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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Dec 15, 1993

Nationwide Mutual Insurance v. Stokes

Mary Stokes was injured in a car accident caused by Russell Caldwell and Steven Schwartz. She settled with their insurer, Aetna Insurance Company, for the policy limit of $10,000. Stokes then sought underinsured motorist benefits from her own insurer, Nationwide Mutual Insurance Company, which provided $50,000 in coverage. Nationwide argued it was entitled to offset the $10,000 settlement and $2,100 in Workers’ Compensation benefits from Stokes's coverage. The Supreme Court initially allowed both offsets, limiting Stokes's recovery to $37,900. On appeal, the court ruled that the $10,000 tortfeasor settlement could not be offset against the underinsurance limits, but the Workers’ Compensation benefits could. Therefore, the order was modified to remove the $10,000 offset but affirmed regarding the Workers’ Compensation offset.

Underinsured motoristInsurance benefitsOffsetWorkers' Compensation benefitsAutomobile accidentArbitrationAppellate procedureStatutory interpretationInsurance LawCPLR
References
5
Case No. ADJ8149660
Regular
Sep 19, 1943

Jeffrey Doty vs. Fred Stoke, dba Stoke Trust and Uninsured Employers Benefits Trust Fund

The Workers' Compensation Appeals Board granted reconsideration to amend findings, concluding applicant Jeffrey Doty was an employee because he performed work requiring a contractor's license without possessing one. However, the Board affirmed the denial of benefits, agreeing with the WCJ that Doty failed to prove he worked the requisite 52 hours within the 90 days preceding his injury. This failure to meet the statutory threshold for residential employees excluded him from benefits. Therefore, Doty is not entitled to workers' compensation despite being deemed an employee.

Workers' Compensation Appeals BoardFred StokeUninsured Employers Benefits Trust FundIndependent ContractorEmployee StatusContractor's LicenseLabor Code Section 2750.5Tree PruningResidential Dwelling Employee52-Hour Rule
References
10
Case No. MISSING
Regular Panel Decision

Sheet Metal Workers' National Pension Fund v. Accra Sheetmetal, LLC

The Plaintiffs, a group of five multi-employer employee benefit plans, initiated an action against Accra Sheetmetal, LLC and Orlando Stokes in July 2012, seeking to enforce the Defendants' obligations to make contributions to the plans under ERISA. They alleged unpaid contributions, interest, liquidated damages, and attorney's fees, and also claimed individual Defendant Stokes breached his fiduciary duties. The Plaintiffs subsequently filed an unopposed motion for summary judgment, requesting a judgment of approximately $35,469.02. Presided over by District Judge Spatt, the Court denied the motion without prejudice, citing the Plaintiffs' failure to provide sufficient evidence to demonstrate the inaccuracy of the employer's contributions, specifically lacking details on employees and hours worked. Consequently, the Plaintiffs did not meet their burden of proof for summary judgment, though they were granted leave to renew their motion with a more complete record.

ERISAEmployee BenefitsPension FundsSummary Judgment MotionUnpaid ContributionsFiduciary BreachCollective Bargaining AgreementsLiquidated DamagesAttorney FeesDenial Without Prejudice
References
12
Case No. MISSING
Regular Panel Decision
Dec 21, 1992

Claim of Stokes v. Permanente

The Workers' Compensation Board initially ruled that the claimant sustained a compensable injury after being struck by a car while crossing a street from a parking lot to her workplace. This decision and an amended decision were subsequently appealed. The appellate court found substantial evidence to support the Board's finding that the injury occurred while the claimant was entering the employment premises, thus arising out of and in the course of her employment. Consequently, the court affirmed the Board's decision and amended decision.

Workers' CompensationEmployment InjuryCompensable InjuryGoing and Coming Rule ExceptionParking Lot InjuryAppellate ReviewBoard Decision Affirmed
References
0
Case No. MISSING
Regular Panel Decision

Claim of Stokes v. Valeo Electrical Systems, Inc.

Claimant filed a workers' compensation claim in 1999 for repetitive-motion injuries, and the case was initially closed in February 2000 by a WCLJ who found an occupational disease but no prima facie evidence of permanency, allowing for reopening. The case was reopened in 2001 to include shoulder injuries, leading to the involvement of prior employers General Motors Corporation and ITT Automotive for Workers’ Compensation Law § 44 apportionment. In 2003, claimant was deemed permanently partially disabled, and liability was apportioned, with all employers subsequently filing claims for reimbursement from the Special Disability Fund. The WCLJ later determined that the case was "truly closed" in February 2000, making the reimbursement claims timely, but the Workers’ Compensation Board reversed this determination. The Appellate Division reversed the Board's decision, concluding that the case was indeed truly closed in February 2000, which made the employers' reimbursement claims timely, and remitted the matter for further proceedings.

