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

Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. SFO 0499272
Regular
Jul 07, 2008

Helen Miller vs. Green Gulch Farm and Zen Center, EVEREST NATIONAL INSURANCE

The Workers' Compensation Appeals Board affirmed the administrative law judge's finding that Helen Miller was an employee of Green Gulch Farm and Zen Center and sustained an industrial injury to her left ankle. The Board found Miller was not a volunteer due to the extensive benefits received and the employer's control, and her jogging injury during a lunch break was a reasonable expectancy of employment, not barred by Labor Code section 3600(a)(9). Therefore, her injury arose out of and occurred in the course of her employment.

Workers' Compensation Appeals BoardHelen MillerGreen Gulch Farm and Zen CenterEverest National InsuranceGallagher BassettSFO 0499272Opinion and Decision After ReconsiderationLabor Code Section 3351Labor Code Section 3352(i)Employee definition
References
Case No. ADJ10423250
Regular
Jul 21, 2025

MARC LAFLEUR vs. MILHOUSE CHILDREN'S SERVICES, NON-PROFITS UNITED, SEDGWICK CLAIMS MANAGEMENT SERVICES, INCORPORATED

Applicant Marc Lafleur sought reconsideration of an April 18, 2025 Findings and Award, which denied his Petition to Reopen for new and further disability. The initial award found no evidence of new and further disability within five years of his June 11, 2015 injury. Lafleur argued that the workers' compensation administrative law judge (WCJ) should have relied on the opinion of Agreed Medical Evaluator (AME) Thomas Pattison, M.D., and correctly identified his occupation. The Appeals Board granted the petition for reconsideration, stating that this is not a final order on the merits but defers a final decision for further review of factual and legal issues, encouraging the parties to consider mediation.

Petition for ReconsiderationNew and Further DisabilityStipulated AwardAgreed Medical EvaluatorPermanent DisabilityFive-Year RuleLabor Code Section 5909Substantial EvidenceContinuing JurisdictionFinal Order
References
Case No. ADJ3304426
Regular
Apr 14, 2017

JIMMIE WISE vs. EASTSIDE RESERVOIR PORJECT/AWZ, ITT HARTFORD, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves a defendant's petition for reconsideration of a Workers' Compensation Arbitrator's (WCA) award for further medical treatment, specifically surgery. The defendant did not dispute the need for surgery but challenged a mediator's prior order as exceeding authority. The Workers' Compensation Appeals Board (WCAB) dismissed the petition primarily because the defendant failed to serve it on the WCA, which is a procedural defect. The Board noted that the WCA's subsequent order was also untimely and without jurisdiction due to the lack of proper service.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardWorkers' Compensation ArbitratorFurther Medical TreatmentSurgerySecond Medical OpinionAlternative Dispute ResolutionMediationMediator's Authority
References
Case No. ADJ3817494 (LAO 0863722)
Regular
Jun 21, 2017

CHRISTINE RANGEL vs. HONEYWELL INTERNATIONAL, INC, ZURICH NORTH AMERICA, MATRIX ABSENCE MANAGEMENT, INC

Applicant Rangel petitioned for reconsideration of a WCJ's award finding industrial injury and $63\%$ permanent disability, arguing she was permanently and totally disabled. Following a Commissioners' Settlement Conference, the parties executed a Compromise and Release agreement. The Board, after reviewing the agreement and the record, found it adequate and in the applicant's best interest, rescinded the prior award, and approved the Compromise and Release. This action included releasing any potential death benefit claims and approving the agreed-upon attorney's fees.

