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

Case No. ADJ9873554
Regular
Feb 05, 2016

DINO MONTEVERDE vs. WATERMARK CAPITAL, HARTFORD SACRAMENTO

This case involves an applicant seeking reconsideration of a Workers' Compensation Appeals Board decision denying his claim for psychiatric injury. The primary issue was whether the applicant's employment duration met the six-month threshold required by Labor Code section 3208.3(d) for psychiatric claims. The Board upheld the judge's finding that the applicant did not meet this requirement, as his employment lasted less than six months. Therefore, reconsideration was denied.

Workers' Compensation Appeals BoardLabor Code section 3208.3(d)psychiatric injurysix-month employment requirementindustrial injuryAOE/COEpetition for reconsiderationdenial of petitioninside salespersonV.A. treatment
References
Case No. ADJ7873127
Regular
May 08, 2012

MICHAEL DE SANTIAGO vs. ST, JOHN'S COMPANY, FEDERAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding 6% permanent disability for a lumbar spine injury. Applicant's counsel argued for 12% based on a stipulation classifying the applicant as a furniture mover (OGN 560), but the WCAB found the applicant's deposition testimony contradicted this, indicating an indoor salesperson role (OGN 212). The Board also issued a notice of intention to sanction applicant's attorney and law firm $400 for filing a petition with demonstrably false statements regarding trial necessity and misrepresented facts about the record.

WCABPetition for ReconsiderationFindings and AwardPermanent DisabilityOccupational Group NumberStipulationsSanctionsLabor Code 5813Rule 10561Bad Faith Actions
References
Case No. ADJ3646270 (AHM 0108634)
Regular
Mar 20, 2009

GERLYNN GILLOGLY vs. KIMCO STAFFING SERVICES INC., LIBERTY MUTUAL

This case involves a workers' compensation applicant claiming injury in 1999. The defendant sought removal of an order that took the case off calendar, arguing years of delay and prejudice. However, the Appeals Board denied removal, finding that delays were partly due to the applicant's right to change attorneys. The Board concluded there was no irreparable harm to the defendant and that evidentiary objections could be addressed at trial.

GERLYNN GILLOGLYKIMCO STAFFING SERVICES INC.LIBERTY MUTUALADJ3646270AHM 0108634Petition for RemovalOrder Denying PetitionDeclaration of Readiness to ProceedQualified Medical EvaluationTelemarketer
References
Case No. MON 0304723
Regular
Jul 15, 2008

KHALIL TANTAWI vs. UNIFORMS, INC., MICROSOURCE MANAGEMENT, INC., GRANITE STATE INSURANCE COMPANY, AIG CLAIM SERVICES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of an arbitrator's decision that Granite State Insurance Company and State Compensation Insurance Fund only covered clerical and outside sales staff for Microsource Management, Inc. The Board found the arbitrator's decision lacked required express findings of fact and a determination of rights, and rescinded the decision. The case is returned to the trial level for further development of evidence regarding the applicant's exact job role on the date of injury and to issue a new decision with proper findings and an order.

Workers Compensation Appeals BoardKhalil TantawiUniforms IncMicrosource Management IncGranite State Insurance CompanyAIG Claim Services IncState Compensation Insurance Fundspecial employergeneral employeroutside salesperson
References
Case No. ADJ8205235
Regular
Feb 06, 2013

HECTOR GOMEZ vs. FASTENAL, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case concerns an injured worker, Hector Gomez, who sought medical treatment outside his employer's Medical Provider Network (MPN). The Board overturned the finding that the employer lost control of medical treatment, finding that the employer's technical failure to schedule the initial MPN visit did not deny treatment. The Board also held that the worker could not select a non-MPN specialist simply because an MPN specialist declined to act as a primary treating physician. Therefore, the applicant must obtain treatment through the defendant's MPN.

