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

Case No. ADJ8101494
Regular
Mar 14, 2017

ROBERTO ESCOBAR-IZARRARAS vs. ACCORN ENGINEERING, PACIFIC COMPENSATION INSURANCE COMPANY

The Appeals Board reconsidered a WCJ's decision disallowing the remainder of a hospital's lien. The WCJ found the lien unreasonable based on an incorrect standard, as the hospital's services were not subject to the Official Medical Fee Schedule and were to be paid on a "reasonable cost basis." The Appeals Board rescinded the prior decision, returning the case to the trial level for further proceedings and a new decision. This decision clarifies that the lien claimant bears the burden of proving the reasonableness of its charges on a cost basis, not just its usual fees.

WCABReconsiderationLien ClaimantMonrovia Memorial HospitalKunz studyReasonable Cost BasisOMFSLabor Code § 4600Burden of ProofPreponderance of the Evidence
References
2
Case No. ADJ1210556 (AGO 0018589)
Regular
Oct 10, 2008

EDWIN MILLER vs. KEEBLER COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for removal and granted reconsideration of the WCJ's prior decisions regarding medical mileage and penalties. The Board found the WCJ failed to properly consider statutory factors in determining a "reasonable geographic area" for the applicant's medical treatment. Consequently, the WCAB rescinded the WCJ's decisions and returned the case to the trial level for further proceedings and a new decision addressing all outstanding issues, including the definition of a reasonable geographic area for treatment.

WCABPetition for RemovalPetition for ReconsiderationMedical MileageReasonable Geographic AreaLabor Code Section 4600Administrative Director Rule 9780(h)WCJBoltonRamirez
References
2
Case No. ADJ3651901 (VNO 0315654) ADJ2601607 (VNO 0380819) ADJ3998237 (VNO 0416450)
Regular
Feb 01, 2010

DAVID GORDON vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration of three consolidated cases, finding the WCJ's decisions inadequate. The Board rescinded the original decisions and returned the matters to the trial level. This action was taken due to the WCJ's failure to make specific findings on all disputed issues, sufficiently reference the evidence relied upon, and adequately explain the basis for decisions on permanent disability and apportionment.

WCABReconsiderationFindings and OrderFindings and AwardApportionmentPsychiatric InjuryPermanent DisabilityAOE/COEStatute of LimitationDuplication of Claim
References
5
Case No. LAO 0803576
Regular
Jun 02, 2008

CESAR GARCIA LOPEZ vs. ROYAL PRINTEX INC., KYUN HYUN RYU, EUL KYEONG KIM, UEBTF

This case involves lien claimants challenging a WCJ's decision disallowing their claims for medical treatment provided to the applicant for a low back injury. The Appeals Board granted reconsideration because the WCJ's decision lacked clarity regarding which specific lien claims were denied and the precise basis for those denials. The matter is remanded to the trial level for further proceedings to clarify the lien claimants, the evidentiary record, and the reasons for any future decision.

WCABReconsiderationLien ClaimantsSupplemental Findings and OrderReasonable and Necessary TreatmentIndustrial InjuryPermanent DisabilityReport and RecommendationEvidentiary RecordLabor Code § 5313
References
0
Case No. ADJ338022 (VNO 0469583)
Regular
Feb 05, 2009

FERMIN ANTONIO AMAYA vs. JOAQUIN VARGAS FLORES, UNINSURED EMPLOYERS FUND, JOANNE L. CORDOVA, FIRE INSURANCE EXCHANGE

The Appeals Board granted reconsideration for the Uninsured Employers Fund (UEF) to clarify findings regarding the applicant's employment status and the UEF's involvement. The WCJ's prior decision rescinded a supposed dismissal of UEF and found the applicant was not an employee of the homeowner, but the record lacked clarity on these points. The Board found the WCJ's decision lacked sufficient factual basis and legal reasoning required by statute. Therefore, the matter was returned to the trial level for further proceedings and a new decision.

