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

Case No. ADJ1139186 (OAK 0308001) ADJ483865 (OAK 0308002) ADJ6524430
Regular
Jan 06, 2011

PATRICK RECORDS vs. WASTE MANAGEMENT OF ALAMEDA COUNTY AND CIGA, CONVERIUM, ACE, ET AL.

The Workers' Compensation Appeals Board granted reconsideration to address CIGA's claim for contribution against Converium for a cumulative trauma injury ending February 15, 2000. CIGA argued that the statute of limitations was tolled by medical treatment and payments made under a Compromise and Release Agreement. However, the Board found the record insufficient, lacking crucial medical evidence regarding the cumulative trauma injury and benefit payment details. Therefore, the case was returned to the trial level to allow the admission of necessary documents, including the Agreed Medical Examiner's reports and a clear benefit payment printout, to determine the validity of CIGA's contribution claim.

CIGAConverium InsuranceContribution claimCumulative traumaStatute of limitationsCompromise and Release AgreementTollingMedical treatmentAgreed Medical ExaminerApplication for Adjudication of Claim
References
Case No. ADJ4454017 (VNO 0518656)
Regular
Aug 11, 2009

SERGIO PLACENCIA vs. ANVIL STEEL CORPORATION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted defendant's Petition for Reconsideration. The Board found the WCJ erred by issuing a decision on an undeveloped record regarding lien claimant's medical billings. The WCJ identified issues needing further evidence, particularly concerning the reasonableness and necessity of treatment and the adherence to the Official Medical Fee Schedule, but failed to allow parties to supplement the record. Consequently, the May 19, 2009 Findings and Award were rescinded, and the case was returned for further development of the record.

Lien claimantPetition for ReconsiderationOfficial Medical Fee Schedule (OMFS)WCJFindings and AwardFurther development of the recordLabor Code sections 5701 and 5906Reasonably required medical treatmentReasonable expense of treatmentRescinded
References
Case No. ADJ282433 (LAO 0880367)
Regular
Jun 08, 2015

MICHAEL DUFFEY vs. CMH RECORDS, STATE FARM INSURANCE COMPANY

The Appeals Board granted reconsideration to admit previously excluded defendant exhibits, specifically the depositions and report of Drs. Miller and Saint Martin. Despite ruling the exhibits admissible, the Board affirmed the original finding that defendant failed to present substantial evidence to terminate applicant's continuing home health care. Dr. Miller's change of opinion was deemed unsubstantiated, and Dr. Saint Martin's opinion was deemed irrelevant to the specific terms of the prior stipulation. The Board emphasized that admitting the evidence ensures due process and reinforces the integrity of its decision.

Petition for ReconsiderationFindings and AwardHome Health CareSubstantial EvidenceAdmissible ExhibitsDepositionMedical ReportAgreed Medical EvaluatorPrimary Treating PhysicianDue Process
References
Case No. VNO 275186
Regular
Aug 08, 2007

BILLY RECORD vs. ALL PAYMENT PAYROLL SERVICES, STU SEGALL PRODUCTIONS, INC., TIG INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed a lien claimant's petition for reconsideration as untimely because it was filed three days after the statutory deadline. The Board clarified that the time limit for filing a petition for reconsideration is jurisdictional and cannot be extended by citing clerical error or Code of Civil Procedure section 473. Therefore, the petition was dismissed, and the Board noted it would have been denied on the merits even if timely.

Lien claimantPetition for Reconsiderationuntimelyclerical errorofficial medical fee scheduleusual and customary chargesWCJLabor CodeCode of Civil Procedurejurisdictional
References
Case No. ADJ8479429
Regular
Feb 25, 2016

OSCAR PINEDA vs. MAGIC FIX AUTO, MID CENTURY INSURANCE

The applicant's claim for psychiatric injury is barred by Labor Code section 3208.3(d) because he was employed for less than six months and the injury was not caused by a sudden and extraordinary employment condition. The finding of permanent disability is rescinded as it included psychiatric impairment and was based on an incorrect occupational group. The finding of temporary total disability is also rescinded due to lack of substantial evidence and undeveloped record regarding orthopedic issues. The matter is returned for further development of the record concerning orthopedic injuries.

