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Case Law Database

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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. SDO 0341777
Regular
Sep 21, 2007

ARMANDO GALLEGOS vs. A.O. REED & COMPANY, ST. PAUL TRAVELERS INSURANCE, UNIVERSAL MECHANICAL (EMCOR), AMERICAN CASUALTY COMPANY OF READING, PA., SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board affirmed an arbitration award against A.O. Reed & Company, finding that the arbitrator had jurisdiction despite Reed not being a signatory to the collective bargaining agreement. Reed waived its objections by participating in the arbitration and discovery without protest, thus effectively agreeing to the process. The Board also found that Reed could have discovered its signatory status with reasonable diligence prior to the arbitration.

Workers' Compensation Appeals BoardArmando GallegosA.O. Reed & CompanySt. Paul Travelers InsuranceUniversal MechanicalAmerican Casualty CompanySpecialty Risk ServicesSDO 0341777Opinion and Decision After ReconsiderationArbitrator jurisdiction
References
Case No. ADJ8996641
Regular
May 07, 2018

RAUL SANDOVAL vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION

The WCAB affirmed an award of 89% permanent disability for a correctional officer injured in an admitted industrial incident affecting his head, psyche, shoulders, neck, and spine. The defendant sought reconsideration, arguing a newly discovered QME report in psychology should be admitted, but the Board found it inadmissible due to the defendant's failure to demonstrate reasonable diligence. The Board also found substantial medical evidence supported the disability rating, and the applicant's return to work did not indicate improved capacity but rather economic necessity.

Workers' Compensation Appeals BoardReconsiderationFindings of Fact and AwardPermanent DisabilityQualified Medical EvaluatorNewly Discovered EvidenceSubstantial Medical EvidenceMaximum Medical ImprovementAdmissibilityWCAB Rule 10856(e)
References
Case No. ADJ8642319
Regular
Apr 24, 2015

ISABEL RAMIREZ-RAMOS (spouse), ANGEL RAMIREZ (deceased) vs. OSTERIA COPPA, LLC, TRUCK INSURANCE EXCHANGE (FARMERS INSURANCE)

This case involves a deceased worker whose employer, Osteria Coppa, LLC, is challenging the Workers' Compensation Appeals Board's award of death benefits. The employer argued the WCJ erred by disallowing cross-examination and excluding a medical report. The Board denied reconsideration, affirming the original award because the employer failed to reject the claim within 90 days, thus triggering a presumption of compensability under Labor Code section 5402(b). Furthermore, the employer could not rebut this presumption with the excluded medical report, as the information it contained was discoverable within the 90-day period through reasonable diligence.

WCABIsabel Ramirez-RamosAngel RamirezOsteria CoppaLLCTruck Insurance ExchangeADJ8642319Opinion and Order Denying Petition for Reconsiderationindustrial injurydeath benefits
References
Case No. ADJ9390618
Regular
Jan 19, 2018

PEDRO TISTA MENDOZA (Deceased) vs. GEORGE HUANG, Uninsured, UNINSURED EMPLOYERS BENEFITS TRUST FUND, MEI Y. HUANG, Homeowner, FARMERS INSURANCE

The Workers' Compensation Appeals Board denied George Huang's Petition for Reconsideration, upholding the original decision that the deceased was an employee of Mr. Huang and suffered a compensable death. The Board adopted the Workers' Compensation Judge's report, finding that Mr. Huang failed to demonstrate why newly discovered evidence, primarily consisting of bank records and a declaration from his sister, could not have been presented earlier with reasonable diligence. Furthermore, Mr. Huang's claims of fraud and misunderstanding of the proceedings were rejected, as he had been repeatedly advised to seek legal representation and had attended prior conferences. The Board also noted that Mr. Huang's supplemental filings did not meet procedural requirements.

