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

Case No. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ7505154
Regular
Nov 18, 2011

LATONYA SIMS vs. LOS ANGELES COUNTY METROPOLITAN TRANSPORTATION AUTHORITY

The Workers' Compensation Appeals Board granted reconsideration to rescind an earlier finding that applicant LaTonya Sims sustained an injury arising out of and in the course of employment. The Board determined that the robbery and assault were not sufficiently connected to her employment as a bus operator. Citing case law, the Board concluded that personal assaults, such as this robbery for the applicant's purse and cash, do not arise out of employment when the employment merely provides a stage for the event and the assailant's motive is purely personal. Therefore, the applicant's claim was denied.

Workers' Compensation Appeals BoardLatonya SimsLos Angeles County Metropolitan Transportation Authoritybus operatorinjury arising out of employmentinjury in course of employmentpersonally motivated robberygoing and coming rulethird-party assaultbunkhouse rule
References
Case No. VNO 0386181
Regular
Apr 05, 2007

SUSAN PASCALE vs. BLUE CROSS/WELLPOINT DENTAL, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION on behalf of FREMONT INDEMNITY

This case concerns applicant Susan Pascale's claim for workers' compensation benefits due to industrial injuries resulting in fibromyalgia and other conditions. The WCJ awarded 80% permanent disability, apportioning 20% to applicant's pre-existing personality traits based on medical opinions. The Appeals Board affirmed this decision, finding the apportionment was supported by substantial medical evidence of causation, as allowed by recent statutory changes.

Workers' Compensation Appeals BoardSusan PascaleBlue Cross/Wellpoint DentalCalifornia Insurance Guarantee AssociationFremont IndemnityVNO 0386181Opinion and Decision After ReconsiderationApplicantDefendantWCJ
References
Case No. ADJ6671912
Regular
Nov 20, 2013

HONG GUANG ZHU, Deceased HE RUI YUN, Spouse vs. TRI VILLAGE CHINESE RESTAURANT, FARMERS INSURANCE GROUP

The Workers' Compensation Appeals Board affirmed a prior finding that the decedent chef's death arose out of and occurred in the course of employment. The decedent was shot and killed while resting in his car during a split shift, a common and permitted practice. The Board found this constituted a neutral risk, as no personal motive for the murder was identified, thus satisfying the "personal comfort doctrine." Therefore, the death was deemed compensable as it was linked to his employment by time, place, and circumstance.

WORKERS' COMPENSATION APPEALS BOARDRECONSIDERATIONFINDINGS OF FACTCOURSE OF EMPLOYMENTARISING OUT OF EMPLOYMENTCHEFSPLIT SHIFTPERSONAL COMFORT DOCTRINENEUTRAL RISKUNKNOWN MOTIVE
References
Case No. ADJ8801352
Regular
Jun 06, 2014

Robert Coon vs. Swift Transportation, Gallagher Bassett Services, Inc.

This case involves a student truck driver attacked while on a dinner break, sustaining severe injuries including partial quadriplegia. The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding the finding that the injury arose out of and in the course of employment. The Board applied the "commercial traveler" rule and the "personal comfort" doctrine, finding the employee's actions were incidental to his employment. Crucially, the Board determined the attack was a "neutral risk" as there was no evidence of personal motive for the assault.

AOE/COECommercial Traveler RulePersonal Comfort DoctrineNeutral Risk DoctrineThird-Party AssaultUnknown MotiveUnprovoked AttackLong Haul TruckerStudent DriverMentor
References
Case No. ADJ14015513
Regular
Feb 15, 2023

BRADEN NANEZ vs. 3 STONEDEGGS, INC., TECHNOLOGY INSURANCE COMPANY, AMTRUST NORTH AMERICA

The Appeals Board rescinded the initial Findings and Order, finding the applicant's petition for reconsideration was timely due to defective service. The Board applied the commercial traveler rule, determining the applicant's injury arose out of and in the course of employment. The claim is not barred by the going and coming rule or intoxication, and the applicant sustained a fractured right femur. Issues of traumatic brain injury and bruised lung are deferred for further proceedings.

Workers' Compensation Appeals BoardReconsiderationOpinion and DecisionFindings and OrderApplicantEmployerAdjustedAdjudication NumberRedding District OfficeInjury Arising Out of and In the Course of Employment (AOE/COE)
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. AHM 129038
Regular
Jul 19, 2007

FRANCISCO OLIVA vs. LAIDLAW TRANSIT COMPANY, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case involves a bus driver, Francisco Oliva, who claimed an industrial injury to his right hand and upper extremity. The defendant, Laidlaw Transit Company, sought reconsideration of the initial award, arguing the injury was personal and not work-related, and challenging reimbursement to the Employment Development Department (EDD). The Appeals Board granted reconsideration, affirmed the finding of industrial injury, but amended the award to remove the reimbursement requirement to the EDD.

Workers Compensation Appeals BoardLaidlaw Transit CompanyInsurance Company of the State of PennsylvaniaFrancisco Olivaindustrial injuryright handupper right extremitybus driverassaultpersonally motivated
References
Case No. ADJ7177544
Regular
Aug 12, 2013

ADRIAN IBANEZ vs. GOLDEN DEN CORPORATION/DENNY'S; USF & G

This case involves an applicant claiming industrial injury from an assault that occurred on May 20, 2008. The initial finding determined the assault did not arise out of employment, but the Appeals Board has overturned this. The Board found the applicant was in the course of employment during a break, even if off-premises, and that the assault, having an unknown motive, arose out of employment. The matter is now remanded for further proceedings on all outstanding issues.

Workers Compensation Appeals BoardGolden Den CorporationDenny'sAdrian IbanezPetition for Reconsiderationindustrial injuryassaultarose out of employmentin the course of employmentpersonal comfort doctrine
References
Case No. ADJ7332384
Regular
Jul 19, 2011

DEBORAH CULP vs. UNITED HEALTH GROUP, U.S. FIDELITY & GUARANTY INSURANCE, Administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board denied reconsideration of the applicant's claim. The applicant argued her injury during an extended break en route to a PTA meeting was compensable. The Board adopted the judge's report, which found the injury did not arise out of and occur in the course of employment. This conclusion was based on stipulated facts indicating the accident occurred during more than a lunch break, for a personal errand unrelated to employment.

Workers' Compensation Appeals BoardPetition for ReconsiderationDeniedStipulated FactsAOE/COEGoing and Coming RulePersonal Comfort DoctrineCompensable InjuryNon-compensable InjuryPaid Lunch Break
References
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