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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ7016413
Regular
Jun 24, 2010

KEITH TRIGG vs. ASPLUNDH TREE EXPERT COMPANY, LIBERTY MUTUAL FIRE INSURANCE COMPANY

The Appeals Board granted defendant's petition for removal, rescinding the WCJ's order to obtain medical records. The Board found no abuse of discretion in the WCJ's decision to submit the case for decision on the existing record, emphasizing that parties presented witnesses and appeared satisfied with their evidence. The Board reasoned that the WCJ observed witness demeanor and credibility, and no reason existed to believe a determination could not be made on the presented testimony. The case was returned to the WCJ for submission on the current record.

Petition for RemovalWorkers' Compensation Appeals BoardWCJIndustrial InjuryMedical RecordsTrial StrategyDiscoveryLabor Code Section 5502(c)(3)Labor Code Section 5701Labor Code Section 5906
References
Case No. ADJ9178187
Regular
Mar 22, 2018

VICENTE IVAN GARCIA DIAZ vs. AUBERGE DU SOLEIL, HARTFORD INSURANCE COMPANY OF THE MIDWEST, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted reconsideration, rescinded the WCJ's order dismissing the case, and returned the matter for further proceedings. The Board found that the applicant, who claimed incarceration and mental health issues prevented his appearance, was entitled to a hearing to determine if there was good cause to set aside the dismissal. The WCJ incorrectly believed they lacked jurisdiction to revisit the dismissal order. The applicant's due process rights require an opportunity to present evidence and testimony regarding the dismissal.

Petition for ReconsiderationOrder Dismissing CaseFailure to AppearIncarcerationMental HealthDue ProcessFair HearingWCJ DutySet Aside DismissalJurisdiction to Vacate
References
Case No. ADJ7264010, ADJ7498085
Regular
Mar 16, 2017

SANDRA CATLIN vs. J.C. PENNEY, INC., AMERICAN HOME ASSURANCE CO.

This case involves a defendant's petition for removal of a WCJ's order requiring the applicant to undergo a treatment consultation with an Agreed Medical Evaluator (AME) under Labor Code § 4050 and directing the defendant to provide a nurse case manager. The defendant argued that § 4050 grants them the right to select a physician for examination and that the AME consultation order was improper, as was the indefinite appointment of a nurse case manager. The Appeals Board granted the petition for removal, affirming the WCJ's orders except for the AME re-evaluation, which was deferred due to a lack of statutory basis and evidence presented. The Board found that § 4050 has been largely subsumed by more specific statutes governing medical evaluations and treatment disputes.

Petition for RemovalAgreed Medical Evaluator (AME)Labor Code § 4050Nurse Case ManagerMedical TreatmentUtilization Review (UR)Compromise and Release (C&R)Declarations of Readiness to Proceed to Expedited Hearing (DOR)Medical ExaminationQualified Medical Examination
References
Case No. ADJ7709362
Regular
Dec 05, 2011

Gloria Kudelko vs. UNITED SERVICES AUTOMOBILE ASSOCIATION, HARTFORD INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case involves a defendant's petition for removal and reassignment of a Workers' Compensation Appeals Board matter. The defendant sought removal of an order from August 9, 2011, which scheduled trial, ordered a claims adjuster to appear, and ordered her to show cause for failing to appear at a prior conference. The Board granted the petition, rescinded the August 9, 2011 order, and returned the case for reassignment to a different WCJ for trial. The Board also stated the current WCJ should proceed with the sanctions issue, allowing the adjuster an opportunity to show good cause for her non-appearance.

