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

Case No. 1:08-CV-0164
Regular Panel Decision

Ruggles v. WellPoint, Inc.

Plaintiffs, including named individuals Fay Ruggles, Maurice Billman, Karen Hawkins, Harriet Childress, and Nancy Coleman, initiated a collective action against Wellpoint, Inc., alleging violations of the Fair Labor Standards Act and New York Labor Law for unpaid overtime. The plaintiffs sought to amend their complaint to incorporate additional class action claims under California and Illinois state laws and requested approval for ten consent forms filed after the court-imposed deadline. Defendant Wellpoint opposed both motions, citing undue delay and potential prejudice. The United States Magistrate Judge granted both motions, finding no bad faith or significant undue prejudice to the defendant, and emphasized judicial economy in consolidating related state law claims and allowing the late opt-ins.

FLSAOvertime CompensationWage and HourCollective ActionClass Action CertificationMotion PracticePleadings AmendmentJudicial DiscretionPrejudice AnalysisEquitable Tolling
References
31
Case No. ADJ9031976
Regular
Jul 10, 2017

MARTHA CORDERO vs. WELLPOINT, ZURICH NORTH AMERICA

This case involves an applicant seeking reconsideration of a workers' compensation award. The original award allowed treatment outside the defendant's medical provider network (MPN) for neck and bilateral upper extremities injuries. The applicant contended the award should also include treatment for fibromyalgia, which was stipulated as a work-related injury. The Appeals Board granted reconsideration, adopting the judge's recommendation to amend the award to include fibromyalgia, thus affirming the original decision with this correction. The Board also admonished the applicant's counsel for procedural non-compliance with filing rules.

Workers' Compensation Appeals BoardMedical Provider NetworkMPNPetition for ReconsiderationFindings of FactOpinion on DecisionAdministrative Law JudgeWCJFibromyalgiaStipulations
References
1
Case No. ADJ9589089
Regular
Sep 28, 2018

Ellen Deubner vs. Wellpoint, Zurich North America

The Workers' Compensation Appeals Board denied Ellen Deubner's Petition for Removal. Removal is an extraordinary remedy that requires a showing of substantial prejudice or irreparable harm. The Board found that Deubner failed to demonstrate either, and that reconsideration would be an adequate remedy if an adverse decision is ultimately issued. Therefore, the petition for removal was denied.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportsubstantial prejudiceirreparable harmreconsiderationadequate remedyextraordinary remedydenial of removalcase ADJ9589089
References
2
Case No. ADJ1156815 (OXN 0136421)
Regular
Jul 16, 2013

MARIA WARREN vs. WELLPOINT, INC.; ZURICH NORTH AMERICA

This case concerns an applicant's industrial injury to her back and psyche. The primary dispute was over two lien claims for medical-legal evaluation and interpretation services. After the defendant sought reconsideration regarding the initial award, the parties settled the medical-legal lien claim, rendering it moot. The Board affirmed the finding of industrial injury to the psyche and remanded the interpreter services lien claim for parties to adjust the amount, reserving jurisdiction.

Workers' Compensation Appeals BoardIndustrial InjuryBack InjuryPsyche InjuryMedical-Legal EvaluationLien ClaimInterpretation ServicesPenaltyInterestReimbursement
References
1
Case No. ADJ2973393 (LAO 0883929)
Regular
Mar 27, 2014

CLEVETTE THOMAS vs. WELLPOINT, INC.; ZURICH NORTH AMERICA

The Workers' Compensation Appeals Board granted reconsideration to a lien claimant seeking reimbursement for a Functional Capacity Evaluation (FCE). The Board found sufficient evidence that the FCE was requested by the applicant's primary treating physician, Dr. Mays, despite the lack of formal designation. The Board also noted the defendant's failure to respond to the authorization request for the FCE. Ultimately, the Board rescinded the judge's denial and ordered reimbursement for the lien claimant's services.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and OrdersAdministrative Law JudgeFunctional Capacity Examination (FCE)Primary Treating PhysicianReimbursementCompromise and Release AgreementCumulative Trauma Injury
References
0
Case No. ADJ1245384 (VNO 0361404)
Regular
Jul 27, 2009

Lenard E. Taylor vs. WELLPOINT HEALTH NETWORKS, INC., CIGA

The Workers' Compensation Appeals Board (WCAB) affirmed a finding that Lenard Taylor sustained a cumulative trauma injury to multiple conditions, including psychological impairment, resulting in 100% permanent disability. While the WCAB agreed with the original judge's findings regarding the injury and benefits, it rescinded a $2,500 sanction imposed on the defendant. The Board determined that the sanction under Labor Code §5813 was improperly applied to penalize delays in benefit payments, as that section is intended to address litigation abuses, not payment delays.

