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Case Law Database

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

Case No. ADJ2 186466 (LAO 0872140) ADJ1902141 (LAO 0877542)
Regular
Dec 08, 2015

AMADO URIAS vs. VALLEY COUNTY WATER DISTRICT, ACWA JOINT POWERS INSURANCE AGENCY

The applicant, Amado Urias, sought reconsideration of a Workers' Compensation Appeals Board decision regarding claims for back, internal system, and psychological injuries. The Board agreed to amend the temporary disability end date to May 3, 2007, as stipulated by both parties. However, the Board rescinded findings on permanent disability and attorney fees, remanding the issue of apportionment of the applicant's hypertension impairment back to the trial level for further development of the record. The WCJ's reasoning on vocational expert opinions and psychiatric apportionment was adopted, but Dr. Stewart's apportionment of hypertensive impairment was rejected for failing to meet California's causation-based standard.

Workers' Compensation Appeals BoardAmado UriasValley County Water DistrictACWA Joint Powers Insurance AgencyOpinion and Decision After ReconsiderationAmended Joint Findings Award and Ordervocational expertdiminished future earnings capacityapportionmentpsychiatric disability
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. ADJ353821 (VNO 0385973)
Regular
Dec 13, 2010

ALAN CRONIN vs. MEDICAL DATA ELECTRONICS, TRAVELERS DIAMOND BAR

This case involves an employer's petition for reconsideration of an order denying their request to depose the applicant's wife and imposing sanctions for a frivolous filing. The employer argued the deposition was necessary to investigate falls from the applicant's wheelchair and potential subrogation, but the Workers' Compensation Appeals Board (WCAB) affirmed the administrative law judge's decision. The WCAB found no good cause for the deposition, deeming the petition frivolous due to the lack of evidence supporting the employer's claims and the applicant's testimony that he was not injured from the fall. Therefore, the WCAB denied the employer's petition for reconsideration and upheld the sanctions.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderDepositionProtective OrderSanctionsLabor Code section 5813Frivolous PetitionCaregiver ServicesSubrogation
References
Case No. ADJ7296817
Regular
Apr 25, 2017

BEATRICE SYWASSINK vs. PACIFIC GAS AND ELECTRIC COMPANY

The Workers' Compensation Appeals Board affirmed a prior decision denying Pacific Gas and Electric Company's (PG&E) claim for credit against Beatrice Sywassink's National Vaccine Injury Compensation Program (NVICP) award. The Board found that the NVICP, designed as a no-fault system, expressly prohibits compensation for expenses already covered by state compensation programs like workers' compensation. Allowing PG&E a credit would frustrate the intent of the federal program and potentially violate the Supremacy Clause. Furthermore, PG&E lacked standing to pursue a claim under the NVICP itself, and the program, not PG&E, holds subrogation rights to prevent double recovery.

NVICPthird party creditsubrogation statutesLabor Code section 3861Petition for ReconsiderationFindings and Ordervaccine injury compensationduplicative recoveryMICRAGraham v. Workers' Comp. Appeals Bd.
References
Case No. ADJ2117331 (OAK 0261803)
Regular
May 31, 2017

Janice Payne vs. Federal Express, BROADSPIRE

This case involves Janice Payne seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying her weight loss program extension. The WCJ initially ruled he lacked jurisdiction due to prior Utilization Review (UR) and Independent Medical Review (IMR) denials, which were not appealed. However, the applicant argued a 2003 Compromise and Release agreement designated Dr. Mandel as the ultimate medical arbiter for treatment disputes, superseding UR/IMR. The WCAB granted reconsideration, finding the contractual agreement to use Dr. Mandel remains enforceable despite subsequent UR/IMR legislation. The case is remanded to the trial level to consider Dr. Mandel's opinions on the weight loss program's medical necessity.

