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Case Law Database

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

Case No. ADJ739750 (FRE 0217695) ADJ3422922 (FRE 0217696) ADJ4620151 (FRE 0217213)
Regular
Sep 23, 2010

JERRY P. WILLIAMS vs. GOLDEN STATE VINTNERS and STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) initially issued a Notice of Intention to Impose Sanctions against State Compensation Insurance Fund (SCIF) for failing to provide a computer printout of benefits. SCIF objected, asserting the printout was available at a prior Mandatory Settlement Conference (MSC) with a former attorney. Although the printout was not explicitly mentioned in the MSC pre-trial statement or offered at trial, the WCAB accepted SCIF's representation of its availability. Consequently, finding no willful failure to comply with a regulatory obligation, the WCAB dismissed the Notice of Intention to Impose Sanctions.

Workers' Compensation Appeals BoardNotice of Intention To Impose SanctionsWCAB Rule 10607computer printout of benefitsMandatory Settlement Conference (MSC)Declaration of Desiree A. Mercadopre-trial conference statementproposed exhibitsEAMSwillful failure to comply
References
Case No. ADJ3724129 (VNO 0414129) ADJ1154072 (VNO 0414130)
Regular
Oct 15, 2012

William Young vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied William Young's petition for reconsideration, upholding a judge's decision to deny penalties for the City of Los Angeles' delay in authorizing spinal surgery. The Board agreed that Labor Code section 5814(c) barred the penalty claim due to applicant's failure to properly preserve the issue. While a concurring opinion found the defendant's 32-month delay and failure to comply with statutory obligations sanctionable under Labor Code section 5813, the majority denied reconsideration. Therefore, the applicant's request for sanctions and attorney fees was ultimately unsuccessful.

Labor Code section 5814(c)unreasonable delayspinal surgerypenaltyLabor Code section 5813attorney feesLabor Code section 5814.5Petition for ReconsiderationJoint Findings and OrderWCJ
References
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. ADJ6693564; ADJ7721572 ADJ7721564; ADJ7721602 ADJ7721615; ADJ7721619 ADJ7731091
Regular
Mar 30, 2012

SHARON PORTER vs. SAVEMART SUPERMARKET, PEGASUS RISK MANAGEMENT

This case involves applicant Sharon Porter's petition for removal, seeking to overturn an administrative law judge's denial of her Petition for Relief. Porter alleged that California's statutory and regulatory scheme for obtaining Qualified Medical Evaluator (QME) panels unconstitutionally discriminates against represented workers, offering them a slower process and fewer choices than unrepresented workers. However, Porter has since obtained a QME, rendering her claim that she is currently suffering a detriment moot. Therefore, the Workers' Compensation Appeals Board dismissed her petition for removal.

Workers' Compensation Appeals BoardPetition for RemovalWCJDWC Medical UnitQualified Medical EvaluatorQME panelstatutory-regulatory schemeLabor Code section 139.2(h)(1)Administrative Director Rule 31.1(c)due process
References
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. ADJ9531226
Regular
Dec 04, 2018

JULICES MARTINEZ vs. SUN VALLEY GROUP, ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a lien claimant's petition for reconsideration, upholding the administrative law judge's decision. The lien claimant argued that the defendant's explanations of review (EORs) were deficient and did not trigger the lien claimant's obligation to request a second review. However, the Board found that the defendant's EORs substantially complied with statutory requirements and provided sufficient guidance to the lien claimant. Because the lien claimant failed to request a second review within the statutory timeframe, their objections to the billing were deemed waived.

Workers' Compensation Appeals BoardLien ClaimantExplanation of Review (EOR)Labor Code Section 4622Medical-legal ExpensesContested ClaimPetition for ReconsiderationAdministrative Director Rule 9794Second ReviewBill Review
References
Case No. MON 0310969 MON 0310972
Regular
Jul 25, 2008

SHARON DUNNIGAN vs. CITY OF INGLEWOOD

The Workers' Compensation Appeals Board granted reconsideration to amend the date from which vocational rehabilitation maintenance allowance (VRMA) was awarded. The Board found the applicant entitled to VRMA at the temporary disability rate from January 28, 2005, due to the defendant's breach of its obligation to provide timely notice of vocational rehabilitation eligibility. This date was established by calculating ten days after the defendant's presumed receipt of a physician's report indicating eligibility, accounting for mailing time.

Workers' Compensation Appeals BoardVocational Rehabilitation Maintenance Allowance (VRMA)Petition for ReconsiderationAgreed Medical EvaluatorDr. SadoffAdministrative Director Rule 9813(d)(2)Breach of ObligationQualified Injured WorkerDr. SobolDelay Rate
References
Case No. ADJ122717
Regular
Dec 13, 2012

JOE MARTINEZ vs. CDC-CORCORAN STATE PRISON, STATE COMPENSATION INSURANCE FUND

Here is a summary of the case in four sentences: The Workers' Compensation Appeals Board denied a lien claim by the CCPOA Benefits Trust Fund for over $42,000 paid to applicant Joe Martinez for living expenses. The Board found no statutory authority under Labor Code sections 4903 or 4903.1 to allow reimbursement for living expenses paid by a self-insured employee welfare benefit plan. Specifically, Labor Code section 4903.1(a)(3) only permits such liens for group disability policies under specific conditions not met here. The Board affirmed the trial judge's decision disallowing the lien.

Workers' Compensation Appeals BoardLien claimLabor Code section 4903(c)Living expensesSelf-insured employee welfare benefit planStatutory authorizationReimbursementPermanent disabilityTemporary disabilityGroup disability policy
References
Case No. ADJ1787217
Regular
Jul 27, 2011

OFELIA LLAMAS vs. SUN TEN LABORATORIES INC., ZENITH INSURANCE CO.

The Appeals Board denied a lien claimant's petition for reconsideration, upholding the disallowance of their liens for unauthorized treatment outside the Medical Provider Network (MPN). The lien claimant's arguments regarding defendant's denial of benefits and MPN notification failures were rejected, as the evidence showed timely MPN care was offered and the MPN notification issue was not raised at trial. The Board also initiated sanctions against the lien claimant's representative for filing a frivolous petition citing non-existent documents and outside evidence, finding this constituted bad faith and a waste of Board resources.

Workers' Compensation Appeals BoardLien ClaimantMPN providersunauthorized treatmentself-procure medical treatmentMPN employee notification requirementsCCR 9767.12reasonableness and necessityPetition for ReconsiderationOrder of Removal
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
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