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

Case No. ADJ10232182
Regular
Jul 07, 2017

JOSE SAENZ vs. WILLIAM STOESSER, CLAIRE WERNER, REBECCA B. PISCITELLI 2012 SPECIAL TRUST DATED 12/21/2012, ADAM W. BUCK 2012 SPECIAL TRUST Dated 12/21/2012, BENJAMIN C. BUCK 2012 SPECIAL TRUST Dated 12/21/2012, STATE FARM INSURANCE

This case involves a workers' compensation claim where the applicant, Jose Saenz, was injured on April 10, 2015. State Farm sought reconsideration of an arbitrator's finding that four of its insurance policies provided coverage. The Appeals Board granted reconsideration, finding the arbitrator's coverage determination premature. The Board rescinded the prior order and returned the matter to the trial level for a determination of who constitutes the applicant's employer(s) before insurance coverage issues can be addressed.

Workers Compensation Appeals BoardPetitions for ReconsiderationDecision After ReconsiderationWilliam StoesserClaire WernerRebecca B. Piscitelli 2012 Special TrustAdam W. Buck 2012 Special TrustBenjamin C. Buck 2012 Special TrustState Farm InsuranceHomeowner's Policy
References
Case No. ADJ1040857
Regular
Feb 24, 2014

IRENE CHAVEZ vs. SOUTHERN CALIFORNIA AUTO AUCTION, BROADSPIRE

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board adopted the Administrative Law Judge's (ALJ) report, which found no violation of Labor Code section 132a. The ALJ credited the testimony of defense witnesses regarding the applicant's attendance issues and the employer's policies. The applicant failed to prove she was treated differently or suffered disadvantages due to her work-related injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportGarza v. Workmen's Comp. Appeals Bd.LC 132a violationcredibility findingattendance policyterminationdepositionsecurity video
References
Case No. ADJ3566620 (SBR 0331934) ADJ3758235 (SBR 0336076)
Regular
Jun 01, 2009

MELANIE MEDBERY vs. PAYLESS SHOE SOURCE, INC.

The Workers' Compensation Appeals Board denied Payless Shoe Source's petition for reconsideration. The Board upheld the finding that the applicant sustained an industrial injury to her right knee and lower extremity. Crucially, they affirmed the administrative law judge's determination that Payless violated Labor Code section 132a by unlawfully terminating the applicant. The employer's stated reason for termination, a violation of the attendance policy, was deemed pretextual and not supported by the evidence or the company's own handbook.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryRight Knee InjuryRight Lower Extremity InjuryLabor Code Section 132aViolationDiscriminationDifferential Treatment
References
Case No. ADJ4639392 (SDO 0292761)
Regular
Aug 31, 2010

LISA FOWLER vs. AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA, LIBERTY MUTUAL

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior finding that Automobile Club of Southern California discriminated against Lisa Fowler under Labor Code section 132a. The Board found Fowler failed to establish a prima facie case of discrimination because her termination resulted from her failure to return to work after being released by her physician, in accordance with a uniformly applied company attendance policy. The employer's witness testified that work-related and non-work-related leaves were treated the same. Therefore, Fowler was not singled out for disadvantageous treatment compared to similarly situated employees.

Labor Code 132aDiscriminationReinstatementLost WagesWork BenefitsPrima Facie CaseAttendance PolicyUniformly AppliedTemporary DisabilityPermanent and Stationary
References
Case No. ADJ4629950
Regular
Dec 21, 2012

JOHNNY BETTENCOURT vs. DONALD WILLIAMS, SAFECO INSURANCE COMPANY, UNINSURED EMPLOYERS' BENEFIT TRUST FUND DEPARTMENT OF INDUSTRIAL RELATIONS

The Uninsured Employers' Benefit Trust Fund (UEBTF) sought reconsideration, arguing Safeco's policy covered the applicant's injury. The Arbitrator previously ruled Safeco had no liability as its policy with Donald Williams did not include "comprehensive personal liability" insurance as required by Insurance Code section 11590. The Appeals Board affirmed this decision, finding the Safeco policy explicitly limited coverage to premises liability and lacked the necessary language for comprehensive personal liability coverage. Therefore, Safeco was correctly found not liable for the applicant's injury.

