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

Case No. ADJ14547470
Regular
Apr 17, 2025

RICHARD LYNN vs. CONTRA COSTA ELECTRIC, AMERICAN CASUALTY COMPANY OF READING, PA

The Workers' Compensation Appeals Board granted reconsideration to applicant Richard Lynn, who challenged a Workers' Compensation Arbitrator's (WCA) denial of his right to a Qualified Medical Evaluator (QME) examination. The WCA had found that Lynn forfeited this right by not attending a scheduled QME exam, citing an Alternate Dispute Resolution (ADR) agreement. The Board determined that the ADR section did not mandate forfeiture and that the WCA, like a WCJ, possessed discretion to appoint a medical examiner to ensure due process and fully adjudicate issues, especially given the lack of medical-legal reporting on industrial causation. Consequently, the Board rescinded the WCA's Findings and Order and returned the matter for further proceedings consistent with its decision.

ADR ProgramQMELabor Code Section 3600(a)(10)NECA/IBEWsubstantial justicedue processmedical-legal evaluationrescindedreturnedarbitraton
References
14
Case No. ADJ2134688 (ANA 0372559)
Regular
Nov 19, 2010

ABNER K. JUNKIN III (TREY JUNKIN) vs. ARIZONA CARDINALS/TIG INSURANCE as administered by RISK ENTERPRISE MANAGEMENT

This case concerns TIG Insurance's petition for reconsideration of a Workers' Compensation Arbitrator's (WCA) decision regarding cumulative trauma injury benefits for professional football player Trey Junkin. The WCA found the cumulative trauma ended January 9, 2003, and ordered TIG to reimburse Gulf/Travelers for 83% of rehabilitation benefits paid until February 9, 2004, due to Junkin's return to work. The Board denied TIG's petition, affirming the WCA's jurisdiction over vested rehabilitation benefits and upholding the allocation of liability based on prior final findings of fact regarding employment periods and the date of injury. The Board also affirmed the WCA's discretion in transferring the administration of future benefits to TIG.

Cumulative TraumaLabor Code Section 5500.5Labor Code Section 5412Vocational RehabilitationContribution ProceedingsDate of InjuryLiability Among CarriersCompromise and ReleasePenalties and InterestReimbursement
References
3
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
0
Case No. ADJ11073230
Regular
Mar 24, 2025

EMILIO VALENCIA vs. BLUEWATER ENVIRONMENTAL SERVICES, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board considered a Petition for Reconsideration filed by Bluewater Environmental Services and Zurich American Insurance Company, challenging a December 13, 2024, Findings of Fact and Award. The WCA had found applicant Emilio Valencia sustained an industrial lumbar spine injury resulting in permanent total disability. Defendants argued the WCA should have adopted their vocational expert's findings and lacked authority to develop the record further. The Board granted the petition for reconsideration, deferring a final decision pending further review of the merits and the complete record, affirming the WCA's authority to develop the record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardPermanent Total DisabilityVocational ExpertAlternative Dispute ResolutionQualified Medical EvaluatorAsbestos Removal WorkerLumbar Spine InjuryLabor Code Section 5909
References
25
Case No. ADJ4680684 (LAO 0878962) ADJ2228561 (LAO 0878963)
Regular
Feb 19, 2016

ARTURO AVILA vs. CARIMEX INTERNATIONAL TRADING, EVEREST NATIONAL INSURANCE CO., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., STATE COMPENSATION INSURANCE FUND

This case involves a dispute over contribution liability between two insurance carriers for an applicant's cumulative trauma injury. The original Findings and Award determined Everest National Insurance was 68% liable and SCIF 32% liable, ordering Everest to pay SCIF $31,513.97. Everest's petition for reconsideration focuses solely on the monetary calculation, not the proportional liability. The Appeals Board granted reconsideration to rescind the original award, as the WCA's attempt to rescind it was untimely. The matter is returned to the WCA for further proceedings and a proper decision on the monetary calculations.

Petition for ReconsiderationFindings and AwardPetition for ContributionEquitable ContributionCumulative Trauma InjurySpecific InjuryJoint Compromise and ReleaseCredit for PaymentsSupplemental ProceedingsLabor Code Section 5500.5
References
0
Case No. ADJ1153014 (LBO 0337870) ADJ2765368 (LBO 0337981) ADJ2277604 (LBO 0337982)
Regular
Jan 09, 2009

Arthur O'Campo vs. Continental Graphics, Liberty Mutual Insurance Company

Liberty Mutual's petition for reconsideration is denied. The WCA correctly found that Labor Code section 5500.5 does not apply because there is no cumulative trauma injury.