Workers Compensation Appeals BoardReconsiderationCumulative Trauma InjuryAggravation of DiabetesAggravation of HypertensionAggravation of Cardiovascular DiseaseAggravation of GERDAggravation of EyesPsychological ImpairmentMajor Depressive Episode
References
2
Case No. ADJ2719991 (VNO 0485134) ADJ1334047 (VNO 0428744)
Regular
Aug 20, 2009

Catalina Barajas vs. WELLPOINT HEALTH NETWORK, INC., ZURICH LOS ANGELES

This case involves an applicant who initially sustained a cumulative trauma injury to her upper extremities during a period covered by one insurer. After returning to work with modified duties, she experienced a recurrence and worsening of symptoms, necessitating further treatment and surgery, which the Board now recognizes as a separate cumulative trauma injury. The Workers' Compensation Appeals Board granted reconsideration, reversing the prior finding of a single cumulative trauma injury. The Board held that distinct periods of compensable temporary or permanent disability, as established by medical evidence and treatment, demarcate separate cumulative trauma injuries, aligning with the *Rodarte* precedent. Consequently, the applicant was found to have sustained two separate cumulative trauma injuries, each attributed to different insurance coverage periods.

cumulative traumaanti-merger doctrineLabor Code sections 3208.25303Rodartecompensable temporary disabilitypermanent disabilitywage lossmodified workbilateral upper extremities
References
3
Case No. ADJ2470044
Regular
Oct 04, 2010

PATRICIA COSTA vs. WELLPOINT, INC., ZURICH NORTH AMERICA - LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration of a lien claimant's petition because the claimant alleged fraud in the settlement of his lien, claiming he was not a party to the agreement. The Board found the record unclear regarding which specific liens were resolved and noted significant procedural issues, including potential name confusion and inadequate service. Due to these ambiguities and due process concerns, the case was returned to the trial level for further development of the record. This action ensures the lien claimant receives proper notice and an opportunity to present their claim on the merits.

Lien claimantPetition for reconsiderationFraudulent procurementStipulation and orderWorkers' compensationAdministrative law judgeReconsiderationTrial levelFurther developmentMedical lien
References
4
Case No. BAK 144423
Regular
Nov 13, 2007

Martha Gallegos vs. WELLPOINT HEALTH NETWORKS, ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, reversing the prior award of temporary disability indemnity for Martha Gallegos after June 4, 2004. The Board found that Gallegos' resignation was due to her extended commute, not her industrial injury, thus disqualifying her from further temporary disability benefits. However, the Board affirmed the finding of 17% permanent disability, finding the treating physician's reports substantial evidence despite the defendant's arguments.

Workers Compensation Appeals BoardIndustrial InjuryCarpal TunnelUpper ExtremitiesTemporary Disability IndemnityPermanent DisabilityEmployment Development DepartmentReconsiderationMedical CareQualified Medical Examiner
References
15
Case No. ADJ2038754 [VNO434607]
Regular
Sep 08, 2008

LYNDON VARGAS-MACHUCA vs. WELLPOINT HEALTH NETWORK, ZURICH NORTH AMERICA CLAIMS

The WCAB granted reconsideration and apportioned applicant’s psychiatric disability (20%) based on Dr. Lustig’s opinion, resulting in a 44% permanent disability rating.

Workers' Compensation Appeals BoardReconsiderationAmended Findings and AwardClerical AssistantPsychiatric InjuryCumulative TraumaApportionmentPermanent DisabilityMedical CareHostile Work Environment
References
10
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