Uninsured Employers FundReconsiderationAmended Findings and AwardJurisdictionCompromise and ReleaseDismissalHomeownerEmployeeLabor Code 3352(h)Lien Claimants
References
2
Case No. ADJ9290189
Regular
Aug 07, 2014

CAROL GOLD vs. GROFF & LEVY INSURANCE BROKERS, EMPLOYER'S COMPENSATION INSURANCE COMPANY

The applicant sought reconsideration of a WCJ's decision denying benefits for injuries sustained at work, alleging error in crediting defense testimony and denying rebuttal evidence. The Appeals Board granted reconsideration to amend the WCJ's order, but otherwise affirmed the decision. The Board found no basis to disturb the WCJ's credibility determination that the applicant's fall did not result in an industrial injury compensable under Labor Code section 3600(a)(5). The Board corrected the order to remove the dismissal of the application, as such dismissal was procedurally improper.

WCABPetition for ReconsiderationFindings and OrderAdministrative Law JudgeGroff & Levy Insurance BrokersEmployer's Compensation Insurance CompanyJanuary 162014Injury arising out of and in the course of employmentIntentionally self-inflicted
References
1
Case No. ADJ8237248
Regular
Feb 21, 2014

ALBERTO PARRA vs. COSTA VIEW FARMS NO 2, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the WCJ's decision due to an inadequate trial record. Key issues include the defendant's contention that the claim is barred by Labor Code section 3600(a)(10) as retaliatory and by section 5400 for late reporting, as well as the WCJ's failure to properly admit and consider evidence like a video. The Board found the record unclear regarding the types of injury claimed and the basis for the WCJ's findings, necessitating a return to the trial level for further proceedings and a clarified decision.

WCABReconsiderationLabor Code 3600(a)(10)Statute of Limitations 5400Industrial InjuryCumulative TraumaSpecific InjuryIndependent Medical EvaluatorBurden of ProofPost-Termination Defense
References
1
Case No. ADJ3770794 (MON 0325184)
Regular

KATHRYN MOSS vs. VIVENDI/UNIVERSAL (UNIVERSAL MUSIC GROUP), AMERICAN HOME ASSURANCE COMPANY, CHARTIS

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for reconsideration, rescinded the previous Findings and Award, and returned the case for a new decision. The WCAB found that the original decision by the Workers' Compensation Judge (WCJ) failed to adequately reference specific evidence and failed to provide a sufficient basis for its findings on permanent disability and apportionment. Additionally, the WCAB determined that the attorney's fee award lacked proper explanation and calculation. The matter is to be returned to the WCJ to issue a new decision that fully complies with legal requirements, particularly Labor Code section 5313.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationIndustrial InjuryPermanent DisabilityApportionmentFibromyalgiaIrritable Bowel Syndrome (IBS)Skin DisorderNeurodermatitis
References
10
Case No. ADJ7191867
Regular
Mar 23, 2012

ARTURO ESCOBAR vs. HENRY WINE GROUP dba ZEPHYR EXPRESS, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision because the WCJ's imposition of a 20% penalty for delayed payment did not adequately explain the penalty amount based on established legal factors. While a delay in payment was found, the Board remanded the case for the WCJ to re-evaluate penalties and interest by clearly applying factors from relevant case law and justifying the awarded amounts with specific evidence. The original decision also failed to separately address statutory interest owed on the delayed payment. The Board emphasized the need for decisions to articulate the evidentiary basis and reasoning for penalty assessments.

Labor Code section 5814Petition for ReconsiderationFindings and AwardWCJZurich American Insurance CompanyArturo EscobarHenry Wine GroupZephyr ExpressCompromise & Releasepenalty
References
7
Case No. ADJ8241985
Regular
Dec 06, 2018

Juan Cortez vs. Cortez Construction, State Compensation Insurance Fund

The Workers' Compensation Appeals Board (WCAB) reconsidered an applicant's petition after an initial award. The Board amended the original Findings and Award to defer a decision on the applicant's claimed left hip injury due to insufficient grounds presented by the WCJ. The WCAB increased the applicant's permanent disability rating to 18% and found no legal basis for apportionment. This decision was based on a review of conflicting medical reports and the WCJ's failure to adequately support the original findings.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent Disability RatingApportionmentMedical EvidenceSubstantial EvidencePQMEAMELeft Hip Injury
References
1
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