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

Case No. MISSING
Regular Panel Decision

Langford v. Rogers

A paraplegic claimant, declared permanently disabled from a 1972 work accident, sought to modify his challenging New Jersey home for wheelchair accessibility. The Workers’ Compensation Board found these modifications medically necessary under Workers’ Compensation Law § 13 (a) and ordered the carrier, Westchester Fire Insurance Company, to pay for them, removing an initial $30,000 cap. Expert testimonies highlighted the extreme difficulty and high cost ($40,000-$60,000) of the modifications, with one expert deeming the project "an exercise in futility" due to safety and functional deficiencies, and another unable to give a technical feasibility opinion without further studies. The appellate court reversed the Board's decision, concluding that the proposed modifications were unreasonable as a matter of law because alternative housing options were not explored, the cost could exceed the property's value, and the house would remain unsafe and functionally deficient even after renovations. The matter was remitted to the Workers’ Compensation Board for further proceedings consistent with the court's findings.

Workers' CompensationPermanent DisabilityParaplegiaHome ModificationWheelchair AccessibilityMedical NecessityStatutory InterpretationReasonableness TestAppellate ReviewCosts
References
14
Case No. ADJ3857516 (VNO 0505788)
Regular
Sep 20, 2013

ALBERTO ALCAZAR vs. PACTIV CORPORATION

This case involves a worker's compensation claim where the employer, Pactiv Corporation, was found to have unreasonably delayed necessary medical treatment, including transportation and home care. The Appeals Board modified a prior decision, finding the unreasonable delay occurred from December 20, 2010, to March 2, 2011, and reduced the penalty from 25% to 15% of the delayed benefits. The Board reversed the penalty for two instances of transportation failure by a hired company, deeming it not the employer's unreasonable conduct. Finally, attorney fees were reduced as some services were deemed unnecessary for the period of unreasonable delay.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of FactAward and OrderUnreasonable DelayMedical TreatmentTransportationHome Care AssistanceLabor Code section 5814Penalty
References
1
Case No. ADJ2607862 (SDO 0334155)
Regular
Feb 17, 2012

JAVIER HERNANDEZ vs. SWEETWATER UNION HIGH SCHOOL DISTRICT, Permissibly Self-Insured, Administered By CORVEL CORPORATION

This case concerns an employer's unreasonable delay in providing a new treating physician to an applicant with a psyche injury, leading to a penalty under Labor Code section 5814. The defendant argued the delay was not unreasonable and was applicant's fault, but the Board found the employer has an affirmative duty to actively provide medical care. Based on the WCJ's report, which indicated no evidence of the defendant's efforts to locate a physician, reconsideration was denied. The Board affirmed the finding of unreasonable delay and the imposition of a penalty.

Labor Code section 5814unreasonable delaymedical treatmenttreating physicianpenaltypsyche injuryhealth care technicianCORVEL CORPORATIONSWEETWATER UNION HIGH SCHOOL DISTRICTpermanent disability
References
6
Case No. ADJ2562535 (BAK 0151733)
Regular
Jan 07, 2014

STEVE ADAMS vs. COUNTY OF KERN, Permissibly Self-Insured

The Workers' Compensation Appeals Board reversed a finding that the defendant did not unreasonably delay compensation payments. The applicant sustained an industrial injury to his pulmonary system, and medical evidence confirmed the injury was work-related. The Board found that despite the existence of an agreed medical examiner's report confirming the injury, the defendant's denial of liability persisted for an unreasonable period. Consequently, the defendant was found to have unreasonably delayed payments for temporary disability, permanent disability, and mileage reimbursement, with the penalty amount to be determined.

Industrial InjuryPulmonary SystemCode Compliance OfficerPermanent DisabilityReconsiderationLabor Code 5814Delay PenaltiesAgreed Medical ExaminerPulmonary DiseaseOccupational Asthma
References
6
Case No. ADJ3085209 (LAO 0871020), ADJ2932964 (LAO 0828514), ADJ8066790
Regular
Jul 06, 2018

MARC KELLER vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board (WCAB) rescinded a prior finding of unreasonable delay in payments by the City of Los Angeles (City). The WCAB found that the City's application of a credit from one case to the front end of an award in another case was not unreasonable, as the stipulation was silent on the deduction method. Additionally, the WCAB determined that the City's deduction for the present value of a commuted attorney's fee in a separate case was a proper calculation of the award, not an unreasonable withholding. Consequently, no penalties or interest were deemed due.