Workers' Compensation Appeals BoardChristine RangelHoneywell International IncZurich North AmericaMatrix Absence Management IncReconsiderationFindings and AwardCardiovascular system injuryPsyche injurySleep disorder
References
Case No. ADJ7258268
Regular
Dec 20, 2013

PATRICIA SMITH vs. WELLPOINT HEALTH NETWORKS, INC.; and ZURICH NORTH AMERICA INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the original award. The Board found substantial evidence supported the necessity of a Jenny Craig weight loss program, including special diet food products, as reasonably necessary treatment. This was based on the applicant's need to lose weight for industrial back surgery and the program's proven success, evidenced by the applicant's 54-pound weight loss. The Board adopted the administrative law judge's report and recommendation in its entirety.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationDENIEDJenny Craigweight loss programspecial diet food productsreasonably necessary treatmentindustrial back surgerysubstantial evidencemedical treatment
References
Case No. ADJ7531724, ADJ7531690
Regular
Dec 01, 2017

AURORA LEMUS vs. FREEBIRDS WORLD BURRITO, GRANITE STATE INSURANCE COMPANY, MARK ORFALIA, REDWOOD FIRE AND CASUALTY COMPANY

This case involves a dispute between Granite State Insurance Company and Redwood Fire and Casualty Company regarding contribution for workers' compensation benefits paid to applicant Aurora Lemus. Granite, initially denied contribution by the WCJ, petitioned for reconsideration. The parties subsequently settled the contribution claim for $22,500.00 through mediation, which has been approved by the Board. This stipulation fully resolves Granite's claims against Redwood.

Workers' Compensation Appeals BoardReconsiderationContributionReimbursementJoint Findings of FactCompromise and ReleaseStipulationVoluntary MediationCommissioners' Settlement ConferenceInsurer
References
Case No. ADJ8480026
Regular
Jan 14, 2019

Patricia Tapia vs. International Laser, Twin City Fire Insurance

This case involves a workers' compensation applicant, Patricia Tapia, who sustained spinal and upper extremity injuries. The defendant, Twin City Fire Insurance, sought reconsideration of a prior order finding that lien claimant Scripte Corporation had timely filed a required declaration. The parties subsequently engaged in mediation and reached a settlement resolving Scripte's lien for $2,850.00. The Board rescinded the original Findings and Order and approved the lien settlement agreement.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderAdministrative Law JudgeCumulative InjuryCervical SpineLumbar SpineRight Upper ExtremityLien ClaimantLabor Code Section 4903.05(c)
References
Case No. ADJ1518346 (MON 0297186)
Regular
Nov 20, 2017

THOMAS MARTINEZ vs. RALPHS GROCERY COMPANY, Permissibly Self-Insured; Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a WCJ's decision allowing a lien claim of $51,400.37 for medical treatment. During reconsideration, the defendant, Ralphs Grocery Company, and the lien claimant, Motion Picture Health Fund (MPHF), resolved the lien dispute through mediation. They agreed to a settlement payment of $29,950.00. Consequently, the WCAB rescinded the original WCJ order, approved the settlement agreement, and dismissed the defendant's petition for reconsideration as moot.

Workers' Compensation Appeals BoardRalphs Grocery CompanySedgwick Claims Management ServicesMotion Picture Health Fundlien claimmedical treatment expensepenaltiesinterestreconsiderationvoluntary mediation
References
Case No. ADJ3547384; ADJ1113447
Regular
Jul 07, 2025

JOSE BERRIOS vs. JERRYS FAMOUS DELI, CALIFORNIA INSURANCE COMPANY, INTERCARE HOLDINGS INSURANCE SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, CENTRE INSURANCE

The applicant's current attorney petitioned for reconsideration of a Workers' Compensation Administrative Law Judge's (WCJ) order that awarded the entire $90,000 attorney's fee to the applicant's prior counsel due to the current attorney's failure to file a timely disclosure statement. The Appeals Board found that the current attorney's initial disclosure statement did not comply with Labor Code § 4906(e) and that payment is precluded for services rendered before a compliant form is filed. However, the Board granted the petition for reconsideration to allow further review of the factual and legal issues, noting that the order is not a final decision on the merits and encourages mediation.

Workers' Compensation Appeals BoardPetition for ReconsiderationAttorney's FeesLabor Code § 4906Disclosure StatementCompromise and ReleaseCIGACentre InsuranceWCJReconsideration Granted
References
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