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Case Law Database

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

Case No. ADJ7643460 ADJ8909733
Regular
Jan 03, 2020

Tracy Lee vs. XCHANGING, GRANITE STATE INSURANCE

The Workers' Compensation Appeals Board (WCAB) denied applicant Tracy Lee's multiple Petitions for Removal, adopting the reasoning of the workers' compensation judge. The WCAB admonished the applicant that repetitive, meritless filings may lead to a declaration as a vexatious litigant under WCAB rule 10782. This rule outlines criteria for identifying and restricting such litigants, including those who repeatedly relitigate determined issues or file unmeritorious motions. The applicant's continued filings without apparent merit have resulted in this denial and a warning against further vexatious conduct.

Petitions for RemovalVexatious LitigantPropria PersonaMeritless FilingsHarassmentDelayPrefiling OrderReopeningLabor CodeWCJ Reports
References
0
Case No. ADJ5761209
Regular
Sep 20, 2010

RICHARD PADGETT vs. AON CORPORATION, CAMBRIDGE/XCHANGING

The Workers' Compensation Appeals Board (WCAB) granted the defendant Aon Corporation's petition for reconsideration of an administrative law judge's findings. This decision was made to allow for a more thorough review of the case's factual and legal issues. Additionally, the WCAB granted the defendant's request to file a supplemental brief within 15 days. All future correspondence regarding this case should be directed to the WCAB's Office of the Commissioners.

ADJ5761209Petition for ReconsiderationFindings of FactSupplemental BriefAppeals Board Rule 10848Decision After ReconsiderationOffice of the Commissioners
References
0
Case No. ADJ814222 (MON 0256079) ADJ855629 (MON 0236639) ADJ302781 (MON 0236638)
Regular
Jun 23, 2010

JEROME KELLMAN vs. CROSSROADS SCHOOL, XCHANGING/ CIGA for FREMONT COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of an order finding CIGA solely liable for temporary disability benefits for the period of July 25, 2007, to December 18, 2008. The Board adopted the WCJ's reasoning that there was no jurisdiction to order State Compensation Insurance Fund (State Fund) to pay these benefits, as the need for temporary disability did not commence within five years of State Fund's insured injuries. The Board also admonished the applicant for submitting unadmitted evidence and CIGA for attaching documents in violation of WCAB rules. The WCJ found CIGA solely responsible, rejecting arguments that State Fund was jointly liable or that the temporary disability should have commenced earlier.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCAB Rule 10842Administrative Law JudgeTemporary DisabilityPetition to ReopenNew and Further DisabilityState Compensation Insurance FundCalifornia Insurance Guarantee AssociationFremont Compensation Insurance Company
References
1
Case No. ADJ6698865
Regular
Aug 12, 2010

VALENTINO VILLALPANDO vs. CINTAS CORPORATION, INC., XL SPECIALTY INSURANCE Administered By CAMBRIDGE/XCHANGING

The Workers' Compensation Appeals Board denied Cintas Corporation's Petition for Reconsideration and Removal. The Board affirmed the finding that the applicant needs further medical treatment but clarified that this does not preclude future challenges to specific treatment. The Board also upheld the striking of the QME report due to procedural violations by the defendant, including failure to provide a log of records and a Spanish interpreter. Consequently, the defendant's challenges to the QME report and orders regarding Dr. Bogerty's evaluation were also denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalFurther Medical Treatment (FMT)Utilization ReviewMedical Provider Network (MPN)Qualified Medical Evaluator (QME)Medical UnitDr. SoongDr. Bogarty
References
0
Case No. ADJ7643460
Regular
May 01, 2017

Tracy Lee vs. XCHANGING, GRANITE STATES INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case concerns Defendant's Petition for Removal seeking a new Qualified Medical Evaluator (QME) panel due to a QME's untimely supplemental report. The Appeals Board denied the petition, finding Defendant failed to demonstrate substantial prejudice or irreparable harm. While the QME's report was late, Labor Code Section 4062.5 and Rule 31.5(a)(12) do not mandate replacement for untimely supplemental reports, making the decision discretionary. The WCJ's decision not to order a replacement was reasonable given the QME's extensive involvement and the lack of a mandatory replacement provision.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorQME panelsupplemental reportuntimelysubstantial prejudiceirreparable harmLabor Code section 4062.5Rule 31.5(a)(12)
References
5
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
18
Case No. ADJ1256092 (VNO 0458544)
Regular
Oct 07, 2011

