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

Case No. ADJ7959316 ADJ8228747
Regular
Jul 05, 2018

ALAN LIVHITS vs. DEPENDABLE CARE TRANSPORTATION, DEPENDABLE CARE AMBULANCE, SUSSEX INSURANCE COMPANY, CALIFORNIA INSURANCE COMPANY, PRAETORIAN INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address defendant California Insurance Company's (CIC) contentions. CIC disputes the arbitrator's finding that applicant was not employed by Dependable Care Ambulance and argues that certain insurance policies should provide coverage under equitable principles. The Board found the arbitrator's decision lacked an adequate evidentiary record, specifically noting the failure to admit and clearly identify documentary evidence. Therefore, the matter is returned to the arbitrator to create a complete record before issuing a new decision.

ADJ7959316ADJ8228747Dependable Care TransportationDependable Care AmbulanceCalifornia Insurance CompanyPraetorian Insurance CompanySussex Insurance CompanyPetition for ReconsiderationArbitratorLabor Code Section 5500.5
References
Case No. ADJ10968412
Regular
Mar 05, 2020

MAGDALENA PACHECO DE AVILA vs. TACO STATION, MID CENTURY INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision concerning applicant Magdalena Pacheco de Avila's right hand and wrist injury. The WCAB affirmed the finding of injury AOE/COE and the 8% permanent disability award. However, the WCAB deferred the issue of the employer's entitlement to credit for a $7,349.60 temporary disability overpayment against the permanent disability award. The case is returned to the WCJ for further proceedings on this credit issue, considering equitable principles outlined in *Maples*.

Petition for ReconsiderationFindings and AwardPermanent Disability IndemnityTemporary Disability Indemnity OverpaymentCreditLabor Code Section 4909Equitable PrinciplesMaples v. Workers' Comp. Appeals Bd.Agreed Medical ExaminerMaximum Medical Improvement
References
Case No. ADJ7251479
Regular
Jun 02, 2015

ROBERT NORTON vs. NEO DIGITAL, A DIVISION OF 20TH CENTURY FOX/FOX ENTERTAINMENT GROUP

This case concerns defendant Neo Digital's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying a credit for alleged permanent disability overpayment. The WCJ previously found defendant was not entitled to a credit of $7,350.86 against benefits and liens. The WCAB denied reconsideration, agreeing that allowing such a credit against future medical treatment would disrupt the applicant's ability to receive necessary care. The Board emphasized that credit allowance is discretionary and equitable principles, including protecting the applicant from prejudice, guide such decisions.

Petition for ReconsiderationPermanent Disability OverpaymentAgreed Medical ExaminerStipulated AwardCredit for OverpaymentLabor Code § 4909Discretionary AuthorityEquitable PrinciplesDisruptive BenefitsPrejudice to Employee
References
Case No. ADJ14373904, ADJ14373906
Regular
Feb 21, 2023

BRANDI WOODS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted reconsideration and affirmed an award of temporary disability from January 6, 2021, through May 2, 2022. The Board found that the applicant's treating physician's opinion supported this extended period of disability, even when denied treatment requests by the defendant. However, the Board deferred the issue of whether the defendant is entitled to a credit for permanent disability payments made against temporary disability, remanding it for further consideration due to equitable principles. This deferral is to ensure the applicant is not prejudiced by the defendant's actions, especially when seeking credit across different benefit types.

Workers' Compensation Appeals BoardBrani WoodsLos Angeles Unified School DistrictJoint Findings and AwardPetition for ReconsiderationTemporary DisabilityPermanent DisabilityLumbar Spine InjuryPrimary Treating PhysicianPanel Qualified Medical Evaluator
References
Case No. ADJ9158320, ADJ6695957
Regular
Oct 23, 2017

Marvin Rogers vs. American Medical Response, ACE American Insurance Company

This case concerns a workers' compensation insurer seeking credit for overpaid temporary disability benefits. The applicant, Marvin Rogers, sustained a lumbar spine injury as a paramedic. The insurer paid temporary disability benefits beyond the applicant's permanent and stationary date, but sought credit at the full overpaid amount against permanent disability indemnity. The Appeals Board denied the defendant's petition for reconsideration, upholding the administrative law judge's decision to allow credit only at the lower permanent disability indemnity rate. This denial was based on equitable principles and the fact that the applicant did not act in bad faith, preventing prejudice to the injured worker.

