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

Case No. ADJ9346293
En Banc
Jan 13, 2020

ANTHONY DENNIS vs. STATE OF CALIFORNIA – DEPARTMENT OF CORRECTIONS AND REHABILITATION INMATE CLAIMS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) issued a Notice of Intention to hold that Administrative Director (AD) Rule 10133.54 is invalid. The WCAB reasoned that the rule exceeds the AD's statutory authority and improperly restricts the WCAB's exclusive jurisdiction to adjudicate disputes over supplemental job displacement benefits (SJDB). The board also intends to affirm its prior decision that an employer must make a bona fide offer of work to an injured employee to be exempt from providing an SJDB voucher.

AD Rule 10133.54Supplemental Job Displacement BenefitBona Fide OfferExclusive JurisdictionAdministrative DirectorWorkers' Compensation Appeals BoardInmate LaborerStatutory AuthorityEn Banc DecisionReconsideration
References
Case No. ADJ9346293
En Banc
Apr 13, 2020

ANTHONY DENNIS vs. STATE OF CALIFORNIA – DEPARTMENT OF CORRECTIONS AND REHABILITATION INMATE CLAIMS, STATE COMPENSATION INSURANCE FUND

The WCAB holds that Administrative Director Rule 10133.54 is invalid as it exceeds the statutory authority granted to the Administrative Director and restricts the WCAB's exclusive power to adjudicate compensation claims. It also holds that an employer must provide a bona fide offer of work to avoid liability for a supplemental job displacement benefit voucher.

AD Rule 10133.54Supplemental Job Displacement BenefitWCAB exclusive jurisdictionadministrative director authoritybona fide work offerinmate laborstatutory authorityadjudicatory poweren banc decisionreconsideration
References
Case No. ADJ9346293
Significant
Apr 13, 2020

Anthony Dennis, Applicant vs. State of California – Department of Corrections and Rehabilitation Inmate Claims, State Compensation Insurance Fund

The Workers’ Compensation Appeals Board holds that Administrative Director Rule 10133.54 is invalid because it exceeds the AD's statutory authority and that an employer must make a bona fide offer of work to avoid liability for a supplemental job displacement benefit voucher.

AD Rule 10133.54Supplemental Job Displacement BenefitSJDB voucherexclusive jurisdictionWorkers' Compensation Appeals BoardWCABAdministrative Directorstatutory authoritybona fide offerregular work
References
Case No. ADJ9346293
Significant
Jan 13, 2020

ANTHONY DENNIS vs. STATE OF CALIFORNIA – DEPARTMENT OF CORRECTIONS AND REHABILITATION INMATE CLAIMS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board issued a Notice of Intention to find Administrative Director Rule 10133.54 invalid, asserting it oversteps the Administrative Director's authority and infringes upon the WCAB's exclusive jurisdiction to adjudicate disputes over supplemental job displacement benefits (SJDB). The Board also intends to hold that an employer must make a bona fide offer of work to avoid liability for an SJDB voucher.

Supplemental Job Displacement BenefitSJDB voucherAdministrative DirectorAD Rule 10133.54Workers' Compensation Appeals BoardWCABexclusive jurisdictionstatutory authoritybona fide offerregular work
References
Case No. ADJ2255696 (VNO 0497652)
Regular
May 15, 2009

TATIANA ZAKIANS vs. BLOOMINGDALES

Lien claimant Sam Alaiti, M.D., sought reconsideration of a WCJ's order reducing his lien by over $80\%$. The WCJ recommended granting reconsideration, noting procedural issues with the petition's timely attention by the judge. The Appeals Board found the petition timely filed, but it did not come to their attention until after the statutory reconsideration period had passed. Citing due process principles, the Board held the reconsideration period begins upon their actual notice. Therefore, the Board granted reconsideration, rescinded the prior order, and returned the matter to the trial level for further proceedings.