MARIA TOLEDO vs. WELLPOINT HEALTH NETWORK INC, CIGA for FREMONT in liquidation, administered by XCHANGING, ZURICH AMERICAN INSURANCE

This case involves Zurich American Insurance seeking reconsideration of a decision that extended applicant Maria Toledo's cumulative trauma injury period to November 1, 2001, placing liability on Zurich. Zurich argued the injury date should be December 2000, during Fremont/CIGA's coverage, as medical evidence, including the Agreed Medical Examiner (AME) Dr. Sohn's reports, allegedly only supported exposure until that earlier date. The Board denied reconsideration, affirming that the AME found the totality of applicant's employment duties, including those as a sales assistant after a job change, contributed to her cumulative trauma until November 1, 2001. Therefore, Zurich remains liable for the injury.

Cumulative traumaDate of injuryPeriod of injurious exposureLabor Code section 5412Section 5500.5Agreed Medical Examiner (AME)Dr. Roger SohnMedical evidenceZurich North AmericaFremont Compensation Insurance
References
1
Case No. ADJ865164 (AHM 0127447)
Regular
Mar 22, 2011

DARRIEN GORDON vs. OAKLAND RAIDERS, PACIFIC EMPLOYERS INSURANCE COMPANY, XCHANGING, INC., ATLANTA FALCONS, ST PAUL TRAVELERS

This case concerns a professional football player's cumulative trauma injury claim. The Workers' Compensation Appeals Board granted reconsideration to correct an arbitrator's apportionment of liability. The Board found that under Labor Code section 5500.5, liability should be based on employment within the one year preceding the date of injury. Consequently, Travelers Indemnity, as insurer for the Atlanta Falcons, was ordered to reimburse the Oakland Raiders for 4% of benefits paid, reflecting the Falcons' minimal employment during the last year of injury. This reversed the original award which had apportioned liability at 39%.

Cumulative TraumaProfessional Football PlayerDate of InjuryLast Year of EmploymentApportionment of LiabilityContinuous TraumaOccupational DiseaseInsurer LiabilityContribution ClaimWorkers' Compensation Appeals Board
References
0
Case No. ADJ1737228 (LBO 0307803)
Regular
Aug 30, 2010

THOMAS MATHENY vs. CATALINA WATER COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION Administered By XCHANGING For FREMONT INSURANCE COMPANY, In Liquidation

The California Workers' Compensation Appeals Board granted reconsideration of an order directing the defendant to pay a lien due to defective service. The defendant argued it did not receive notice of the lien claim or the order until after the deadline to object, thus being denied due process. The Board found issues with case number referencing and service of the Notice of Intention to Pay Lien, noting the defendant had not had a proper opportunity to present its defense. Consequently, the Board rescinded the order and returned the matter for further proceedings.

Workers' Compensation Appeals BoardPetition for ReconsiderationOrder to Pay LienNotice of Intention to Pay LienCompromise and ReleaseLabor Code Section 5903Official Address RecordCalifornia Insurance Guarantee AssociationLiquidationElectronic Adjudication Management System
References
0
Case No. ADJ865164 (AHM0127447)
Regular
Jun 13, 2011

DARRIEN GORDON vs. OAKLAND RAIDERS, PACIFIC EMPLOYERS INSURANCE COMPANY, XCHANGING, INC., ATLANTA FALCONS, ST. PAUL TRAVELERS

The Appeals Board granted reconsideration and vacated its prior decision because the insurer for the Atlanta Falcons' petition for reconsideration of the original arbitrator's award was untimely filed. The Board found that the petition was received and electronically filed after the statutory deadline. Therefore, the Board rescinded its March 22, 2011 decision and dismissed the Falcons' untimely petition. This ruling effectively reinstates the original arbitrator's award concerning employer liability for applicant Darrien Gordon's workers' compensation claim.

Darrien GordonOakland RaidersPacific Employers Insurance CompanyXchanging Inc.Atlanta FalconsSt. Paul TravelersDarrien GordonDarrien GordonDarrien GordonDarrien Gordon
References
5
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