Petition for ReconsiderationTemporary Disability IndemnityPermanent DisabilityCreditOverpaymentLabor Code section 4909Discretionary AuthorityEquitable PrinciplesGood FaithEstoppel
References
Case No. ADJ2154550 (MON 0115928)
Regular
Oct 14, 2008

JAMES PERRY vs. ALCO PACIFIC, AIG DOMESTIC CLAIMS, INC. for AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior order disallowing lien claims, and remanded the case for further proceedings. The Board found that Labor Code section 4903.5(a) was not applicable as the liens were filed prior to its enactment, and the defendant failed to establish the equitable defense of laches. The original compromise and release agreement also explicitly stated that all liens would be adjusted outside of the settlement.

Labor Code section 4903.5(a)lien claimantsreconsiderationcompromise and releaselachesprejudicejurisdictionstatutory applicationequitable doctrinerescinded order
References
Case No. ADJ9211017
Regular
Mar 28, 2017

JOSE MENDOZA vs. KINGSLEY COMPANIES; SAMSUNG FIRE AND MARINE c/o BROADSPIRE

The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration regarding the denial of a credit for benefits paid. The WCAB found that the administrative law judge's decision not to grant the credit was within their discretion and not an abuse of discretion, considering the lack of wrongdoing by the applicant. The applicant's petition for reconsideration was dismissed as skeletal and unsupported by specific references to the record and legal principles, as required by statute and board rules. Therefore, the WCAB upheld the original denial of the credit and dismissed the applicant's petition.

WCABPetition for ReconsiderationDenying PetitionDismissing PetitionLabor Code section 4909CreditDiscretionary AuthorityEquitable PrinciplesSkeletal PetitionAppeals Board Rules
References
Case No. ADJ3637976 (BAK 0135676)
Regular
Jul 17, 2012

ANGEL VILLATORO vs. KERN LABOR CONTRACTING, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for PAULA INSURANCE, in liquidation

The Workers' Compensation Appeals Board affirmed the disallowance of the Center for Orthopedic Surgery's (COS) lien for unpaid medical treatment. COS provided treatment in 2001, received a partial payment from the insurer, Paula Insurance, and later filed a lien claim in 2011. The Board found the lien claim was barred by the statute of limitations under Labor Code Section 4903.5, which dictates specific filing deadlines after injury, service, or case resolution. Arguments for equitable tolling or estoppel were rejected, as COS unreasonably delayed filing its lien for nearly nine years after the insurer's partial payment.

CIGAPaula InsuranceCenter for Orthopedic SurgeryLien claimStatute of limitationsLabor Code § 4903.5Compromise & ReleaseReconsiderationMedical treatment lienEquitable estoppel
References
Case No. MON 0325089 MON 0325090
Regular
Oct 05, 2007

NORA MEDEARIS vs. COUNTY OF LOS ANGELES

This case concerns the denial of an applicant's petition for reconsideration of a workers' compensation award. The applicant sought further temporary disability benefits beyond the 104-week limit imposed by Labor Code § 4656(c)(1). The Workers' Compensation Appeals Board denied the petition, finding the applicant failed to prove equitable estoppel against the defendant's application of the statutory limit, despite the defendant's initial refusal to authorize shoulder surgery. The Board adopted the WCJ's reasoning that the applicant did not demonstrate reliance on any conduct by the defendant that prevented her from timely pursuing authorization for the surgery.

Workers' Compensation Appeals BoardNora MedearisCounty of Los AngelesPermissibly Self-InsuredMON 0325089MON 0325090Opinion and Order Denying Petition for ReconsiderationInterim Joint Findings and AwardCentral Services TechnicianIndustrial Injury
References
Case No. ADJ8130064
Regular
Mar 29, 2019

Victor Juarez vs. Masonry by Joe, State Compensation Insurance Fund, Imperium Insurance Company, Athens Administrators, Endurance Southern Insurance

This case involves lien claimants who filed their liens in 2012 but failed to submit timely Labor Code section 4903.8(d) declarations, which were required for liens filed before January 1, 2013, by January 1, 2014. The WCAB granted reconsideration, rescinded the WCJ's order dismissing the liens, and returned the matter for further proceedings. The Board found that while the declarations were untimely, the specific remedy for such untimeliness for pre-2013 liens is not defined in the statute. However, the Board noted that the WCAB possesses equitable powers, including the application of the doctrine of laches, to address unjustifiable delay in lien claims.

Labor Code section 4903.8(d)Lien claimantsPetition for ReconsiderationFindings and Orderuntimely declarationsLabor Code section 4903.8(e)Senate Bill 863equitable doctrine of lachesunjustifiable delayequitable powers
References
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