Workers' Compensation Appeals BoardReconsiderationLabor Code Section 3208.3(d)Psychiatric InjurySudden and Extraordinary Employment ConditionSix-Month Employment ThresholdPermanent DisabilityApportionmentTemporary DisabilityAgreed Medical Evaluator
References
Case No. ADJ4016080 (VNO 0496113)
Regular
Sep 08, 2009

SUZANNE KUYUMDZHYAN vs. JONS MARKETPLACE, ZURICH NORTH AMERICA

The Appeals Board granted reconsideration for both the defendant and lien claimant concerning an Amended Findings and Award. The original decision awarded the lien claimant payment for 18.5 hours of interpreting services, but the defendant argued the lien claimant failed to prove reasonableness and necessity of the services. The Board found the record undeveloped regarding the reasonableness and necessity of Dr. Rahimi's treatment and consequently, the derivative interpreting services. Therefore, the matter is remanded to the trial level for further proceedings to develop the record on these issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationAmended Findings and AwardLien claimantInterpreting servicesCertified interpreterReasonable and necessary treatmentMedical-legal reportsCompromise and ReleaseBurden of proof
References
Case No. ADJ8015216
Regular
Aug 27, 2018

RAMON CANO-RODRIGUEZ vs. ODONA CENTRAL SECURITY CORP.; TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The WCAB granted reconsideration for both applicant and defendant, rescinding the prior award and remanding the case for further proceedings. The board found that the secondary physicians' reports, relied upon by the WCJ for findings on headaches, hypertension, diabetes, and gastritis, lacked substantial medical evidence due to inadequate history and review of medical records. The WCAB also granted applicant's petition to allow further development of the record concerning the proper method for calculating permanent disability, specifically regarding the rebuttal of scheduled ratings. This ensures substantial justice by preventing undeveloped matters from being left unaddressed.

WCABPetition for ReconsiderationIndustrial InjuryCervical SpineLumbar SpineRight ShoulderPsycheSleep DisorderGastritisHeadaches
References
Case No. ADJ6875791
Regular
Dec 17, 2009

ARTHUR GRIMES vs. GUARANTEE RECORDS MANAGEMENT, LIBERTY MUTUAL INSURANCE GROUP

The WCJ's Order regarding discovery and the production of documents does not constitute a final order. Defendant failed to establish that the order will result in significant prejudice or irreparable harm. The petition is dismissed.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalDiscoveryClaims FileDeclaration Under Penalty of PerjurySubpoena Duces TecumAttorney Client PrivilegeWork Product PrivilegeTrade Secret
References
Case No. ADJ870919 (ANA 0406270) ADJ2721302 (ANA 0406269)
Regular
Jun 08, 2009

DANIEL COOPER, vs. RECORDING INDUSTRY ASSOCIATION OF AMERICA, STATE COMPENSATION INSURANCE FUND

This case involves a workers' compensation applicant who sustained a psyche injury. The defendant, State Compensation Insurance Fund, initially denied liability but later accepted and paid temporary disability benefits. The Workers' Compensation Appeals Board granted reconsideration, modifying a prior award. The Board held that applicant's attorney was entitled to fees on temporary disability paid directly to the applicant, but not on amounts paid to satisfy a lien claim by the Employment Development Department. This determination was based on specific statutory requirements for fees from lien claimant recoveries, which were not met in this instance.

Workers Compensation Appeals BoardReconsiderationJoint Findings Award and OrdersAdministrative Law JudgeIndustrial InjuryPsycheTemporary DisabilityAttorney FeesState Compensation Insurance FundEmployment Development Department
References
Case No. ADJ3817836 (SJO 0250881)
Regular
May 31, 2012

ZUFAN A. REDA vs. FRY'S ELECTRONICS, INC., ZURICH NORTH AMERICAN INSURANCE

This case concerns applicant Zufan A. Reda's claim for permanent total disability due to a psychiatric injury. The Workers' Compensation Appeals Board (WCAB) is ordering the development of the record because neither the applicant's QME, Dr. Sidle, nor the defendant's QME, Dr. Keins, provided substantial evidence regarding the apportionment of psychiatric permanent disability. The WCAB found that Dr. Sidle's report incorrectly addressed causation of injury rather than apportionment of disability, and Dr. Keins' report was rejected as non-substantial due to prior rulings on industrial causation. Therefore, the WCAB has appointed Dr. Roy Curry as a "regular physician" to conduct a new evaluation on the issue of psychiatric permanent disability.

Petition for ReconsiderationDevelopment of RecordLabor Code section 5701Industrial InjuryPsychiatric InjuryCompensable ConsequenceSection 5803Section 5804Section 5410Permanent Total Disability
References
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