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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. ADJ2759696 (VNO 0492027)
Regular
Oct 11, 2010

WOON YOUNG PARK vs. FILM PAYMENT SERVICES, INC., CHARTIS INSURANCE

The Board granted reconsideration, rescinding the WCJ's decision on the defendant's credit for overpaid temporary disability. The defendant is allowed credit for temporary disability payments made from March 26, 2009, to June 3, 2009, at the temporary disability rate. Further credit is granted for payments made from June 4, 2009, to December 7, 2009, at the permanent disability rate of $185.00 per week. The Board denied further credit due to insufficient evidence regarding post-AME report overpayments.

Petition for ReconsiderationPermanent DisabilityTemporary DisabilityCreditStipulated AwardAgreed Medical ExaminationPermanent and StationarySection 4909Abuse of DiscretionDue Process
References
Case No. ADJ7454224
Regular
May 13, 2016

JEFF REECE vs. SAN BERNARDINO COUNTY PROBATION DEPARTMENT; COUNTY OF SAN BERNARDINO

The Appeals Board denied the defendant's petition for reconsideration regarding the lien of the California Law Enforcement Association (CLEA). The defendant voluntarily paid CLEA before the WCJ's decision became final, despite knowing reconsideration could negate their liability. As this voluntary payment constitutes a new issue, any claim for credit must first be addressed at the trial level. The Board affirmed its prior decision to remove CLEA's lien from the award.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings Award and OrdersLien WithdrawalVoluntary PaymentLabor Code Section 4909Credit for PaymentTrial Level Jurisdiction
References
Case No. ADJ387954 (OXN 0145858) ADJ2973719 (OXN 0145147)
Regular
Oct 27, 2017

FRANCISCO PRIETO vs. O.C. CONTRACTING, INC., AMERICAN INTERNATIONAL GROUP, INC., UNINSURED EMPLOYERS BENEFITS TRUST FUND

This case concerns a Petition for Reimbursement filed by Granite State Insurance Company against the Uninsured Employers Benefits Trust Fund (UEBTF). Granite State mistakenly paid workers' compensation benefits to an employee injured while working for an uninsured employer. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order granting reimbursement, holding that UEBTF is not statutorily liable to reimburse insurance carriers for erroneous payments. The WCAB emphasized that UEBTF's purpose is to provide benefits to injured workers of uninsured employers, not to indemnify insurers. A dissenting opinion argued for amending the order to allow reimbursement to Granite State through applicant from funds UEBTF owes the applicant.

Uninsured Employers Benefits Trust FundGranite State Insurance CompanyPetition for ReimbursementLabor Code sections 37153716mistaken paymentillegally uninsured employerLabor Code section 4909creditdirect reimbursement
References
Case No. ADJ2852888 (AHM 079739) ADJ6775021
Regular
Dec 11, 2010

PAUL BUTELO vs. LEIGHTON AND ASSOCIATES, AMERICAN MOTORISTS INSURANCE COMPANY

This case concerns a dispute over a defendant's credit for long-term disability (LTD) payments received by the applicant. The Appeals Board granted reconsideration to correct an error where the trial judge erroneously denied a credit for a $102,237.77 third-party recovery. However, the Board affirmed the judge's denial of credit for the LTD payments because the defendant failed to prove the payments were intended as an advance on workers' compensation benefits. The case was returned to the trial level for further proceedings consistent with this decision.

Long Term DisabilityThird Party RecoveryCreditWCJReconsiderationTemporary Disability IndemnityPetition for ReconsiderationEAMSInvited ErrorDue Process
References
Case No. ADJ2591614 (MON 301409) ADJ3783399 (MON 303806)
Regular
May 13, 2009

John Cromwell vs. RMD REBAR, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award due to unclear reasoning and an incomplete record. The Board remanded the case for a new decision, requiring the judge to address all contentions regarding the calculation of temporary disability, penalties for late payments, attorney's fees, and defendant's credit for prior payments. Both applicant and defendant had petitioned for reconsideration, raising issues such as the correct calculation of benefits, additional penalties, and the application of Labor Code section 4659(c). The Board emphasized the need for a clear record and a comprehensive decision explaining the judge's determinations.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardTemporary Total DisabilityPermanent DisabilityPenaltiesAttorney's FeesLabor Code section 4659(c)Credit for PaymentsStipulated Award
References
Case No. ADJ9942080 ADJ10381122 ADJ10260028
Regular
Apr 07, 2017

MARIO PADILLA vs. RIO FARMS, LLC, NATIONAL UNION FIRE INS. CO.

