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

Case No. ADJ 4200496 (GRO 0030688)
Regular
Jan 19, 2010

FRANCISCO MARTINEZ-REYES vs. SOLAMAR FARMS, INC., STATE COMPENSATION INSURANCE FUND

This case concerns the proper method for calculating permanent disability award commutations for a farm laborer with 100% disability sustained on February 10, 2004. The applicant appeals the administrative law judge's decision favoring the Uniformed Reduction (UR) method, arguing the Uniformed Increasing Reduction (UIR) method better accounts for state average weekly wage (SAWW) increases mandated by Labor Code section 4659. The Appeals Board granted reconsideration, rescinded the prior decision, and remanded the case for a new decision. The Board found the UIR method better serves the goal of consistent periodic payments, and the SAWW increase commencement date was not moot.

Workers' Compensation Appeals BoardUniformed Reduction (UR)Uniformed Increasing Reduction (UIR)State Average Weekly Wage (SAWW)Permanent Disability AwardCommutationLabor Code Section 4659Life PensionTotal Permanent DisabilityCost of Living Adjustment (COLA)
References
1
Case No. MON 0304723
Regular
Jul 15, 2008

KHALIL TANTAWI vs. UNIFORMS, INC., MICROSOURCE MANAGEMENT, INC., GRANITE STATE INSURANCE COMPANY, AIG CLAIM SERVICES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration of an arbitrator's decision that Granite State Insurance Company and State Compensation Insurance Fund only covered clerical and outside sales staff for Microsource Management, Inc. The Board found the arbitrator's decision lacked required express findings of fact and a determination of rights, and rescinded the decision. The case is returned to the trial level for further development of evidence regarding the applicant's exact job role on the date of injury and to issue a new decision with proper findings and an order.

Workers Compensation Appeals BoardKhalil TantawiUniforms IncMicrosource Management IncGranite State Insurance CompanyAIG Claim Services IncState Compensation Insurance Fundspecial employergeneral employeroutside salesperson
References
3
Case No. ADJ288083 (RDG 0128539)
Regular
Jun 01, 2010

JACOB VERVALIN vs. MISSION UNIFORM & LINEN, TRAVELERS INSURANCE

The Appeals Board rescinded the original decision, finding that the WCJ erred in admitting a supplemental AME report and authorizing spinal surgery based on it. The Board determined that the proper procedure under Labor Code sections 4610 and 4062 for disputing spinal surgery recommendations was not followed. Specifically, the medical opinions from Dr. Jones and Dr. Pappas were found to be based on inadequate reviews of the applicant's medical records, necessitating further development of the record. Consequently, the case was returned to the trial level for additional proceedings and a new decision.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjurySpinal SurgeryAgreed Medical Examination (AME)Utilization Review (UR)Labor Code Section 4610Labor Code Section 4062Second Opinion Report
References
5
Case No. MISSING
Regular Panel Decision

Claim of Buchanon v. Adirondack Steel Casting Co.

The Workers' Compensation Board's decision and amended decision, which found that the claimant did not have a total industrial disability, were affirmed on appeal. The employer's argument regarding the untimeliness of the claimant's supplemental notice of appeal was rejected due to lack of proof of service for the amended decision. The Board's plenary authority to modify previous decisions was upheld, as no facts indicated arbitrary or capricious action in amending its prior decision. The court concluded that the Board's finding of no total industrial disability was supported by substantial evidence, noting that the case involved a conflict of medical opinion, which is a factual matter for the Board to resolve. All remaining arguments by the claimant were considered and dismissed.

Workers' Compensation Law § 23Industrial DisabilityAppellate ReviewBoard Decision AffirmationMedical Opinion ConflictSubstantial EvidenceTimeliness of AppealArbitrary and Capricious StandardFactual DisputeClaimant's Appeal
References
4
Case No. MISSING
Regular Panel Decision
Dec 21, 1992

Claim of Stokes v. Permanente

The Workers' Compensation Board initially ruled that the claimant sustained a compensable injury after being struck by a car while crossing a street from a parking lot to her workplace. This decision and an amended decision were subsequently appealed. The appellate court found substantial evidence to support the Board's finding that the injury occurred while the claimant was entering the employment premises, thus arising out of and in the course of her employment. Consequently, the court affirmed the Board's decision and amended decision.

Workers' CompensationEmployment InjuryCompensable InjuryGoing and Coming Rule ExceptionParking Lot InjuryAppellate ReviewBoard Decision Affirmed
References
0
Case No. MISSING
Regular Panel Decision

Claim of Farcasin v. PDG, Inc.

