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Case Law Database

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

Case No. ADJ8925091, ADJ6820644
Regular
Aug 29, 2017

ALFRED MCKNIGHT vs. CITY OF SANTA MONICA

The Workers' Compensation Appeals Board denied the applicant's petition for disqualification of the Workers' Compensation Judge (WCJ). The Board found that the petition lacked specific facts demonstrating bias, an unqualified opinion on the merits, or enmity, as required by statute. Furthermore, the Board denied the petition for a change of venue due to the applicant failing to provide sufficient reasons for the request. The WCJ's report, detailing these deficiencies, was adopted and incorporated into the Board's decision.

Petition for DisqualificationWorkers' Compensation Appeals BoardWCJLabor Code section 5311Code of Civil Procedure section 641biasprejudiceunqualified opinionfactual basisevidentiary basis
References
Case No. ADJ9928707
Regular
Oct 20, 2017

Victorino Aragon Orta vs. Classic Party Rentals, Old Republic General Insurance Co.

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the Administrative Law Judge's (ALJ) order disallowing Reshealth Medical Group's lien. The ALJ had found the assignment of the lien invalid due to an undated, untitled, and illegibly signed document, and because Reshealth was a suspended corporation. However, the WCAB found that the ALJ failed to provide a sufficient opinion, develop the record regarding Reshealth's corporate status and the assignment date, and potentially denied due process by raising the assignment's validity sua sponte without notice. The case was returned to the trial level for further development of the record.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAssignment ValiditySuspended CorporationCorporate StatusStandingLien DisallowanceDue ProcessFair Hearing
References
Case No. ADJ2132852 (VNO 0380163)
Regular
Jan 23, 2009

TOMAS SANCHEZ vs. ST. GEORGE TRUCKING, AMERICAN HOME ASSURANCE, Administered by AIG DOMESTIC CLAIMS

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior order imposing sanctions and costs on the applicant's attorney and hearing representative. The WCAB found that the original order was based on a critical factual error regarding the applicant's attendance at a prior trial, which was not properly corrected. Due to significant factual disputes and potential due process issues, the WCAB returned the matter to the trial level for further proceedings and a new decision on sanctions and costs by a different WCJ. The petition for removal was dismissed as reconsideration was deemed an adequate remedy.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationFindings and OrderSanctionsCostsAdministrative Law JudgeHearing RepresentativeDue ProcessSubstantial Evidence
References
Case No. MON 0318706
Regular
Jul 11, 2008

EDGAR BENITEZ vs. IRISH COMMUNICATIONS, AIG CLAIMS SERVICES, INC.

This case concerns the appropriate permanent disability rating schedule. The applicant argues the 1997 schedule applies due to his physician indicating permanent disability before January 1, 2005, an exception to the 2005 schedule's use. The Board granted reconsideration, agreeing that the physician's report finding the applicant eligible for vocational rehabilitation constituted an indication of permanent disability, thus triggering the 1997 schedule. The matter is returned to the trial level for rating under the 1997 schedule and subsequent issuance of a decision.

Permanent Disability Rating ScheduleLabor Code Section 4660(d)Primary Treating PhysicianVocational RehabilitationComprehensive Medical-Legal ReportPermanent and Stationary StatusGenlyte Group v. ZavalaZenith v. CuginiVera v. Workers' Comp. Appeals Bd.Agreed Medical Evaluator
References
Case No. ADJ8101494
Regular
Mar 14, 2017

ROBERTO ESCOBAR-IZARRARAS vs. ACCORN ENGINEERING, PACIFIC COMPENSATION INSURANCE COMPANY

The Appeals Board reconsidered a WCJ's decision disallowing the remainder of a hospital's lien. The WCJ found the lien unreasonable based on an incorrect standard, as the hospital's services were not subject to the Official Medical Fee Schedule and were to be paid on a "reasonable cost basis." The Appeals Board rescinded the prior decision, returning the case to the trial level for further proceedings and a new decision. This decision clarifies that the lien claimant bears the burden of proving the reasonableness of its charges on a cost basis, not just its usual fees.

