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

Case No. MISSING
Regular Panel Decision

Northbrook Excess & Surplus Insurance v. Chubb Group of Insurance Companies

This declaratory judgment action addresses the hierarchy of excess insurance policies in a situation where one policy is primary for owned vehicles but excess for non-owned, and the second is an umbrella policy covering multiple risks. The case stems from an accident involving a rented van, which led to a $650,000 settlement. After the primary insurer paid $500,000, Chubb Group of Insurance Companies and Northbrook Excess and Surplus Insurance Co. each contributed $75,000, pending a determination of their respective excess coverage obligations. The Supreme Court initially ruled for ratable contribution. However, citing State Farm Fire & Cas. Co. v LiMauro, the appellate court reversed, holding that Northbrook's umbrella policy constitutes a final tier of coverage, not required to contribute ratably with Chubb's excess policy. Consequently, summary judgment was granted to Northbrook, entitling it to a $75,000 reimbursement from Chubb.

Excess InsuranceUmbrella InsuranceDeclaratory JudgmentInsurance Policy InterpretationInsurance Coverage DisputeAutomobile Liability InsuranceNon-Owned VehicleRatable ContributionFinal Tier CoverageSummary Judgment
References
2
Case No. AHM 0136908
Regular
Mar 07, 2008

JUAN JESUS GARCIA vs. ALEXIS CONSTRUCTION CLEANUP INC., GRANITE STATE INSURANCE COMPANY, AIG CLAIMS SERVICES

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior award of no permanent disability. The Board found that the medical reports were not ratable by the Disability Evaluation Unit. The case is returned to the trial level to allow examination of the DEU rater, aiming to develop the record and ensure a decision on the merits.

Workers' Compensation Appeals BoardAlexis Construction Cleanup Inc.Granite State Insurance CompanyAIG Claims ServicesJuan Jesus Garcialabor contractindustrial injuryback injurypermanent disabilityratable permanent disability
References
4
Case No. SAC 308714SAC 341852
Regular
Oct 01, 2007

WAYNE LEWIS vs. BEUTLER HEATING AND AIR, ARCH INSURANCE, ST. JOHN'S RETIREMENT VILLAGE, STATE COMPENSATION INSURANCE FUND

This case concerns the applicability of the 1997 vs. 2005 Schedule for Rating Permanent Disabilities. The Workers' Compensation Appeals Board denied reconsideration, upholding the administrative law judge's finding that the 2005 Schedule applied. This was based on the crucial determination that no treating physician's report before January 1, 2005, indicated the applicant had reached permanent and stationary status with a ratable disability.

Workers' Compensation Appeals BoardReconsiderationPermanent Disability ScheduleLabor Code Section 4660(d)Treating Physician ReportPermanent and Stationary StatusRatable DisabilityIndustrial InjuryMaintenance Worker1997 Schedule
References
1
Case No. MON 320947
Regular
Sep 24, 2007

LaVerne Davis vs. CITY OF SANTA MONICA, Permissibly SelfInsured

The applicant sustained a low back injury prior to January 1, 2005, but no medical report prior to that date clearly stated the applicant had a "ratable disability" that had reached "permanent and stationary" status. Therefore, the 2005 permanent disability rating schedule, rather than the 1997 schedule, was correctly applied by the WCJ. The Board denied the applicant's petition for reconsideration, upholding the application of the 2005 schedule.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and Awardpermanent disabilitycumulative traumalow back injurypermanent disability rating scheduleLabor Code section 4660(d)1997 schedule2005 schedule
References
2
Case No. ADJ6772869
Regular
Jan 17, 2012

Michelle Jones vs. CITY OF LONG BEACH

This case involves a worker seeking compensation for a sleep disorder in addition to her admitted industrial shoulder injury. The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award. The Board found that the applicant's hypersomnia was not a separate ratable sleep disorder, but rather a consequence of pain from her industrial shoulder injury. Therefore, the case was returned for a new permanent disability rating that excludes the sleep disorder.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjurySleep DisorderPermanent DisabilityRight ShoulderHypersomniaAMA GuidesPain Questionnaire
References
1
Case No. SAC 0343332
Regular
Jun 12, 2007

