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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ799117 (LBO 0393727)
Regular
Jan 14, 2010

FRANK CRUZ (Deceased), DIANA CRUZ (Widow) vs. KRETSCHMAR & SMITH, INC., STATE COMPENSATION INSURANCE FUND

This case involves a widow's claim for death benefits following her husband's fatal industrial injury. The employer argued the claim was barred by a "carve-out" agreement under Labor Code §3201.5, which allows alternative dispute resolution for unionized employees. The Workers' Compensation Appeals Board rescinded the dismissal, finding that carve-out agreements under §3201.5 apply only to employees, not to dependents' death benefit claims. The Board determined that dependents' death benefits are independent rights, not derived from the employee's claim. The case is returned for further proceedings on the merits of the widow's claim.

Carve-out agreementLabor Code § 3201.5Death benefitsDependentsCollective bargaining agreementWorkers' Compensation Appeals BoardReconsiderationRescinded orderLabor Code § 3202Independent claim
References
Case No. ADJ8969518
Regular
Mar 30, 2015

EDUARDO FLORES RAMOS vs. LETNER ROOFING CO.; GALLAGHER BASSETT

The Workers' Compensation Appeals Board (WCAB) dismissed Eduardo Flores Ramos's petition for reconsideration because it was untimely filed. The petition was filed on January 11, 2015, which was more than 25 days after the WCJ's December 11, 2014 decision. The WCAB emphasized that the deadline for filing a petition for reconsideration is jurisdictional and proof of mailing is insufficient. The WCAB noted that the applicant may pursue their claim through alternative dispute resolution under a Union Collective Bargaining Agreement.

Petition for ReconsiderationUntimely FilingJurisdictional LimitWCABWCJ ReportLabor CodeCalifornia Code of RegulationsAlternative Dispute ResolutionCollective Bargaining AgreementUnion Agreement
References
Case No. ADJ3560082 (ANA 0380953)
Regular
Mar 12, 2009

MARGARITA SERRANO vs. 3 DAY BLINDS, STATE COMPENSATION INSURANCE FUND

This case involves a lien claim by Huntington Beach Hospital for medical services rendered to an injured worker. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to reverse a prior finding, determining that contractual agreements between the hospital, Blue Cross, and the defendant insurer (SCIF) constitute an "express agreement" under Labor Code section 5304. This express agreement, which includes binding arbitration provisions, divests the WCAB of jurisdiction over the lien dispute. Therefore, the WCAB rescinded its prior award and ordered the parties to arbitrate the dispute according to the terms of their contract.

Workers' Compensation Appeals BoardState Compensation Insurance FundHuntington Beach HospitalComprehensive Contracting Hospital AgreementWorkers' Compensation Managed Care Service AgreementOther PayorLabor Code Section 5304Labor Code Section 4609Express AgreementBinding Arbitration
References
Case No. ADJ2200226
Regular
Apr 08, 2014

RUDY GALLARDO vs. SOUTHERN CALIFORNIA EDISON

The WCAB reversed a prior decision, finding it lacked jurisdiction over a hospital's lien claim for unpaid services. The Appeals Board held that an "express agreement," as required by Labor Code Section 5304 to divest the WCAB of jurisdiction, existed through a chain of contracts between the hospital, a network administrator (Blue Cross), and the self-insured employer. This chain of agreements fixed the payment amounts, thus precluding the WCAB from adjudicating the fee dispute. Any claims of contract breach or non-compliance with other statutes like Section 4609 must be pursued in a different forum.

WCAB jurisdictionLabor Code Section 5304express agreementchain of contractsHuntington HospitalSouthern California EdisonBlue Cross of CaliforniaOfficial Medical Fee Schedulelien claimfee dispute
References
Case No. ADJ6663169
Regular
Jan 27, 2010

RICHARD SHILTS (Deceased), KAAREN GUEST (Widow) vs. BRUNTON ENTERPRISES, INC., SEABRIGHT INSURANCE CO.