Workers' Compensation Appeals BoardUninsured Employers Benefits Trust FundPetition for ReconsiderationNewly Discovered EvidenceReasonable DiligenceWCJ ReportSupplemental PleadingOrder Denying PetitionFraudulent ProcurementFindings of Fact
References
Case No. ADJ3172767
Regular
May 10, 2017

VICTOR GONZALEZ vs. CITISTAFF SOLUTIONS, STATE COMPENSATION INSURANCE FUND

The Appeals Board affirmed the WCJ's decision finding the lien claimant, Monrovia Memorial Hospital, was entitled to nothing for its services. The WCJ properly excluded the lien claimant's expert declaration as it was submitted after discovery closed. The lien claimant failed to meet its burden of proving its charges were reasonable and based on a reasonable cost basis, as required by precedent in cases exempt from the Official Medical Fee Schedule. Mere presentation of usual and customary charges, without evidence of reasonableness or comparability, is insufficient.

Workers' Compensation Appeals BoardVictor GonzalezCitistaff SolutionsState Compensation Insurance FundMonrovia Memorial Hospitallien claimantbill review expertdue processreasonableness of chargesOMFS exemption
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. ADJ 7511877, ADJ 7396932
Regular
May 03, 2017

MARIA MORALES vs. MONTEBELLO UNIFIED SCHOOL DISTRICT, YORK RISK SERVICES GROUP, INC.

The Appeals Board affirmed the WCJ's decision disallowing further payment on Monrovia Memorial Hospital's lien. The court found that Monrovia failed to provide sufficient evidence to establish that its requested charges were reasonable and consistent with a "reasonable cost basis" as required for long-term care hospitals exempt from the Official Medical Fee Schedule. Lien claimants bear the affirmative burden of proving the reasonableness of their liens by a preponderance of the evidence. The Board also noted that discovery was properly closed at the lien conference, precluding Monrovia's delayed introduction of evidence.

Workers' Compensation Appeals BoardJoint Findings and OrderIndustrial InjuryCervical SpineLumbar SpineRight HipBilateral KneesPsycheLien ClaimantMonrovia Memorial Hospital
References
Case No. ADJ6884625
Regular
Jun 19, 2012

JASON PETERSON, KIRSTIE MCCRAINE-PETERSON vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

This case concerns the death of Jason Peterson, a correctional officer, from a pulmonary embolism after injuring his calf in a kickboxing class. The applicant, his widow, claimed the injury and death were work-related, arguing the kickboxing class was a reasonable expectancy of employment due to a general fitness requirement and incentive program. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's decision, finding the claim barred by Labor Code Section 3600(a)(9) because the decedent's belief that kickboxing was required was not objectively reasonable, as mere general assertions of fitness expectations are insufficient. Commissioner Brass dissented, believing the decedent's participation was both subjectively and objectively reasonable given its likely benefit to his job performance as a correctional officer.

Labor Code Section 3600(a)(9)Pulmonary EmbolismCorrectional OfficerKickboxingOff-duty Recreational ActivityReasonable Expectancy of EmploymentSubjective BeliefObjective ReasonablenessEzzy testCity of Stockton v. Workers' Comp. Appeals Bd. (Jenneiahn)
References
Case No. ADJ2519091 (LAO 0824930) ADJ4160066 (LAO 0824931) ADJ188382 (LAO 0828971)
Regular
Aug 18, 1941

MARIA MARXUACH vs. WESTIN BONAVENTURE HOTEL, ZURICH NORTH AMERICAN INSURANCE

The Workers' Compensation Appeals Board denied reconsideration in this case, upholding the judge's decision. Discovery closed by operation of law on September 12, 2007, and the applicant's attorneys failed to demonstrate due diligence in listing crucial medical reports as exhibits prior to this closure. Despite numerous continuances and attempts to amend the exhibit list, discovery was never formally reopened. The Board adopted the judge's reasoning that the applicant did not establish why the exhibits could not have been presented with reasonable diligence before discovery closed.

Mandatory Settlement ConferencePre-trial conference statementdiscovery closureadministrative law judgePetition for Reconsiderationreopen discoverydue diligenceexhibition listWCJ reportWorkers' Compensation Appeals Board
References
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