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Case Law Database

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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ3525697 (LAO 0534774) ADJ2342373 (LAO 0512482) ADJ1310306 (LAO 0568035) ADJ2645702 (LAO 0519888) ADJ1384751 (LAO 0568036) ADJ2871875 (ANA 0235799)
Regular
Feb 03, 2017

ALICE BRYANT vs. REGENTS OF THE UNIVERITY OF CALIFORNIA, permissibly self-insured, UCLA MEDICAL CENTER; SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves applicant Alice Bryant's petition for reconsideration of prior dismissed workers' compensation claims and a Labor Code section 132a retaliation claim. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, upholding the administrative law judge's findings. The WCAB concluded that Bryant's claims were previously dismissed, with some dismissed by her own request and others for failure to prosecute. Furthermore, the WCAB found that Bryant failed to demonstrate extrinsic fraud and lacked the required diligence to reopen these final dismissals, even with newly discovered evidence.

Workers' Compensation Appeals BoardRegents of the University of CaliforniaSedgwick Claims Management ServicesPetition for ReconsiderationFindings and OrdersWorkers' Compensation Administrative Law JudgeLabor Code section 132aRetaliation claimExtrinsic fraudDismissed claims
References
Case No. ADJ1282419 (LAO 0846452) ADJ915214 (LAO 0854736)
Regular
Feb 01, 2010

VALERIE VANCE DILLON vs. TJ MAXX, CNA CLAIMS PLUS

This case involves a Compromise and Release agreement between the applicant and defendants. The Board granted reconsideration, rescinded the prior decision, and returned the matter to the trial level. This action is contingent on the workers' compensation administrative law judge approving the settlement. If not approved, the original decision could be reinstated, with the right to seek reconsideration.

Compromise and ReleasePetition for ReconsiderationGrant ReconsiderationRescind DecisionTrial LevelWorkers' Compensation Appeals BoardAdministrative Law JudgeSalvage and ClaimsSalvage and ClaimsSalvage and Claims
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ9030735
Regular
Jul 08, 2014

HECTOR CASILLAS vs. XERXES CORPORATION, BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board denied Xerxes Corporation's Petition for Removal. The Board found that while the defendant raised legitimate concerns about potential fraud, these issues were not relevant to the applicant's current claim. The Board adopted the administrative law judge's report, concluding that the evidence presented did not support a fraudulent claim and the forum was not appropriate for addressing concerns about running, capping, and steering. Therefore, the petition was denied.

Petition for RemovalWorkers' Compensation Appeals Boardrunningcappingsteeringfraudulent claimadministrative law judge reportADJ9030735Xerxes CorporationBroadspire Claims Services
References
Case No. MNKOI 0000714498
Regular
Jul 03, 2018

SALVADOR MOTA vs. BOSKOVICH FARMS, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION

The Workers' Compensation Appeals Board denied CIGA's petition for reconsideration regarding a lien claim. CIGA argued the lien was barred by Insurance Code section 1063.1(c)(9) because the claimant, VQ Ortho/Vision Quest Industries, Inc. (VQ), was an assignee. However, the Board found VQ was the original claimant who had temporarily assigned and then reassigned the claim back to itself. This allowed VQ to assert the lien as the original provider of services, consistent with the legislative intent of CIGA to protect original claimants.

CIGACovered ClaimInsurance Code 1063.1(c)(9)AssigneeOriginal ClaimantLien ClaimReconsiderationWCABWCJVQ Ortho/Vision Quest Industries
References
Case No. ADJ656822 (RIV 0015821)
Regular
May 08, 2012

WILLIAM WEBB vs. SID STONE CONSTRUCTION COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For CALIFORNIA COMPENSATION INSURANCE COMPANY, In Liquidation

This case concerns CIGA's liability for lien claims from Coast Plaza Doctors Hospital and Valley Plaza Doctors Hospital. CIGA argued it was not obligated to pay because the hospitals "assigned" their claims to Innovative Medical Management for collection, which CIGA contends is an excluded claim under Insurance Code section 1063.1(c)(9)(B). The Board affirmed the WCJ's finding that no true legal assignment occurred, as Innovative was merely hired for collection services and the hospitals retained ownership and control. Therefore, the lien claims were not excluded from coverage as assignee claims.

CIGAassigned claimlien claimantchose in actionlegal titleInnovative Medical ManagementWCABcompromise and releaseworkers compensationsubrogation
References
Case No. ADJ4014154 (ANA 0408143)
Regular
Jun 19, 2009

JUAN LOPEZ vs. LIBERTY GLASS FABRICATORS, INC., AMERICAN HOME ASSURANCE COMPANY

This case involves a worker claiming a back injury on October 1, 2007, but reporting it on October 5, 2007, the same day his employment was terminated. The employer contends the claim is barred under Labor Code section 3600(a)(10) as a post-termination claim, arguing the worker's notice of injury was not provided prior to termination. The Appeals Board granted reconsideration, reversed the initial award, and found the claim non-compensable, ruling the worker failed to provide timely notice of the injury before his termination. The Board emphasized the purpose of section 3600(a)(10) is to prevent spurious claims filed after termination.

Labor Code section 3600(a)(10)Post-termination claimReconsiderationFindings and AwardCompensable industrial injuryLaborerLiberty Glass FabricatorsAmerican Home Assurance CompanyWorkers' Compensation Appeals BoardWCJ Report and Recommendation
References
Case No. ADJ6736069 ADJ6736155 ADJ7147776
Regular
Jul 07, 2010

YVETTE WHITMER vs. HI SHEAR CORPORATION, ZURICH NORTH AMERICA, GOLDEN STATE FOODS, LIBERTY MUTUAL, SANTA BARBARA APPLIED RESEARCH

This case involves Yvette Whitmer's claims for back injuries allegedly sustained on May 1, 2008, and June 13, 2008. The defendant, Hi Shear Corporation, sought reconsideration of the initial findings, arguing the claims were non-compensable post-termination claims under Labor Code section 3600(a)(10). The Appeals Board granted reconsideration, finding that Whitmer failed to provide timely notice of her injuries to the employer prior to her termination on June 23, 2008. Consequently, her claims were barred, and she was awarded no benefits.

Labor Code section 3600(a)(10)post-termination claimscompensable industrial injuriesWCJreconsiderationFindings of Factregional managerZurich North AmericaLiberty Mutualarising out of and in the course of employment
References
Case No. ADJ4593512 (AHM077352)
Regular
Jul 12, 2010

FRANCISCO ENRIQUEZ vs. DOUGLAS FURNITURE OF CALIFORNIA, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, BROADSPIRE

The WCAB granted CIGA's petition for reconsideration to address its contention that the administrative law judge (WCJ) erred in finding a medical lien constituted a "covered claim" under Insurance Code § 1063.1(c). Although the WCJ ultimately disallowed the lien because its reasonable value had been paid, CIGA argued that the "covered claim" finding created potential collateral estoppel issues. Finding these findings irrelevant to the ultimate resolution, the WCAB amended the original order to delete the specific findings regarding the "covered claim" status. The WCAB affirmed the disallowance of the remaining lien balance.

CIGACalifornia Insurance Guarantee AssociationReconsiderationLien ClaimCovered ClaimInsurance Code § 1063.1(c)Findings and OrderWCJTorrance Memorial Medical CenterAssignment for Collection
References
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