Lien claimantPetition for ReconsiderationOrder Reducing LienOrder to Pay Lienworkers' compensation administrative law judgeEAMSFileNetstatutory time periodAppeals Boarddue process
References
Case No. ADJ9346293
Regular
Jul 03, 2018

ANTHONY DENNIS vs. STATE OF CALIFORNIA - DEPARTMENT OF CORRECTIONS INMATE CLAIMS, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and overturned a prior decision finding the applicant, an inmate, ineligible for Supplemental Job Displacement Benefits (SJDB). The Board determined that while the applicant's appeal of the Administrative Director's presumed denial was untimely under specific regulations, the Board retains exclusive jurisdiction to adjudicate SJDB eligibility. They found the employer's offer of modified work was not bona fide as the applicant was released from prison, thus the statutory exception to SJDB did not apply. Therefore, the applicant is entitled to SJDB.

Workers' Compensation Appeals BoardSupplemental Job Displacement BenefitSJDBAdministrative DirectorRule 10133.54untimely appealdue processexclusive jurisdictioninmate laborervocational rehabilitation
References
Case No. ADJ6552646
Regular
Mar 26, 2014

CYNTHIA MOLINA vs. NORDSTROM, INC.

The Workers' Compensation Appeals Board (WCAB) rescinded a prior ruling that held the applicant responsible for medical bills incurred outside Nordstrom's Medical Provider Network (MPN). The WCAB determined that a "hold-harmless" clause in a stipulated award had no legal effect, as employers cannot assign their statutory duty to provide medical treatment. Lien claimants are subject to the WCAB's exclusive jurisdiction and can only recover from the employer under Labor Code section 4600 if the employer neglected to provide treatment. For self-procured treatment under section 4605, the employee is personally liable, and providers must pursue collection in civil court, not through WCAB liens.

Workers' Compensation Appeals BoardNordstrom Inc.Medical Provider NetworkStipulations with Request for AwardLabor Code Section 3751(b)Labor Code Section 4605Hold-Harmless ClauseLien ClaimsSelf-Procured TreatmentExclusive Jurisdiction
References
Case No. ADJ9285089
Regular
Aug 24, 2016

ANA RAMIREZ FARIAS vs. ABLE BUILDING MAINTENANCE, ZURICH NORTH AMERICA

The Appeals Board affirmed an arbitrator's decision that applicant Ana Ramirez Farias must transfer medical care to her employer's exclusive provider network, despite her continued treatment with Dr. Arthur Harris. The majority found that the collective bargaining agreement's provisions on medical treatment, negotiated under Labor Code section 3201.5, take precedence over general Medical Provider Network (MPN) statutes like section 4603.2(a)(2). The dissenting opinion argued that the collective bargaining agreement diminishes the applicant's statutory right to treatment and that section 4603.2(a)(2) should apply due to the agreement's silence on transfer of care disputes.

Labor Code section 3201.7Labor Code section 3201.5(b)Alternative Dispute Resolution (ADR)self-procure treatmentmedical controlexclusive provider networkcarve-out agreementMedical Provider Network (MPN)collective bargaining agreementagreed list of providers
References
Case No. ADJ6995425
Regular
Apr 27, 2012

SERGIO SANCHEZ vs. LIDA KOHANSAMEH, PACIFIC SPECIALTY INSURANCE

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior ruling finding the applicant an employee of Lida Kohansameh. While agreeing the applicant was not an employee of Pacific Great West Construction, the Board remanded the case for further proceedings. The trial judge must now determine if the applicant is excluded from workers' compensation coverage under Labor Code sections 3351(d) and 3352(h), specifically regarding residential or casual employment and hours worked. This decision avoids a final determination on employment status and focuses on potential statutory exclusions.

Workers' Compensation Appeals BoardLida KohansamehPacific Specialty InsuranceTristar Risk ManagementSergio SanchezFindings and OrderEmployee statusPacific Great West ConstructionReport and RecommendationPetition for Reconsideration
References
Case No. VNO 497379
Regular
Dec 27, 2007

AGNES MERCADO vs. AMERICAN DAWN, INC., HIGHLANDS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to correct errors in the original award to lien claimant S&B Surgery Center. The Board reduced the award for certain epidural injections and a lysis procedure based on corrected billing and relevance of the comparative study. Despite defendant's arguments, the Board affirmed the award of statutory interest on unpaid medical bills, finding the defendant failed to meet statutory requirements for contesting payment.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationFindings and AwardEpidural BlocksLumbar DiscographyCompromise and ReleaseLabor Code Section 4603.2Medical TreatmentInterest
References
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