Workers' Compensation Appeals BoardMedical Provider Network (MPN)Primary Treating Physician (PTP)SpecialistLabor Code section 4616.3Administrative Director's Rule 9767.6initial medical evaluationchange of physicianforfeiture of medical controlaccess standards
References
Case No. ADJ9141002 [death claim] ADJ6796445 [inter vivos]
Regular
Jan 16, 2014

RAMON PRIETO (Deceased) vs. APACHE AUTO, INC., ZENITH INSURANCE COMPANY, MEADOWBROOK/STAR INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and amended a previous award. The amendment changed the cumulative trauma period for the deceased applicant's industrial injury to his heart and neurological system from December 2007-December 2008 to November 2008-December 26, 2008. This change was made to reflect the correct insurance carrier's coverage period. The Board otherwise affirmed the original findings regarding industrial injury and death.

Workers' Compensation Appeals Boarddeath claiminter vivosindustrial injuryheart/cardiovascular systemneurologic systematrial fibrillationcumulative traumaauto wrecker salespersonZenith Insurance Company
References
Case No. ADJ8141238
Regular
May 01, 2012

KAREN SUMMERS vs. 20-20 COMMUNICATIONS, INC., SPECIALTY RISK SERVICES, LLC

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration of an order approving a Compromise and Release. The petition was dismissed because it was unverified, lacked proof of service on adverse parties, and appeared to be untimely filed. The Board adopted the WCJ's report and recommendations in making its decision. The applicant had claimed industrial injury to her neck and shoulder and alleged her attorney colluded with the claims adjuster.

Workers' Compensation Appeals BoardPetition for ReconsiderationCompromise and ReleaseIndustrial InjuryNeck and ShoulderOffice Supply SalespersonClaims AdjusterVerified PleadingProof of ServiceUntimely Filing
References
Case No. SFO 0438557 SFO 0438562
Regular
May 05, 2008

LISA BURKE vs. WINTERLAND PRODUCTIONS, HARTFORD INDEMNITY & ACCIDENT COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address whether reimbursed expenses should be included in calculating an applicant's temporary disability indemnity rate. The Board reversed the prior award, ruling that reimbursed expenses for meals, lodging, and fuel are special expenses, not remuneration, and therefore should not be included in calculating the applicant's average weekly wage. The decision clarifies that such reimbursements do not constitute "advantages received by the injured employee as part of his remuneration" under Labor Code section 4454.

Workers' Compensation Appeals BoardTemporary Disability IndemnityReimbursed ExpensesEarnings CalculationLabor Code Section 4454RemunerationSpecial ExpensesAverage Weekly WageCumulative TraumaConcert Tour Salesperson
References
Case No. ADJ8076214
Regular
Aug 27, 2018

FRANKLIN REYES vs. INSIDE & OUTSIDE POTTERY; THE HARTFORD

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board found that the defendant's petition improperly sought reconsideration of an interlocutory issue, which should have been addressed through a petition for removal. Even if treated as a petition for reconsideration, the Board agreed with the WCJ that the applicant's objection to the Qualified Medical Evaluator's report was timely under Labor Code section 4061. Therefore, the applicant is entitled to a psychiatric PQME.

AOE/COEPsychiatric PQMELabor Code § 4062Petition for ReconsiderationFindings and OrderWCJFinal OrderInterlocutory OrderMedical-Legal EvaluationPermanent Disability
References
Case No. ADJ7572145
Regular
Aug 09, 2012

ALBERTO CARMONA vs. MEDINA CONCRETE CONSTRUCTION, DELOS INSURANCE COMPANY, RISK ENTERPRISE MANAGEMENT LIMITED

The Workers' Compensation Appeals Board denied reconsideration of a decision that found no industrial injury occurred. The applicant, Alberto Carmona, alleged he fractured his arm in a trench but provided inconsistent accounts of the incident. The Workers' Compensation Judge found the applicant not credible based on contradictory testimony, including evidence that the injury may have occurred from a fall off a ladder inside a house. The Board adopted the Judge's report and reasoning, giving great weight to the credibility findings.

Workers' Compensation Appeals BoardReconsiderationWCJCredibilityIndustrial InjuryFractured HumerusConstruction SiteTrenchLadderMedical Reports
References
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