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

Case No. ADJ2154380
Regular
Jul 21, 2010

SPENCER DAVIS vs. CLARK & SULLIVAN, INC., LWP CLAIMS SACRAMENTO, BERKSHIRE HATHAWAY SAN FRANCISCO, BERKSHIRE HATHAWAY PASADENA

In this case, the defendant sought to disqualify a Qualified Medical Evaluator (QME) due to their alleged unavailability for deposition within 120 days as required by Administrative Director Rule 35.5(f). The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for removal. The WCAB found that Rule 31.5, which allows for replacement panels, does not apply to QME unavailability for deposition. Furthermore, the Board determined the defendant failed to demonstrate significant prejudice or irreparable harm, especially after rescheduling the deposition themselves.

Petition for RemovalQualified Medical EvaluatorDeposition UnavailabilityAdministrative Director RuleMandatory RegulationPrejudice and HarmReplacement PanelWCJ OrderUpper Extremities InjuryPsyche Injury
References
0
Case No. ADJ7516108
Regular
Jun 06, 2011

ANGELICA CROTTE vs. UFO, INC., ILLINOIS MIDWEST INSURANCE AGENCY, VIRGINIA SURETY COMPANY, INC.

The Workers' Compensation Appeals Board (WCAB) dismissed Virginia Surety's petition for removal because it was unverified, violating WCAB Rule 10843(b). The WCAB also noted the petition's excessive length and improper attachments, which violated multiple rules, including CA Rule 10232(a)(10) and WCAB Rule 10842(c). Based on these egregious violations, the WCAB issued a notice of intention to impose a $500 sanction on Virginia Surety's counsel, Sophia E. Martinez, pursuant to Labor Code section 5813.

Petition for RemovalUnverified PetitionWCAB RulesLabor Code 5813SanctionsFrivolousWillful Failure to ComplyWCJAdministrative Law JudgeVirginia Surety Company
References
1
Case No. MISSING
Regular Panel Decision
Apr 17, 1990

Claim of Rogers v. Evans Plumbing & Heating

The claimant appealed a decision from the Workers’ Compensation Board, filed on April 17, 1990, which ruled his application untimely. The claimant had applied on August 31, 1988, to review two Workers’ Compensation Law Judge decisions from August 5, 1985, and October 1, 1985, denying compensation benefits for a period between February 7, 1983, and September 23, 1985. The Board correctly determined that the claimant's application was untimely as it was filed more than 30 days after the original decisions, citing Workers’ Compensation Law § 23 and 12 NYCRR 300.13 (a). The Board's decision to not entertain the untimely application was found to be neither arbitrary nor capricious. The higher court subsequently affirmed the Board's decision.

Untimely ApplicationWorkers' Compensation LawAppellate ReviewBoard DecisionProcedural TimelinessJudicial ReviewAppealSection 23NYCRR 300.13Claimant Benefits
References
1
Case No. ADJ13283392
Regular
Mar 21, 2023

FIDELINA MONTER vs. RANDSTAD NORTH AMERICA, INC., ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision, increasing the applicant's permanent disability rating from 7% to 14% due to insufficient evidence for apportionment by the agreed medical examiner. The WCAB also ruled that the defendant is not entitled to a credit for temporary disability overpayment, citing the hardship it would impose on the applicant. Finally, the WCAB increased the attorney's fee to $2,000.00.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical ExaminerApportionmentPermanent DisabilityTemporary Disability Indemnity OverpaymentSubstantial EvidenceMaximum Medical ImprovementLumbarizationAnterolisthesis
References
6
Case No. ADJ9772365 (MF) ADJ10082338
Regular
Dec 06, 2016

Leonel Hidalgo vs. Hilbert Property Management, Technology Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration, treating it instead as a Petition for Removal. The WCAB granted removal, rescinded the Joint Findings of Fact, and returned the matter for further proceedings. This action was based on the Medical Director applying the incorrect standard when determining that an orthopedic QME panel was in the applicant's medical interest. The WCAB found that the Medical Director should have first determined if the applicant's chosen chiropractic specialty was medically or otherwise inappropriate, as required by Administrative Director Rule 31.5(a)(10).

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME panelspecialty determinationorthopedicschiropracticMedical DirectorAdministrative Director RuleLabor CodePetition for Reconsideration
References
9
Case No. ADJ2065496 (LAO 0777249) ADJ4050189 (LAO 0774705)
Regular
Jan 21, 2010

MIGUEL RODRIGUEZ vs. RALPHS GROCERY COMPANY/FOOD 4 LESS, Permissibly Self-Insured, Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

In this case, the defendant appealed a Rehabilitation Unit Determination, but their appeal was deemed untimely and improper by the WCJ. The defendant argued that filing a Declaration of Readiness (DOR) with their petition was not required and that the governing WCAB Rule was invalid. The Appeals Board affirmed the WCJ's decision, holding that the defendant's appeal was indeed untimely and improper under the then-current WCAB Rule 10955, which mandated the filing of a DOR for such appeals. The Board also upheld the validity of WCAB Rule 10955, confirming the Board's authority to establish procedural rules.