The Workers' Compensation Appeals Board granted reconsideration to address whether the defendant was entitled to a credit for $11,020 in permanent disability advances. The applicant argued against the credit, citing that the Compromise and Release explicitly stated "0.00" permanent disability indemnity paid and did not include any deductions for such advances. The Board found the defendant's interpretation of the addendum ambiguous and against the explicit language of the settlement agreement. Therefore, the Board amended the award to permit credit only for permanent disability advances made *after* the date of the Compromise and Release.

Permanent disability advancesCompromise and ReleasePetition for ReconsiderationJoint Findings and Awardcreditaddendumsettlement negotiationscontract interpretationmutual intentionWCJ
References
Case No. ADJ3234390 (OXN 0146866)
Regular
May 02, 2019

KENNETH CROW vs. COASTLINE EQUIPMENT, AMERICAN CASUALTY INSURANCE COMPANY OF REDDING, PENNSYLVANIA

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the WCJ's finding that a Stipulation with Request for Award was not ambiguous. The defendant sought credit for permanent disability payments made before June 28, 2010, in dismissed cases, arguing the stipulation allowed for credit of "previously made" payments. However, the Board found the stipulation's plain language only entitled the defendant to credit for payments made on or after June 28, 2010, in the primary case. The defendant failed to prove mutual intent for credit of prior payments in dismissed claims.

Stipulations with Request for AwardPetition for ReconsiderationFindings and AwardPermanent Disability IndemnityCredit for PaymentsContract InterpretationDismissed ClaimsMerged CasesWCJ ReportWCAB
References
Case No. ADJ6899721
Regular
Jun 01, 2016

SALLY MARTINEZ vs. COUNTY OF LOS ANGELES, Permissibly Self-Insured, SEDGWICK CMS

The Workers' Compensation Appeals Board granted reconsideration to clarify whether the defendant could take credit for permanent disability advances made prior to the formal award. The Board amended the prior decision, allowing the defendant to claim credit for all permanent disability advances made, including those before the March 20, 2012 award. However, the Board affirmed the finding that the defendant underpaid a Labor Code section 5710 fee and is liable for a penalty due to improper service and failure to timely object. The defendant's contention that improper service excused payment of the 5710 fee was rejected.

Workers Compensation Appeals BoardPetition for ReconsiderationFindings and Orderspermanent disability advancesLabor Code section 5710section 5813 penaltyStipulations with Request for Awardmaximum medical improvementcredit for paymentsdiscretionary authority
References
Case No. ADJ6604427, ADJ8192308
Regular
Jul 31, 2014

CHERRICE MORRIS-GAINES vs. AC TRANSIT, SEDGWICK CLAIMS MANAGEMENT SERVICES

In this workers' compensation case, the applicant initially stipulated to a lower average weekly wage, which the Board found to be a final determination that could not be revisited due to lack of good cause and the five-year statute of limitations. The Board affirmed the employer's credit for payments made to the Employment Development Department (EDD) to prevent double recovery. Furthermore, the Board found no unreasonable delay by the employer in payments to EDD, thus denying the applicant's penalty claim. Finally, the Board rescinded the order requiring the applicant's attorney to repay fees voluntarily paid by EDD, as such repayment was not mandated by law.

Workers' Compensation Appeals BoardAC TransitSedgwick Claims Management ServicesADJ6604427ADJ8192308bus drivercumulative traumatemporary disability indemnityLabor Code section 4656(c)(2)mandatory settlement conference
References
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