Compromise and ReleaseMedical ArbiterUtilization ReviewIndependent Medical ReviewWeight Loss ProgramContractual AgreementJurisdictionSubstantial JusticeStipulationMedical Treatment Dispute
References
Case No. VNO 0467089
Regular
Jun 20, 2008

LUIS ARAGON vs. THE CHEESECAKE FACTORY, U.S. FIDELITY AND GUARANTY, GALLAGHER BASSETT SERVICES

This case concerns a medical provider's lien claim after the applicant's workers' compensation claim was settled. The lien was initially disallowed because the provider had received payment from Medi-Cal and had not yet reimbursed the program. The Appeals Board granted reconsideration, amending the award to allow the provider to pursue its lien claim, but only after proving full reimbursement to Medi-Cal as required by Welfare and Institutions Code section 14124.791. Jurisdiction is reserved for further proceedings at the trial level.

Workers' Compensation Appeals BoardLien claimantMedi-Cal reimbursementWelfare and Institutions Code § 14124.791Industrial injuryBelow the knee amputationCompromise and releasePetition for reconsiderationReport and RecommendationFindings and Award
References
Case No. ADJ1626199 (SAC 323236)
Regular
Apr 14, 2009

STEVEN WILLIAMS vs. EARTHLINK, INC., FEDERAL INSURANCE COMPANY, CHUBB SERVICES CORPORATION

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior award, finding that defendant was not obligated to pay additional funds to the Employment Development Department (EDD). The Appeals Board determined that the EDD lien had been fully resolved through a prior compromise agreement where the defendant paid $13,500.00. Therefore, the defendant is entitled to credit for the full $18,890.00 EDD paid applicant, with no additional indemnity owed to the applicant or attorney fees awarded.

ReconsiderationEDD lientemporary disability indemnitycompromise agreementcreditsubrogationattorney feescumulative traumaFindings and AwardLabor Code
References
Case No. ADJ2296444 (LAO 0786271)
Regular
Feb 10, 2015

CAROLYN HOLMAN vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, P S-I, A B SEDGWICK CLAIMS MANAGEMENT SERVICES

The Workers' Compensation Appeals Board affirmed a WCJ's decision denying liens for Dr. Burstein and The Prescription Center. The Board found no evidence Dr. Burstein treated the applicant for industrial injuries, nor that his services or charges were reasonable and necessary. Consequently, The Prescription Center's lien for filling prescriptions from Dr. Burstein was also denied as not related to the industrial injury. Both lien claimants failed to meet their burden of proof regarding the reasonableness and necessity of their claims.

Workers' Compensation Appeals BoardLien claimantPetition for ReconsiderationFindings and OrdersWCJStipulations with Request for AwardIndustrial injuryReasonableness of chargesNecessity of servicesBurden of proof
References
Case No. ADJ1058308 (VNO 0482296)
Regular
May 28, 2013

DONNA DeRUSSY vs. ANTELOPE VALLEY HEALTH CARE SYSTEM, TRAVELERS INSURANCE, SAFETY NATIONAL, FRONTIER INSURANCE

This case involves a workers' compensation appeal where the defendants seek reconsideration of a prior award. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The primary grounds for this decision were that the defendants were denied due process by not being given an opportunity to cross-examine the rating rater and that the award relied on outdated medical reports. The WCAB also suggested obtaining current medical evaluations due to the time elapsed since the original reports.

Workers' Compensation Appeals BoardReconsiderationJoint Findings and AwardAttorney FeesPermanent Disability RatingApportionmentIndustrial InjuryLumbar SpineTreating PhysiciansMedical Reports
References
Case No. LAO 0762226, LAO 0762227
Regular
Sep 05, 2007

SHIRLEE DYERLY vs. LAWRY'S RESTAURANT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for SUPERIOR NATIONAL INSURANCE COMPANY, INTERCARE INSURANCE SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY

This case involves a dispute over insurance coverage for an applicant's neck and back injuries sustained across specific and cumulative trauma incidents. The Workers' Compensation Appeals Board (WCAB) is reconsidering an arbitrator's decision that ordered Zurich North America Insurance Company to reimburse the California Insurance Guarantee Association (CIGA) for all benefits paid by the liquidated California Compensation Insurance Company (Cal Comp). The WCAB rescinds the arbitrator's order, ruling that CIGA can only recover the amount Cal Comp would have been entitled to collect had it not been liquidated, not the full amount paid.

CIGACal CompZurichliquidationcontributionreimbursementspecific injurycumulative traumastatute of limitationsjoint findings
References
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