ADJ3085209ADJ2932964ADJ8066790Petition for ReconsiderationFindings and Awardunreasonable delayLabor Code 4650Labor Code 5814Labor Code 5814.5attorney's fees
References
15
Case No. ADJ7365717
Regular
Oct 18, 2012

JAMES VAN DELL (Deceased), LORILENE VAN DELL (Dependent) vs. COUNTY OF LOS ANGELES

This case involves a widow's claim for death benefits after her firefighter husband died from prostate cancer. The defendant, County of Los Angeles, unreasonably delayed payment by requesting tax returns that were partially blacked out by the IRS, despite the widow's attorney providing explanations and other evidence of dependency. The Appeals Board rescinded the prior order finding no unreasonable delay, determined that a penalty is warranted due to the defendant's unreasonable refusal to provide benefits. The matter is returned to the WCJ to determine the amount of the penalty based on established legal factors.

Workers Compensation Appeals BoardDeath BenefitsPenaltiesLabor Code Section 3501Labor Code Section 5814DependencyTotal DependentPartial DependentUnreasonable DelayReconsideration
References
2
Case No. ADJ3603721 (ANA 0385798) ADJ3874014 (ANA 4689669) ADJ4689669 (ANA 0388899)
Regular
Nov 07, 2014

CAROL HILL vs. UNILAB CORPORATION/QUEST DIAGNOSTICS, TRAVELERS INSURANCE COMPANY

This case involves an applicant seeking reconsideration of a WCJ's decision regarding unreasonable delays in benefit payments. The Board granted reconsideration and affirmed the finding of unreasonable delay for temporary disability indemnity, awarding a 25% penalty. However, the Board deferred the issue of permanent disability indemnity advance penalties for further analysis due to record ambiguity. The Board also found no unreasonable delay in medical treatment benefits and reversed an award of attorney's fees under LC 5814.5, but allowed fees from the temporary disability penalty recovery.

Workers' Compensation Appeals BoardUnreasonable DelayTemporary Disability IndemnityPermanent Disability Indemnity AdvancesLabor Code Section 5814 PenaltyMedical Treatment BenefitsAttorney's FeesPetition for ReconsiderationAdministrative Law JudgeJoint Findings and Award
References
1
Case No. ADJ954867 (SFO 0497953)
Regular
Dec 29, 2008

HERBERT BARRIOS vs. DEEP VAC, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board partially granted reconsideration, rescinding the award of attorney's fees for frivolous tactics but affirming the award for expert witness costs and a penalty for unreasonable refusal to pay. The Board found that while SCIF's refusal to pay for the diminished future earnings capacity expert was unreasonable, their actions did not rise to the level of bad faith or frivolous conduct required for sanctions. A dissenting opinion argued to affirm the original award of sanctions, finding SCIF's actions to be unreasonable and in bad faith based on prior unfavorable decisions and testimony from SCIF's claims adjustor.

Diminished Future Earnings CapacityVocational RehabilitationLabor Code section 5811Labor Code section 5814Labor Code section 5813Expert Witness FeesReconsiderationFindings and AwardSanctionsBad Faith Tactics
References
3
Case No. ADJ6678537
Regular
Oct 07, 2011

DOTTIE BRANDON-LEGGET vs. SECURITAS SECURITY SERVICES, INC.

This case involves a security guard's claim for industrial injury to her shoulder and knee. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirming the findings of industrial injury and temporary total disability. However, the WCAB reversed the administrative law judge's (ALJ) penalty award under Labor Code §5814, finding that the defendant's delay in paying temporary disability was not unreasonable due to genuine doubt about its liability. The WCAB emphasized that a penalty under §5814 requires unreasonable delay or refusal, and here, the defendant's doubts were not unreasonable given the applicant's delayed treatment and lack of contemporaneous complaints.

Labor Code § 5814Unreasonable DelayTemporary Total DisabilityIndustrial InjuryRight ShoulderRight KneeReconsiderationWCJ FindingsGenuine DoubtMedical Treatment
References
13
Case No. ADJ3905674 (SRO 0031254)
Regular
Feb 02, 2011

DAVID PELLETIER vs. UNITED STRUCTURES, INC., CIGA by its Servicing Facility CAMBRIDGE on behalf of FREMONT COMPENSATION, in liquidation

The Workers' Compensation Appeals Board denied reconsideration of its decision regarding attorney's fees. The applicant's attorney sought fees under Labor Code sections 4607 and 5814.5, arguing the defendant unreasonably failed to appoint a new case manager and pay prior bills. The Board affirmed the judge's finding that Labor Code § 4607 fees are inapplicable when the entire award is not terminated, and Labor Code § 5814.5 fees require an existing award and unreasonable refusal to pay. The Board found no evidence of unreasonable delay by the defendant in appointing a new case manager, thus denying the petition.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesLabor Code Section 4607Labor Code Section 5814.5Medical TreatmentCompromise and ReleasePetition for PenaltyNurse Case ManagerStipulations
References
2
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