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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. ADJ1466843 (FRE 0156295)
Regular
Aug 06, 2019

RICHARD AVILA vs. PAYLESS CASHWAYS, CONTINENTAL INSURANCE COMPANY, CNA CLAIMPLUS

This case involves Applicant Richard Avila's petition for reconsideration of a Workers' Compensation Appeals Board decision. The Board dismissed the petition because it was skeletal and failed to meet statutory and regulatory requirements. Specifically, the petition did not detail the grounds for reconsideration, cite supporting evidence from the record, or clearly set forth legal arguments. Therefore, the Board found the petition procedurally deficient and dismissed it.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalSkeletal PetitionLabor CodeCal. Code Regs.Administrative Law JudgeSpecificityMaterial EvidenceRecord References
References
Case No. ADJ7555362, ADJ7555361
Regular
Nov 12, 2014

GABINO ESTRELLA vs. COVERT IRON WORKS, CYPRESS INSURANCE COMPANY, Administered by Berkshire Hathaway Homestate Companies

This case involves lien claimants seeking reconsideration of an order disallowing their liens. The Workers' Compensation Judge (WCJ) found the lien claimants failed to meet statutory requirements for payment and did not demonstrate the necessity of services for the industrial injury. The settlement agreements presented by the lien claimants were not enforceable against defendant Cypress Insurance Company as they explicitly named other entities for payment and did not show privity with Cypress. Therefore, the Workers' Compensation Appeals Board denied the petition for reconsideration, upholding the WCJ's decision.

Workers' Compensation Appeals BoardLien ClaimantsPetition for ReconsiderationJoint Findings and OrderLabor Code section 4903.8Compromise and ReleaseOrder Approving Compromise and ReleaseSettlement AgreementsPrivityIndustrial Injury
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. ADJ4843767 (MF)
Regular
May 18, 2017

FELIX AGUILAR vs. WAREHOUSE DISCOUNT CENTER, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) dismissed Felix Aguilar's petition for reconsideration. The petition failed to meet statutory and regulatory requirements by being skeletal, lacking specific references to the record and legal principles, and not detailing how evidence supported his claims. Therefore, the WCAB found the petition insufficient and dismissed it.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportLabor Code § 5902Cal. Code Regs. tit. 8 § 10842Cal. Code Regs. tit. 8 § 10846Cal. Code Regs. tit. 8 § 10852skeletal petitionmaterial evidencespecific references
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
Case No. ADJ4647589
Regular
Dec 10, 2019

ORIS PAYTON vs. CAL EXPO FAIRGROUNDS, CALIFORNIA FAIR SERVICES AUTHORITY

The Workers' Compensation Appeals Board (WCAB) denied the applicant's petition for reconsideration. The applicant sought further physical therapy beyond the statutory limit of 24 visits. The WCAB adopted the Workers' Compensation Administrative Law Judge's report, which concluded that the WCAB lacks the authority to challenge the constitutionality of a statute, including Labor Code section 4604.5, which limits physical therapy visits. Therefore, the applicant's request for treatment exceeding the statutory allowance was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAdministrative Law JudgeFindings and AwardIndustrial InjuryCumulative Work ActivitiesMedical TreatmentPhysical TherapyStipulationsAgreed Medical Examiner
References
Case No. ADJ8132431
Regular
Feb 12, 2018

Nichole Delgado vs. EL TEPEYAC CAFÉ; CRMBC(SIG), AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board affirmed a prior decision finding the defendant liable for a lien claimant's photocopying services. The Board determined the lien claimant complied with statutory requirements for valid liens, including a declaration under penalty of perjury. Furthermore, the defendant failed to timely object to the billed services or their reasonableness within the 60-day period mandated by Labor Code section 4622. Consequently, the defendant is liable for the billed amount, a 10% statutory increase, and interest.

Labor Code section 4622Labor Code section 4903.8medical-legal lienphotocopy servicesdeclaration under penalty of perjuryreasonableness of chargesstatutory increaseinterestobjection periodtimely filing
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. ADJ4471046 (STK 0208353)
Regular
Feb 03, 2017

SHARON PADRON vs. FRITO LAY, SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) rescinded the original award due to concerns about exceeding statutory temporary disability limits and an unclear basis for the defendant's credit of $37,700.35. The WCAB found the award for temporary disability indemnity likely surpassed the 104-week statutory maximum under Labor Code section 4656(c)(1). Furthermore, the WCAB determined the credit calculation was not adequately supported by evidence, particularly regarding whether applicant contributed to disability plans and thus whether a proportional credit applied per *Fraide*. The case was returned to the trial level for further proceedings to clarify these issues and recalculate any permissible credit.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardTemporary Disability IndemnityCreditShort-Term DisabilityLong-Term DisabilityLabor Code Section 3751(a)Cumulative Trauma InjuryBilateral Knees
References
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