Rehabilitation UnitDeclaration of ReadinessWCAB Rule 10955Labor Code section 4645Petition for ReconsiderationFindings of Factuntimely appealadministrative law judgeWorkers' Compensation Appeals BoardRalphs Grocery Company
References
1
Case No. ADJ6502775, ADJ6498620, ADJ8109003, ADJ8115890
Regular
May 09, 2014

MARIA POHYAR vs. DEY LP, AMERICAN ZURICH INSURANCE COMPANY, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration because the challenged order was not a "final order" subject to reconsideration. The WCAB also denied the Petition for Removal, agreeing with the Administrative Law Judge that the issue of whether the defendant Zurich is entitled to a new Qualified Medical Evaluator (QME) panel was only before the WCJ based on a procedural rule regarding appointment notification forms, not ex parte communications. The WCAB clarified that issues of ex parte communications and the applicability of related statutes and rules were not yet properly before the Board. Therefore, the applicant's request for the WCAB to assert jurisdiction and rule against Zurich on the QME panel issue was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJurisdictionQualified Medical Evaluator (QME)Panel QMEDivision of Workers' Compensation (DWC) RulesLabor Code section 4062.3Ex parte communicationMedical Director
References
7
Case No. Motions Nos. 5 and 7
Regular Panel Decision
Jul 27, 1978

Rachlin v. Lewis

This case consolidates two CPLR article 78 proceedings challenging the Insurance Department's regulations on attorneys' fees in no-fault automobile insurance disputes and the constitutionality of certain sections of the Insurance Law. The petitioners sought to rescind 11 NYCRR 65.16 and declare Insurance Law section 671 et seq. unconstitutional. The court ruled that sections 11 NYCRR 65.16 (c) (7) (ix), which prohibited attorneys from charging clients fees in excess of insurer-paid fees, and 11 NYCRR 65.16 (c) (7) (vii), concerning the regulation of disbursements, were invalid as they exceeded the scope of the enabling legislation. However, the court upheld the general fee schedule, finding a rational basis for its establishment by the Insurance Department.

Attorney's FeesNo-Fault InsuranceInsurance LawRegulatory ChallengeCPLR Article 78Administrative LawConstitutional LawDisbursementsArbitrationAutomobile Insurance
References
6
Case No. ADJ7628890
Regular
Jan 03, 2020

ELIZA ARRIAGA vs. CALIFORNIA TRUCK EQUIPMENT COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a petition for reconsideration by Eliza Arriaga, who sought to overturn a dismissal of her workers' compensation claim. The Workers' Compensation Appeals Board (WCAB) denied the petition, upholding the dismissal based on WCAB Rule 10582 for lack of prosecution. The Board found the applicant's attorney's arguments misplaced and confirmed the dismissal was appropriate under Rule 10582, not the rule cited by the applicant. The WCAB adopted the administrative law judge's report in its entirety.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportWCAB Rule 10582dismissallack of prosecutionnotice of intention to dismissRoth v Workers' Comp. Appeals Bd.WCAB Rule 10562failure to appear
References
2
Case No. ADJ3447287 (SBR 0263874) ADJ3565604 (ANA 0306676) ADJ3955433 (ANA 0306675)
Regular
Dec 09, 2016

PATSY HENDRY vs. KAISER FOUNDATION HOSPITAL, PERMISSIBLY SELF INSURED

The Workers' Compensation Appeals Board (WCAB) denied a petition to disqualify a workers' compensation administrative law judge (WCJ). The WCAB found that the alleged expressions of opinion by the WCJ did not demonstrate bias or an unqualified opinion as to the merits of the case, but rather reflected rulings based on evidence and law. The board also clarified that erroneous rulings do not constitute grounds for disqualification. Furthermore, the WCAB concluded that the petition, while not subject to strict timeliness rules due to the timing of the alleged events, was still ultimately denied on its merits.

Petition for DisqualificationWCJCode of Civil Procedure section 641formed or expressed an unqualified opinionexistence of a state of mindenmity against or bias towardTaylor v. Industrial Acc. Com.Lumbermen's Mut. Cas. Co. v. Industrial Acc. Com.Kreling v. Superior CourtMcEwen v. Occidental Life Ins. Co.
References
7
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