This case concerns whether a union's "carve-out" agreement, allowing for alternative dispute resolution under Labor Code § 3201.5, applies to dependent death benefits. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, reversing a prior finding. The WCAB held that "carve-out" agreements, by their plain language, apply only to "employees" and not to dependents' death benefit claims. Because dependents' rights to death benefits are independent of the deceased employee's claim and constitutionally mandated, the WCAB found these claims fall under its exclusive jurisdiction.

carve-out agreementLabor Code section 3201.5death benefitsdependents' claimalternative dispute resolutionWCAB jurisdictioncollective bargaining agreementindustrial injurywidowinsurer
References
Case No. ADJ253443 (POM 0286361)
Regular
Jan 17, 2014

JUAN MANUEL RESENDIZ vs. DANNY'S TRIMMING & BINDING CORP., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinding the WCJ's finding that it lacked jurisdiction over a lien dispute between Good Samaritan Hospital and State Fund. The Board found the contracts between State Fund, Blue Cross, and Good Samaritan potentially created an "express agreement" under Labor Code Section 5304, divesting the Board of jurisdiction. However, the Board also noted Good Samaritan failed to meet its initial burden of proof regarding the necessity of its services and that State Fund may not have provided proper notice of its payor status under the contract. The case is returned to the trial level for further evidence development on these issues.

Workers' Compensation Appeals Boardlien claimantPetition for ReconsiderationFindings of FactjurisdictionState Compensation Insurance FundOfficial Medical Fee ScheduleLabor Codeexpress agreementarbitration
References
Case No. SAL 95992 SAL 95993 SAL 97616
Regular
Feb 06, 2008

JOSE G. LIZARRAGA (DECEASED) vs. WATSONVILLE PRODUCE, REPUBLIC INDEMNITY COMPANY OF AMERICA

This case concerns whether a binding compromise and release agreement was formed before the applicant's death. The Appeals Board denied reconsideration, finding that the agreement was not "duly executed" as required by statute because the defendant had not signed it, and a Medicare set aside provision was still pending. The majority concluded that a complete meeting of the minds on all material aspects was lacking, making the WCJ's prior finding of a binding agreement erroneous.

Compromise and ReleaseDuly ExecutedMedicare Set AsideBinding AgreementMeeting of the MindsLabor Code Section 5003Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderIndustrial Injury
References
Case No. ADJ9285089
Regular
Aug 24, 2016

ANA RAMIREZ FARIAS vs. ABLE BUILDING MAINTENANCE, ZURICH NORTH AMERICA

The Appeals Board affirmed an arbitrator's decision that applicant Ana Ramirez Farias must transfer medical care to her employer's exclusive provider network, despite her continued treatment with Dr. Arthur Harris. The majority found that the collective bargaining agreement's provisions on medical treatment, negotiated under Labor Code section 3201.5, take precedence over general Medical Provider Network (MPN) statutes like section 4603.2(a)(2). The dissenting opinion argued that the collective bargaining agreement diminishes the applicant's statutory right to treatment and that section 4603.2(a)(2) should apply due to the agreement's silence on transfer of care disputes.

Labor Code section 3201.7Labor Code section 3201.5(b)Alternative Dispute Resolution (ADR)self-procure treatmentmedical controlexclusive provider networkcarve-out agreementMedical Provider Network (MPN)collective bargaining agreementagreed list of providers
References
Case No. ADJ8937362
Regular
Mar 07, 2014

EDWARD ZWETTLER vs. KKOTTONGNAE RETREAT CENTER

The Workers' Compensation Appeals Board denied Edward Zwettler's petition for reconsideration, upholding the judge's decision that he was not an employee of Kkottongnae Retreat Center (KRC). The judge found Zwettler's testimony regarding an employment agreement with an unauthorized individual and his continued presence on KRC property despite attempts to evict him lacked credibility. Furthermore, even if an agreement existed, it would likely be excluded from workers' compensation coverage due to KRC being a charitable organization providing shelter based on need, not employment.

WCABPetition for ReconsiderationWCJ reportcredibility findingGarza v. Workmen's Comp. Appeals Bd.in pro perShelter Agreementverbal agreementcharitable organizationBr. Philip
References
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