Petition for RemovalWCJ SanctionClaims Adjuster AppearanceReassignment WCJMandatory Settlement ConferenceShow Cause OrderIndustrial InjuryWCAB Rule 10453Interlocutory OrderPetition for Reassignment
References
Case No. ADJ1122368 (SJO 0223390)
Regular
Mar 24, 2015

MINH LY vs. LORAL SPACE SYSTEMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for RELIANCE NATIONAL INDEMNITY COMPANY, in liquidation

The Appeals Board granted removal and rescinded the WCJ's order taking the case off calendar, holding that the applicant is entitled to an expedited hearing regarding the denial of Lyrica prescription refills. The WCJ erred by prematurely determining that utilization review (UR) was timely and jurisdictionally barred further proceedings, without allowing evidence and a hearing. The Board emphasized that the applicant has a right to an expedited hearing to contest UR decisions, challenge their applicability, or present evidence of changed circumstances. The case was returned to the trial level for an expedited hearing and a new decision based on the record.

Utilization ReviewIndependent Medical ReviewPetition for RemovalExpedited HearingOrder Taking Case Off CalendarPrescription MedicationLyricaDue ProcessLabor Code Section 5310Dubon II
References
Case No. ADJ7027968, ADJ5681902, ADJ7028675
Regular
Jul 31, 2014

Satbir Singh vs. Cardinal Freight Fleet, Clarendon National Insurance Company, Protective Insurance Company, SS Delivery, Van Liner Insurance Company

This case involves multiple workers' compensation claims filed by applicant Satbir Singh against various defendants, including Cardinal Freight Fleet and its insurers Clarendon National and Protective Insurance Company. The Workers' Compensation Appeals Board (WCAB) is reconsidering prior decisions by the Administrative Law Judge (WCJ). The WCAB has rescinded and substituted decisions for two cases (ADJ7028675 and ADJ5681902), deferring issues of insurance coverage, contribution/apportionment between defendants, and credit for third-party recovery. These deferred issues will be returned to the trial level for further proceedings and decisions by the WCJ. The WCAB affirmed the WCJ's decision in a third case (ADJ7027968) in its entirety.

ReconsiderationWCJApportionmentContributionInsurance CoverageThird Party RecoveryPermanent DisabilityTemporary Total DisabilitySelf-Procured TreatmentDeferred Issues
References
Case No. ADJ3015096 (STK 0200853)
Regular
Dec 10, 2009

SANDRA CONCEPCION vs. TRAVIS UNIFIED SCHOOL DISTRICT, NORTH BAY SCHOOLS INSURANCE AUTHORITY

Reconsideration granted for petition to disqualify WCJ and for Finding and Order of October 12, 2009 requiring payment of $23,165.00. WCJ to issue Report detailing evidence supporting decision.

Petition for ReconsiderationDisqualification of WCJFinding and OrderDue ProcessSubstantial EvidenceNotice of IntentionOpinion on DecisionReport and RecommendationWorkers' Compensation Appeals BoardDecision After Reconsideration
References
Case No. ADJ9070475
Regular
Dec 15, 2017

CARTO GROZCO vs. SUNSET MASONRY & CONCRETE, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for TOWER CASTLEPOINT INSURANCE

Radiology Disc of Encino's petition for reconsideration is dismissed because it was not filed from a final order. The Appeals Board grants removal, rescinds the previous order, and returns the case to the trial level. This allows Radiology Disc an opportunity to argue its jurisdiction and present evidence regarding its medical-legal services. The WCJ should have adjudicated jurisdiction rather than taking the case off calendar.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalOff-Calendar OrderFinal OrderSubstantive RightInterlocutory OrderMedical-Legal Expense DisputeWCJRemoval Granted
References
Case No. ADJ3180407 (LAO 0785803)
Regular
Nov 10, 2008

Carl Brewer vs. CAPITAL REPROGRAPHICS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for VILLANOVA INSURANCE, In Liquidation

This case concerns CIGA's petition for reconsideration of a WCJ's award of penalties for various payment failures, including attorney fees, home health care, and a case management nurse. CIGA argues these penalties are not "covered claims" under its statutory exemption. The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level due to a missing case file.

CIGAVillanova InsurancePenaltiesAttorneys FeesHome Health CareGuardian Ad LitemCase Management NurseInsurance Code Section 1063.1(c)(8)Covered ClaimsReconsideration
References
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