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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 The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr.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. ADJ3525697 (LAO 0534774) ADJ2342373 (LAO 0512482) ADJ1310306 (LAO 0568035) ADJ2645702 (LAO 0519888) ADJ1384751 (LAO 0568036) ADJ2871875 (ANA 0235799)
Regular
Feb 03, 2017

ALICE BRYANT vs. REGENTS OF THE UNIVERITY OF CALIFORNIA, permissibly self-insured, UCLA MEDICAL CENTER; SEDGWICK CLAIMS MANAGEMENT SERVICES

This case involves applicant Alice Bryant's petition for reconsideration of prior dismissed workers' compensation claims and a Labor Code section 132a retaliation claim. The Workers' Compensation Appeals Board (WCAB) denied reconsideration, upholding the administrative law judge's findings. The WCAB concluded that Bryant's claims were previously dismissed, with some dismissed by her own request and others for failure to prosecute. Furthermore, the WCAB found that Bryant failed to demonstrate extrinsic fraud and lacked the required diligence to reopen these final dismissals, even with newly discovered evidence.

Workers' Compensation Appeals BoardRegents of the University of CaliforniaSedgwick Claims Management ServicesPetition for ReconsiderationFindings and OrdersWorkers' Compensation Administrative Law JudgeLabor Code section 132aRetaliation claimExtrinsic fraudDismissed claims
References
Case No. ADJ1282419 (LAO 0846452) ADJ915214 (LAO 0854736)
Regular
Feb 01, 2010

VALERIE VANCE DILLON vs. TJ MAXX, CNA CLAIMS PLUS

This case involves a Compromise and Release agreement between the applicant and defendants. The Board granted reconsideration, rescinded the prior decision, and returned the matter to the trial level. This action is contingent on the workers' compensation administrative law judge approving the settlement. If not approved, the original decision could be reinstated, with the right to seek reconsideration.

Compromise and ReleasePetition for ReconsiderationGrant ReconsiderationRescind DecisionTrial LevelWorkers' Compensation Appeals BoardAdministrative Law JudgeSalvage and ClaimsSalvage and ClaimsSalvage and Claims
References
Case No. ADJ1643143 (SRO 0122410)
Regular
May 25, 2010

JUAN ESCUTIA vs. NICK LERAS WATER TRUCKS, et al.

The Workers' Compensation Appeals Board affirmed a prior decision holding the State Compensation Insurance Fund (SCIF) liable for reimbursement to the California Insurance Guarantee Association (CIGA). CIGA, adjusting claims for an insolvent insurer, sought reimbursement for various administrative expenses, including bill review, court reporter fees, and opposing counsel fees incurred while administering an injured worker's claim. The Board found these costs, particularly bill review expenses, were part of "incurred losses" under the California Workers' Compensation Uniform Statistical Reporting Plan and thus reimbursable. This decision establishes that CIGA can recover such administrative costs from a solvent insurer when adjusting claims for an insolvent carrier.

CIGASCIFBill ReviewIncurred LossesLoss Adjustment ExpensesInsurance Code Section 1063.1(c)(9)Labor Code Section 5500.5(e)California Workers' Compensation Uniform Statistical Reporting PlanReconsiderationFindings and Orders
References
Case No. ADJ1868495 (VNO 0452398) ADJ4538828 (VNO 0468076)
Regular
Dec 14, 2012

JORGE HERNANDEZ vs. CRESCENT TRUCK LINES, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CLAIMS MANAGEMENT SERVICES, RELIANCE NATIONAL INSURANCE COMPANY

This case concerns the California Insurance Guarantee Association (CIGA) seeking reimbursement from the State Compensation Insurance Fund (SCIF) for costs incurred administering workers' compensation claims. The WCJ initially awarded CIGA reimbursement for benefits paid but not for associated administration expenses. The Appeals Board granted CIGA's reconsideration petition, ruling that CIGA is entitled to reimbursement for both benefits and specific claim administration expenses, including medical-legal costs. The Board amended the findings and award to reflect this, returning the matter to the trial level for further proceedings.