MARY COMPTON vs. WALMART ASSOCIATES, INC., AMERICAN HOME ASSURANCE

The Workers' Compensation Appeals Board granted reconsideration to determine which rating schedule applies to Mary Compton's industrial back injury. The Board found the revised rating schedule applies, not the prior one, because there was no pre-2005 medical report indicating the applicant's permanent and stationary status or ratable disability. Consequently, issues of permanent disability, apportionment, and attorney fees were deferred for further proceedings under the revised schedule.

Workers' Compensation Appeals BoardRating SchedulePermanent DisabilityReconsiderationMedical-Legal ReportTreating PhysicianPermanent and Stationary StatusLabor Code Section 4660(d)Agreed Medical ExaminationAMA Guides
References
3
Case No. ADJ6978832
Regular

Mona Dill vs. CITY OF RANCHO PALOS VERDES, PSI, by CJPIA through their TPA, YORK INSURANCE SERVICES GROUP

The Appeals Board granted the defendant's petition for removal, reversing the WCJ's order for a QME evaluation. The Board found the applicant's stipulated zero percent permanent disability and need for further medical treatment to be adequate, given the treating physician's report of no ratable impairment and the applicant's expressed desire to settle. Therefore, the Stipulations with Request for Award were approved, granting the applicant ongoing medical care and zero percent permanent disability.

Petition for RemovalStipulations with Request for AwardPanel Qualified Medical Evaluator (QME)ApportionmentPermanent DisabilityMedical TreatmentIndustrial InjuryRecreation SupervisorPro PerInformation and Assistance Officer (I & A)
References
0
Case No. ADJ2653887 (SAL 0116844)
Regular
Dec 24, 2008

CARROL BARRIE vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, amending a prior finding to award further medical treatment for admitted industrial hernias. While the original finding denied permanent disability and further treatment, the Board found a stipulation by the parties and the Agreed Medical Evaluator's opinion supported the need for ongoing medical follow-up. The Board affirmed the original finding that the injury did not cause ratable permanent disability based on the AME's report and statutory guidelines.

Workers' Compensation Appeals BoardIndustrial InjuryVentral HerniaUmbilical HerniaRegistered NursePermanent DisabilityFurther Medical TreatmentAgreed Medical EvaluatorAMA GuidesLabor Code Section 5802
References
2
Case No. ADJ8684392;ADJ8683271; ADJ8680023; ADJ8903649; ADJ8903648
Regular
Jul 07, 2016

LEOPOLDINA INSUASTI vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

This case involves an appeal by the Los Angeles Unified School District challenging a prior award of 39% permanent disability. The Board granted reconsideration, finding that the correct occupational group number is 211 and that 10% apportionment to non-industrial causes is appropriate for the lumbar spine injury. Additionally, the Board ruled that sleep disorder is not separately ratable and returned the matter for the WCJ to re-rate permanent disability based on these findings.

Workers' Compensation Appeals BoardOccupational Group NumberPermanent DisabilityApportionmentPQMEJoint Findings and AwardPetition for ReconsiderationAdministrative Law JudgeSubstantial Medical EvidenceLumbar Spine
References
2
Case No. ADJ7481268
Regular
Feb 22, 2016

MICHAEL BEAUCHAMP vs. PACIFIC BELL TELEPHONE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to amend a prior award. The Board affirmed the 82% permanent disability rating but reversed the 15% increase, finding it inapplicable as the applicant voluntarily resigned via a severance package before his condition became permanent and stationary. The Board also affirmed the inclusion of a sleep disorder impairment, though one commissioner dissented, arguing it was not separately ratable from pain. The attorney fees were adjusted accordingly.

WCABPetition for ReconsiderationFindings and AwardLabor Code §4658(d)permanent disabilitysleep disorderhypertensioncarpal tunnel syndromecable splicerenhanced surplus reduction offer (ESRO)
References
6
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