WCABReconsiderationLien ClaimantMonrovia Memorial HospitalKunz studyReasonable Cost BasisOMFSLabor Code § 4600Burden of ProofPreponderance of the Evidence
References
Case No. ADJ4024660 (LAO 0887729)
Regular
Feb 03, 2017

ALFREDO COLLAZO vs. MECA NAG CORPORATION, EMPLOYERS COMPENSATION

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level for a new decision. The WCJ erred in determining the lien claimant's entitlement to payment solely on a multiplier of Medicare rates, rather than a reasonable cost basis. The Board clarified that while the facility's charges are not subject to the Official Medical Fee Schedule, their entitlement must be based on their actual costs plus a reasonable profit. Therefore, further proceedings are required to properly assess the reasonable cost basis for the services rendered.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderLien ClaimantReasonable Cost BasisMedicare ReimbursementOfficial Medical Fee ScheduleLong Term Care HospitalKunz StudyTapia
References
Case No. ADJ6870507
Regular
Jun 24, 2010

ULISES FUENTES vs. DICKIE DOBINS CLEANERS, ILLINOIS WEST INSURANCE AGENCY, TOWER SELECT INSURANCE AGENCY

This case involves a dispute over the issuance of a Qualified Medical Evaluator (QME) panel in a workers' compensation claim. The applicant sought reconsideration of an order for a QME panel, alleging a deviation from an agreed medical evaluator process and lack of notice. The defendant presented a conflicting account of events, claiming the applicant's attorney conditioned the agreed medical evaluation on the defendant providing temporary disability benefits. The Appeals Board found the divergent factual accounts warranted removal and rescinded the QME panel order. The case is returned to the trial level for factual resolution and to determine if sanctions are appropriate.

WORKERS' COMPENSATION APPEALS BOARDRemovalQME PanelLabor Code § 4062.2Agreed Medical EvaluatorPetition to CompelEx parteNoticeSanctionsLabor Code § 5813
References
Case No. ADJ8128282
Regular
Jan 23, 2014

ANGELA EGBIKUADJE vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award, returning the case for further proceedings. The defendant, California Department of Corrections and Rehabilitation, argued that the applicant's psychiatric injury claim was preempted by the ADA and not proven under Labor Code section 3208.3. The Board found the original decision lacked proper analysis regarding predominant industrial causation and the good faith personnel action defense. Therefore, the case was remanded for further development of the record, including expert medical opinion on these issues.

Workers' Compensation Appeals BoardAngela EgbikuadjeCalifornia Department of Corrections and RehabilitationLegally UninsuredState Compensation Insurance FundADJ8128282Van Nuys District OfficeReconsiderationFindings and AwardIndustrial cumulative trauma injury
References
Case No. ADJ8501790
Regular
Jul 29, 2015

Kelly Chase vs. St. Louis Blues Hockey Club, Federal Insurance Company

The Workers' Compensation Appeals Board (WCAB) reversed a prior finding of industrial injury for a professional hockey player against the St. Louis Blues. The WCAB found insufficient connection to California for jurisdiction, citing the player's limited games in the state compared to his overall career. This decision followed the precedent set in *Federal Insurance Co. v. Workers' Comp. Appeals Bd. (Johnson)*, which requires a legitimate and substantial connection to the state for jurisdiction. The WCAB concluded that 21 games out of 485 did not meet this standard for a cumulative injury claim.

WCABSt. Louis Blues Hockey ClubFederal Insurance CompanyADJ8501790Opinion and Decision After Reconsiderationcumulative industrial injuryprofessional hockey playersubject matter jurisdictionstatute of limitationssubstantial medical evidence
References
Case No. ADJ10483516, ADJ6690853, ADJ886741 (POM 0300434)
Regular
May 02, 2018

CAROLINE JOHNSON vs. CAREMARK RX, INC.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Court of Appeal remanded this case to the Appeals Board to award additional attorney's fees to the applicant's attorney for services rendered in opposing the defendant's Petition for Writ of Review. The applicant's attorney sought $9,200.00 for 23 hours of work at $400.00 per hour. After reviewing the petition and considering factors like time, effort, skill, and complexity, the Appeals Board awarded the full requested amount of $9,200.00 in attorney's fees. This award is in addition to any other compensation due to the applicant.

Workers' Compensation Appeals BoardPetition for Writ of ReviewSupplemental attorney's feesLabor Code § 5801Court of Appealappellate attorney's feesapplicant's attorneyhourly ratereasonable feesremand
References
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