set AsideNotice of IntentionAdverse InterestIndependent CounselDissenting Opinion
References
Case No. ADJ2802696 (STK 0206161)
Regular
Mar 23, 2009

PAM ELLIOTT vs. MOSAIC SALES SOLUTIONS, THE HARTFORD

The Workers' Compensation Appeals Board (WCAB) rescinded a prior award and returned the case to the trial level for further proceedings. The applicant, injured in 2004, argued the 2005 permanent disability schedule inadequately addressed her diminished future earning capacity. Citing its recent en banc decisions in *Almaraz/Guzman* and *Ogilvie*, the WCAB found these decisions established that both the AMA Guides and the diminished future earning capacity (DFEC) portions of the 2005 Schedule are rebuttable. The case was remanded for further consideration of the applicant's arguments in light of these binding precedents.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanent Disability Rating2005 ScheduleAMA GuidesDiminished Future Earning CapacityVocational Rehabilitation ExpertRebuttable PresumptionStare DecisisAlmaraz/Guzman
References
Case No. RIV 0032677
Regular
Jan 23, 2008

LUIS VALENCIA vs. VILLA AMALFIRISTORANTE, CALIFORNIA INDEMNITY INSURANCE

The Workers' Compensation Appeals Board denied reconsideration, affirming the administrative law judge's decision regarding the reasonableness of an outpatient surgery center's facility fees. The Board reiterated that the lien claimant bears the burden of proving their charges are reasonable and that the defendant presented credible evidence rebutting the billed amount. The decision also clarified that reasonableness considers various factors beyond just the facility's usual accepted fees, and inadmissible evidence from the lien claimant was appropriately excluded.

Workers' Compensation Appeals BoardLien ClaimantFacility FeeReasonablenessBurden of ProofOutpatient Surgery CenterMedical Treatment ExpenseReconsiderationEvidenceAdministrative Law Judge
References
Case No. ADJ4014154 (ANA 0408143)
Regular
Jun 19, 2009

JUAN LOPEZ vs. LIBERTY GLASS FABRICATORS, INC., AMERICAN HOME ASSURANCE COMPANY

This case involves a worker claiming a back injury on October 1, 2007, but reporting it on October 5, 2007, the same day his employment was terminated. The employer contends the claim is barred under Labor Code section 3600(a)(10) as a post-termination claim, arguing the worker's notice of injury was not provided prior to termination. The Appeals Board granted reconsideration, reversed the initial award, and found the claim non-compensable, ruling the worker failed to provide timely notice of the injury before his termination. The Board emphasized the purpose of section 3600(a)(10) is to prevent spurious claims filed after termination.

Labor Code section 3600(a)(10)Post-termination claimReconsiderationFindings and AwardCompensable industrial injuryLaborerLiberty Glass FabricatorsAmerican Home Assurance CompanyWorkers' Compensation Appeals BoardWCJ Report and Recommendation
References
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