Workers' CompensationOccupational DiseaseRepetitive Motion InjuryCase ReopeningPermanency AssessmentApportionmentSpecial Disability FundTimeliness of ClaimWorkers’ Compensation Board DecisionAppellate Review
References
7
Case No. VNO 0515904
Regular
Oct 15, 2007

CHRISTOPHER STOKES vs. COUNTY OF LOS ANGELES SHERRIF'S DEPARTMENT

The Appeals Board granted reconsideration, reversing the WCJ's decision and finding that the deputy sheriff's bicep injury sustained while training for an employer-sanctioned boxing tournament arose out of and occurred in the course of employment. The Board applied the *Ezzy* test, finding both subjective and objective reasonableness in the applicant's belief that his participation was expected, despite the injury occurring during off-duty training at a private residence. The matter was returned for further proceedings, deferring other issues.

Workers' Compensation Appeals BoardDeputy SheriffInjury AOE/COELabor Code Section 3600(a)(9)Voluntary Recreational Activity ExceptionImplied Employer EncouragementObjective Reasonable BeliefDepartmental Boxing TeamFundraiser EventSergeant Mike Young
References
1
Case No. SBR 0303770 SBR 0313222
Regular
Jun 09, 2008

TIM STOKES vs. STATE OF CALIFORNIA / CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND

The Appeals Board rescinded the prior decision and returned the case for further development of the record on the reasonableness of Premier Outpatient Surgery Center's (POSC) lien claim for services rendered to the applicant. While POSC was correctly deemed licensed and not required to obtain a fictitious-name permit for its outpatient setting services, it bears the burden of proving the reasonableness of its charges. The Appeals Board also found that the award of attorney fees under LC § 5813 was unsupported by the record as no findings of bad faith were made.

Workers' Compensation Appeals BoardState Compensation Insurance FundPremier Outpatient Surgery Centerepidural corticosteroid injectionsfluoroscopic guidancefictitious-name permitMedical Board of CaliforniaDepartment of Health Servicessurgical clinic licenseoutpatient setting
References
9
Case No. ADJ2853562 (SBR 0303770) ADJ1725853 (SBR 0313222)
Regular
Dec 15, 2008

TIM STOKES vs. STATE OF CALIFORNIA / CALIFORNIA HIGHWAY PATROL, legally uninsured, adjusted by STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded the prior order disallowing sanctions against the defendant. The Board found that the defendant's continued assertion that the lien claimant needed a fictitious-name permit was potentially frivolous, especially after the Board's prior decision. The case is remanded to the trial level to determine if the defendant's position was reasonably based on evidence and existing law, and if not, to award attorney fees as a sanction.

Labor Code §5813Premier Outpatient Surgery CenterFictitious-Name PermitMedical Board of CaliforniaOutpatient SettingHealth and Safety Code §1248(c)Bad Faith ActionsFrivolous ClaimAttorney's Fees SanctionWorkers' Compensation Appeals Board
References
5
Case No. SBR 0311485
Regular
Jun 28, 2006

KIMBERLY STOKES vs. PATTON STATE HOSPITAL / DEPARTMENT OF MENTAL HEALTH / STATE OF CALIFORNIA, legally uninsured, administered by STATE COMPENSATION INSURANCE FUND

This case concerns the lien claim of Ambulatory Surgery Center of Pomona (ASCP) for services rendered to an injured worker. The prior decision disallowed the lien because ASCP lacked a fictitious-name permit from the Medical Board of California. ASCP argues a permit wasn't required for "facility fees" and it possessed necessary accreditations. The Appeals Board rescinded the decision, remanding for a determination of whether ASCP operated as a "clinic" requiring a permit or an "outpatient setting" exempt from such if accredited, and whether its accreditation was valid for ASCP.

Fictitious-name permitMedical BoardAmbulatory Surgery CenterClinicOutpatient settingAccreditationBusiness and Professions CodeHealth and Safety CodeLien claimantProfessional services
References
6
Case No. OAK 0314027
Regular
Jul 30, 2007

ANASTACIA MURELLA vs. DEPARTMENT OF INDUSTRIAL RELATIONS / STATE OF CALIFORNIA, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded a prior order disallowing a lien claim from Bay Surgery Center (BSC) for surgical services. The Board found that the administrative law judge incorrectly applied the *Kunz* standard for evaluating outpatient surgical facility fees and that the issue of BSC's licensure and fictitious-name permit requirements needed further consideration. The case is remanded to the trial level for a new decision that properly addresses these issues, ensuring compliance with *Stokes* and *Kunz*.

KunzFictitious-name permitBurden of proofLien claimantMedical BoardAmbulatory surgical centerMedicare rateLicensed physicianAccreditationUsual fee
References
11
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