Claimant, a director of research and publications, developed neck and shoulder pain radiating to his arms and hands after working for the employer for a month, attributing it to a lack of an ergonomically designed workstation and an outdated computer. A Workers’ Compensation Law Judge initially found he suffered an occupational disease. The Workers’ Compensation Board affirmed this decision, but later amended it, ruling that claimant suffered an accidental injury. The employer appealed both decisions. The Court affirmed the Board's decision, finding no abuse of discretion in amending the prior decision and that substantial evidence supported the finding of an employment-related accidental injury, which can be established by medical evidence of repetitive acts causing debilitating injury, even if symptoms accrued gradually.

Workers' CompensationAccidental InjuryOccupational DiseaseRepetitive Strain InjuryErgonomicsAppellate ReviewBoard DecisionJurisdictionMedical EvidenceGradual Injury
References
7
Case No. ADJ984305
Regular
Feb 20, 2015

JOANN MATUTE vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

This en banc decision clarifies that the 30-day deadline to appeal an Independent Medical Review (IMR) determination begins from the "mailing" date, which is legally equivalent to "service by mail." Consequently, the five-day extension provided by Code of Civil Procedure section 1013(a) for service by mail applies, making the effective deadline 35 days. The Appeals Board found the applicant's appeal timely filed on the 34th day and remanded the case for further proceedings on the merits. This ruling ensures uniformity in calculating appeal periods for IMR decisions.

En BancIndependent Medical ReviewIMR DeterminationService by MailCode of Civil ProcedureLabor CodeAdministrative DirectorUtilization ReviewTimeliness of AppealReconsideration
References
9
Case No. ADJ3563222 (SRO 0126894)
Regular
Jul 25, 2013

SHARON KARR-REDDELL vs. CHRISTOPHERSON HOMES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision regarding attorney's fees awarded to applicant's counsel, John Bloom. The WCAB found the original decision erred by calculating fees based on the gross award rather than present value and by not commuting the life pension award for fee payment. The WCAB rescinded the prior order, awarding Mr. Bloom a total of $32,768.18 in attorney's fees based on the present value of both the permanent disability and life pension awards. These fees are to be paid as lump sums commuted from the respective awards through uniform reduction of future payments.

Workers' Compensation Appeals BoardPetition for ReconsiderationPermanent Disability AwardLife Pension AwardAttorney's FeeCommutationPresent ValueUniform Reduction MethodLabor Code Section 4659(c)State Average Weekly Wage
References
0
Case No. ADJ1643143 (SRO 0122410)
Regular
May 25, 2010

JUAN ESCUTIA vs. NICK LERAS WATER TRUCKS, et al.

The Workers' Compensation Appeals Board affirmed a prior decision holding the State Compensation Insurance Fund (SCIF) liable for reimbursement to the California Insurance Guarantee Association (CIGA). CIGA, adjusting claims for an insolvent insurer, sought reimbursement for various administrative expenses, including bill review, court reporter fees, and opposing counsel fees incurred while administering an injured worker's claim. The Board found these costs, particularly bill review expenses, were part of "incurred losses" under the California Workers' Compensation Uniform Statistical Reporting Plan and thus reimbursable. This decision establishes that CIGA can recover such administrative costs from a solvent insurer when adjusting claims for an insolvent carrier.

CIGASCIFBill ReviewIncurred LossesLoss Adjustment ExpensesInsurance Code Section 1063.1(c)(9)Labor Code Section 5500.5(e)California Workers' Compensation Uniform Statistical Reporting PlanReconsiderationFindings and Orders
References
7
Case No. ADJ2218706 (VNO 0501260) ADJ1058308 (VNO 0482296)
Regular
Apr 19, 2010

DONNA DeRUSSY vs. ANTELOPE VALLEY HEALTH CARE SYSTEM, TRAVELER'S INSURANCE, SAFETY NATIONAL, FRONTIER INSURANCE

This case concerns appeals from a workers' compensation judge's decision regarding liability for cumulative trauma injury. The Appeals Board granted reconsideration to clarify the determination of the date of injury under Labor Code § 5412, which is crucial for assigning liability to the insurer covering the last year of exposure. The Board found the WCJ's decision lacked sufficient clarity and specific findings regarding disability and knowledge of causation. Therefore, the prior decision was rescinded, and the case was returned for further proceedings to make clear findings consistent with established legal principles.

Workers' Compensation Appeals BoardDonna DeRussyAntelope Valley Health Care SystemTravelers InsuranceSafety NationalFrontier Insurancecumulative traumadate of injuryLabor Code §5500.5Labor Code §5412
References
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