WORKERS' COMPENSATION APPEALS BOARDLiberty Mutual Insurance CompanyArgonaut Insurance CompanyLabor Code section 5500.5contributionreconsiderationAgreed Medical ExaminerAMEcumulative trauma injuryspecific injury
References
1
Case No. ANA 0347858
Regular
Sep 12, 2008

KEYIN L. ROSS vs. SAN DIEGO CHARGERS and LEGION INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA), SAN DIEGO CHARGERS, KANSAS CITY CHIEFS, TIG

The WCA's decision is affirmed for two reasons: Kansas City is wrong in claiming that San Diego was self-insured, and CIGA's statutes preclude Kansas City from recovering from San Diego.

Workers' Compensation Appeals BoardCIGALegion Insurance CompanyKansas City ChiefsSan Diego Chargerscontributioninsolvent insurercovered claimsInsurance Code section 1063.1(c)(5)deductible reimbursement
References
5
Case No. ADJ1296466 (AHM 0106897) ADJ2492989 (AHM 0106895 ADJ3196303 (AHM 0108789)
Regular
Oct 31, 2008

VERONICA ORTIZ vs. DOWNEY AREA RECYCLING TRANSFER, CIGA by INTERCARE INSURANCE SERVICES for SUPERIOR NATIONAL, in liquidation, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board dismissed the State Compensation Insurance Fund's (SCIF) petition for reconsideration because it was not filed from a final order, as the Board had previously granted reconsideration and remanded the case for further proceedings. The Board also found that the California Insurance Guarantee Association (CIGA) had cured any verification defects in its petition. SCIF's arguments regarding the WCA's denial of contribution and SCIF's coverage as "other insurance" were also addressed and found unpersuasive in light of the procedural dismissal.

Workers' Compensation Appeals BoardDowney Area Recycling TransferCIGASuperior NationalState Compensation Insurance FundPetition for ReconsiderationOpinion and Order Granting ReconsiderationWorkers' Compensation ArbitratorContributionLack of Verification
References
2
Case No. ADJ14138672
Regular
Aug 05, 2025

MARIO HERNANDEZ vs. FRESH QUALITY PRODUCE, INC.; STATE COMPENSATION INSURANCE FUND; CYPRESS INSURANCE C/O BERKSHIRE HATHAWAY HOMESTATE COMPANY

Defendant State Compensation Insurance Fund (SCIF) sought reconsideration of an Arbitrator's Decision on Petition for Contribution, which found Cypress Insurance liable for a portion of contribution. SCIF contended that the WCA should have relied on Labor Code section 5500.5 to determine the last injurious exposure period and award a higher contribution. The Appeals Board received an answer and the Arbitrator's Report and Recommendation, which suggested denying reconsideration. After preliminary review, the Appeals Board granted SCIF's Petition for Reconsideration, but this is not a final order. The final decision after reconsideration is deferred pending further review of the merits and the entire record.

Petition for ReconsiderationState Compensation Insurance FundCypress InsuranceLabor Code section 5500.5contributionlast injurious exposurecumulative injurytimely actednotice of transmissionsubstantial evidence
References
21
Case No. ADJ11114421
Regular
Jun 05, 2025

FELIX CABRERA vs. OAA INVESTMENTS, INC.; CALIFORNIA RESTAURANT MUTUAL BENEFIT CORP.

Defendant California Restaurant Mutual Benefit Corporation (CRMBC) sought reconsideration of a February 19, 2021 Findings and Order (F&O) which found CRMBC liable for coverage of applicant Felix Cabrera's injury, ruling that CRMBC's policy cancellation was premature. CRMBC contended it had no coverage obligations as the applicant was employed by OAA Investments, Inc., not insured by CRMBC, and argued against the applicability of Insurance Code section 676.8. The Appeals Board affirmed the WCA's F&O, treating the petition as one for reconsideration, and found that under Insurance Code section 676.8 and equitable principles, CRMBC was liable for coverage. The Board reasoned that due to a material change in ownership, CRMBC's cancellation notice required 30 days' notice, making January 27, 2018, the earliest effective cancellation date, which was after the November 22, 2017 injury date.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderPolicy CancellationInsurance Code Section 676.8Material Change in OwnershipEquitable EstoppelAffiliate Certificate of Consent to Self-InsureGroup Self-InsurerAD Rule 15480
References
15
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