Uninsured Employers' Benefit Trust Fundcomprehensive personal liability insuranceLabor Code section 3351(d)Labor Code section 3352(h)Insurance Code section 11590premises liability insuranceSafeco Insurance CompanyDonald WilliamsJohnny Bettencourtworker's compensation coverage
References
Case No. ADJ8517777
Regular
Oct 07, 2019

DOUGLAS ARONSON vs. WORLD LEAGUE OF AMERICAN FOOTBALL, LIBERTY MUTUAL INSURANCE, STATE COMPENSATION INSURANCE FUND, PHILADELPHIA EGLES, FAIRMONT PREMIER INSURANCE COMPANY

In *Aronson v. World League of American Football*, the Workers' Compensation Appeals Board denied a petition for reconsideration, upholding an arbitrator's finding. The core issue was whether the State Compensation Insurance Fund's (SCIF) policy covered all employees of the League injured within California's jurisdiction, or only those affiliated with the Sacramento Surge. The Board affirmed that standard workers' compensation policies cover all employees unless explicitly limited, and any ambiguity is resolved in favor of the insured. Therefore, SCIF's policy was interpreted to provide coverage for all League employees injured in California during the relevant period.

Workers' Compensation Appeals BoardPetition for ReconsiderationInsurance Policy InterpretationSCIF PolicyCalifornia JurisdictionAmbiguity Resolved Against InsurerGreatest CoverageArbitrator's DecisionFindings and AwardState Compensation Insurance Fund
References
Case No. ADJ8619480
Regular
Nov 22, 2019

MARCO MARTINEZ, vs. BRAM, LLC, aka VALLEY PROTEIN, LLC, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The WCAB rescinded an arbitrator's decision finding CIGA liable for benefits because the record lacked required findings, stipulations, and evidence, violating WCAB Rule 10566 and *Hamilton*. CIGA argued the policy was canceled due to the employer's failure to pay premiums, which the broker did not timely forward to the insolvent insurer. The Board noted that policy cancellation requires 10 days' written notice and that CIGA is not an insurer with the same responsibilities. The case is returned to the arbitrator to create an adequate record and issue a proper decision.

CIGAinsolvent insurerCastlepointpremium paymentpolicy cancellationauthorized agentWCAB Rule 10566Hamilton v. Lockheed Corp.arbitration recordfindings of fact
References
Case No. ADJ6865421
Regular
Sep 08, 2017

DAVID BERRIOS-SEGOVIA vs. EJ DISTRIBUTION CORPORATION, SOUTHERN INSURANCE COMPANY, MARKEL dba FIRST COMP, STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS, UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case returns to the Appeals Board after the Court of Appeal determined that the rescission of an insurance policy is subject to mandatory arbitration. The Court annulled the arbitrator's prior findings, ordering further proceedings to determine the legal effectiveness of the insurer's rescission. The insurer must prove the employer's misrepresentations were material and that rescission is not being used to circumvent policy approval requirements. The matter is remanded to the arbitrator for further proceedings and a new decision.

Workers' Compensation Appeals BoardRemittiturMandatory ArbitrationLabor Code Section 5275Policy RescissionMaterial MisrepresentationUninsured Employers Benefits Trust FundDepartment of InsuranceInsurance CommissionerPrior Approval
References
Case No. ADJ775111 (AHM 0115194)
Regular
Jun 14, 2010

JUAN VARONA vs. SOFTEX, INC./GRANITE STATE INSURANCE COMPANY as administered by AIG DOMESTIC CLAIMS, INC.

This case involves Granite State Insurance Company's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB upheld the arbitrator's finding that Softex, Inc. was a co-employer responsible for applicant Juan Varona's workers' compensation coverage for a roofing injury. Granite State's arguments, including collateral estoppel based on a prior civil case and contentions about policy coverage and cancellation, were rejected. The WCAB found insufficient grounds to overturn the original decision, denying Granite State's petition.

Workers' Compensation Appeals BoardSoftexGranite State Insurance CompanyAIG Domestic ClaimsCo-employment agreementRoofing workCollateral estoppelRescission of policyMaterial misrepresentationCo-employee coverage
References
Case No. ADJ11155531
Regular
Apr 01, 2020

PATRICK ALLEN vs. UNITED PARCEL SERVICE, LIBERTY MUTUAL INSURANCE CO.

The Workers' Compensation Appeals Board granted applicant's petition for removal, rescinded an order compelling attendance at a medical examination, and returned the matter for further proceedings. The Board found the order violated due process because the applicant did not receive prior notice or an opportunity to be heard. The WCJ issued the order as a "walk-through document" without adhering to the required notice of intention procedure. The Board emphasized that due process requires notice and an opportunity to challenge adverse actions before they are issued.

Petition for RemovalOrder Compelling AttendanceMedical ExaminationDue ProcessNoticeOpportunity to be HeardPetition to Compel AttendanceAgreed Medical Evaluator (AME)Walk-through documentWCAB Rule 10789(h)
References
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