CIGAReliance National Insurance CompanySedgwick Claims Management ServicesState Compensation Insurance Fund (SCIF)Petition for ReconsiderationJoint Findings and Award (F&A)reimbursementassociated expensesmedical treatmentloss adjustment expense
References
Case No. LAO 823855, LAO 823856
Regular
Oct 03, 2007

PEDRO M. RODRIGUEZ vs. RALPHS GROCERY COMPANY

The applicant sought reconsideration of a denial of workers' compensation benefits, which was based on the finding that his claims were filed after notice of termination. The Board affirmed the denial, concluding that the applicant's job abandonment led to a termination prior to the filing of his claims. The Board also determined that the employer properly denied both the specific and cumulative trauma claims, thus negating a presumption of compensability.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderFindings of FactAdministrative Law JudgeApplicantDefendantRalphs Grocery CompanySecurity GuardIndustrial Injury
References
Case No. ADJ4718149 (GRO 0034104) ADJ708995 (GRO 0034105)
Regular
Jul 03, 2012

ART QUIROS vs. SUPERIOR TANK COMPANY, INC., SEABRIGHT INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded an earlier order awarding reimbursement to the Employment Development Department (EDD). The Board found that EDD's claim for reimbursement was invalid because EDD failed to provide the defendant with proper written notice of the lien claim and its extent, as required by Labor Code section 4904(a). Although EDD argued oral notice was given at hearings, the Board held that statutory law mandates written notification for a lien to be valid. Therefore, EDD's claim for reimbursement was disallowed.

Workers' Compensation Appeals BoardSuperior Tank CompanySeabright Insurance CompanyEmployment Development Departmentlien claimCompromise and Releasewritten noticeLabor Code section 4904(a)actual or constructive noticetemporary disability benefits
References
Case No. ADJ746026 (SJO 0221595) ADJ1315805 (SJO 0221596) ADJ2490198 (SJO 0221597) ADJ1525795 (SJO 0234303)
Regular
Feb 03, 2010

GILBERT GASKA vs. EAST SIDE UNION HIGH SCHOOL, ACE/USA, CALIFORNIA INSURANCE GUARANTEE ASSOCATION

This case involves claims for reimbursement between two insurers covering applicant's industrial injuries. CIGA, representing an insolvent insurer, sought reimbursement from ACE/USA for medical benefits paid. The arbitrator initially awarded CIGA approximately $105,000, later amended to $138,555.15 due to a clerical error. ACE/USA petitioned for reconsideration, arguing CIGA's claim was untimely and improperly based on contribution or subrogation. The Board dismissed CIGA's petition as moot because the corrected award had already been issued. The Board denied ACE/USA's petition, clarifying CIGA's claim was for reimbursement under Insurance Code section 1063.1, not untimely contribution or subrogation, and that ACE/USA was liable due to providing "other insurance" for the same injuries.

Workers' Compensation Appeals BoardCalifornia Insurance Guarantee AssociationCIGAACE/USAFremont Compensation Insurance Companyinsolvencycumulative injuryspecific injuryreimbursementcontribution
References
Case No. ADJ1521373 (SFO 0475882)
Regular
Feb 03, 2012

JOHN KOCH vs. R.E. STATE ENGINEERING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INSURANCE GROUP, in liquidation

In this workers' compensation case, the applicant's employer sought reimbursement from CIGA for benefits paid to the applicant following an industrial injury. The applicant was entitled to benefits under both California workers' compensation law and the federal Longshore and Harbor Workers' Compensation Act (LHWCA). CIGA argued it was not liable because the applicant claimed benefits under the LHWCA, which is excluded from CIGA's covered claims. The Appeals Board, however, affirmed the WCJ's decision, finding that the employer's claim for reimbursement of California statutory benefits was a "covered claim" and CIGA was liable due to the insolvency of the employer's insurer, Fremont. The Board reasoned that the employer's payment of LHWCA benefits did not make them "other insurance" and the claim was for benefits due under California law, not the LHWCA itself.

CIGAFremont Insurance GroupLongshore and Harbor Workers' Compensation ActLHWCAcollateral estoppelcovered claimInsurance Code Section 1063.1insolvencyreimbursementstate workers' compensation
References
Case No. ADJ9030735
Regular
Jul 08, 2014

HECTOR CASILLAS vs. XERXES CORPORATION, BROADSPIRE CLAIMS SERVICES

The Workers' Compensation Appeals Board denied Xerxes Corporation's Petition for Removal. The Board found that while the defendant raised legitimate concerns about potential fraud, these issues were not relevant to the applicant's current claim. The Board adopted the administrative law judge's report, concluding that the evidence presented did not support a fraudulent claim and the forum was not appropriate for addressing concerns about running, capping, and steering. Therefore, the petition was denied.

Petition for RemovalWorkers' Compensation Appeals Boardrunningcappingsteeringfraudulent claimadministrative law judge reportADJ9030735Xerxes CorporationBroadspire Claims Services
References
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