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

Case No. ADJ1184992
Regular
Feb 10, 2015

KATHLEEN MURPHY vs. PETSMART, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For FREMONT INSURANCE COMPANY, In Liquidation

The Workers' Compensation Appeals Board (WCAB) rescinded a penalty against Petsmart, Inc. for allegedly unreasonably delaying dental treatment. The Board found that Petsmart had no obligation to pay for the dental surgery in advance, as dictated by Labor Code section 4603.2, which requires payment within 45 days after services are provided. While the treating oral surgeon requested prepayment due to high costs, the WCAB determined that the defendant's utilization review approval for the treatment did not constitute an agreement to advance payment. Therefore, the WCAB concluded there was no unreasonable delay or refusal of treatment, negating the basis for a Labor Code section 5814 penalty.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code section 5814unreasonable delaydental careoral surgeryutilization reviewpre-authorizationpayment in advancefee schedule
References
2
Case No. ADJ207630 (VNO 0423900), ADJ4689357 (VNO 0462906)
Regular
Feb 11, 2015

MANUEL PASQUIER vs. VOLUTONE DISTRIBUTING COMPANY, VIRGINIA SURETY INSURANCE COMPANY

This case concerns applicant Manuel Pasquier's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The WCAB initially found that the defendant unreasonably delayed three lump sum payments, resulting in interest, a $10,000 penalty under Labor Code § 5814, and attorney's fees. Pasquier argued for multiple penalties, citing the distinct nature of the payments, while the WCAB affirmed the single penalty, viewing the late payments as one act of unreasonable delay. The majority also upheld the WCJ's attorney's fee calculation, disagreeing with Pasquier's claim for higher fees and hours. However, one Board member dissented, arguing that the three distinct payments (disability indemnity, MSA seed money, and attorney's fees) constituted separate acts of unreasonable delay, each warranting an individual penalty, and supported the higher attorney's fee rate.

Compromise and ReleaseJoint Findings of Fact and Orderunreasonable delaylump sum paymentsLabor Code section 5814attorney's feeLabor Code section 5814.5Petition for Reconsiderationworkers' compensation administrative law judgeseparate acts
References
12
Case No. ADJ7365717
Regular
Oct 18, 2012

JAMES VAN DELL (Deceased), LORILENE VAN DELL (Dependent) vs. COUNTY OF LOS ANGELES

This case involves a widow's claim for death benefits after her firefighter husband died from prostate cancer. The defendant, County of Los Angeles, unreasonably delayed payment by requesting tax returns that were partially blacked out by the IRS, despite the widow's attorney providing explanations and other evidence of dependency. The Appeals Board rescinded the prior order finding no unreasonable delay, determined that a penalty is warranted due to the defendant's unreasonable refusal to provide benefits. The matter is returned to the WCJ to determine the amount of the penalty based on established legal factors.

Workers Compensation Appeals BoardDeath BenefitsPenaltiesLabor Code Section 3501Labor Code Section 5814DependencyTotal DependentPartial DependentUnreasonable DelayReconsideration
References
2
Case No. SBA 0076630
Regular
Mar 03, 2008

Janice Brackenridge-DeGraff vs. ACTMEDIA, INC., INTERCARE INSURANCE

The Workers' Compensation Appeals Board granted reconsideration, overturning a prior decision that denied penalties for delayed payment. The Board found the employer unreasonably delayed payment of the compromise and release agreement by 10 days beyond the agreed-upon 30-day deadline. Consequently, the Board awarded a 5% penalty on the delayed amount and a separate 5% penalty for the unreasonable delay in paying the legally owed interest.

Labor Code section 5814ReconsiderationCompromise and ReleasePenaltyUnreasonable DelayPaymentInterestAttorney's FeesCIGAWCJ
References
1
Case No. MON 248520, MON 248521 MON 244922
Regular
Oct 01, 2007

MARIA MARQUEZ vs. GEORGE INDUSTRIES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for FREMONT INDEMNITY COMPANY, CAMBRIDGE INTEGRATED SERVICES GROUP

The Workers' Compensation Appeals Board granted reconsideration, finding that Insurance Code section 1063.1(c)(8) does not bar penalties against the California Insurance Guarantee Association (CIGA) for its *own* unreasonable delays in payment. The Board held that this exclusion specifically applies to delays caused by the insolvent insurer, not CIGA's subsequent administration. The case was returned to the trial level to determine if CIGA unreasonably delayed payments and to potentially award penalties.

CIGA liabilityInsurance Code 1063.1(c)(8)Unreasonable delayTemporary disability indemnityFremont Indemnity liquidationStipulated awardLabor Code 5814Labor Code 4650(d)Insolvent insurerCovered claims exclusion
References
16
Case No. ADJ2562535 (BAK 0151733)
Regular
Jan 07, 2014

STEVE ADAMS vs. COUNTY OF KERN, Permissibly Self-Insured

The Workers' Compensation Appeals Board reversed a finding that the defendant did not unreasonably delay compensation payments. The applicant sustained an industrial injury to his pulmonary system, and medical evidence confirmed the injury was work-related. The Board found that despite the existence of an agreed medical examiner's report confirming the injury, the defendant's denial of liability persisted for an unreasonable period. Consequently, the defendant was found to have unreasonably delayed payments for temporary disability, permanent disability, and mileage reimbursement, with the penalty amount to be determined.

Industrial InjuryPulmonary SystemCode Compliance OfficerPermanent DisabilityReconsiderationLabor Code 5814Delay PenaltiesAgreed Medical ExaminerPulmonary DiseaseOccupational Asthma
References
6
Case No. ADJ3896979 (VNO 0446477) ADJ356534 (AGO 0017757)
Regular
May 19, 2010

CLAUDIA BANNISTER vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board rescinded an administrative law judge's award of a 25% increase in permanent disability payments. The Board found no evidence that the City of Los Angeles unreasonably delayed or refused payments. The defendant had advanced over $34,000 in permanent disability payments and had the right to credit these against the applicant's award as stipulated. The matter was returned to the trial level for further proceedings regarding commutation of benefits.

Workers' Compensation Appeals BoardReconsiderationStipulated AwardPermanent DisabilityVocational Rehabilitation Maintenance AllowanceOverpaymentCreditCommutationUnreasonable RefusalLabor Code § 5814
References
0
Case No. SAL 0048019
Regular
May 28, 2008

CONN TRENNER vs. MONTEREY PENINSULA AIRPORT DISTRICT, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, reversing the finding of unreasonable delay in authorizing the applicant's ablation procedure. However, the Board affirmed the finding of unreasonable delay in SCIF's payment of the applicant's co-payment for the procedure, upholding the associated penalty. The matter was returned to the trial level to determine the appropriate attorney's fee award under Labor Code section 5814.5.

Labor Code section 5814Labor Code section 4610Labor Code section 5814.5utilization reviewunreasonable delaypenaltyablation procedureco-paymentreimbursementattorney's fees
References
1
Case No. ADJ1226686 (WCK 60788)
Regular
Oct 29, 2008

CATHY BAKER vs. JAMES H. KHOE, D.D.S., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board corrected a clerical error in a prior decision, specifically changing a finding from "Defendant did unreasonably delay or refuse medical treatment" to "Defendant did *not* unreasonably delay or refuse medical treatment." This correction was made after the defendant alerted the Board to the mistake, and the Board exercised its authority to correct clerical errors at any time. Consequently, the defendant's petition for reconsideration was dismissed as moot.

WORKERS' COMPENSATION APPEALS BOARDCLERICAL ERRORPETITION FOR RECONSIDERATIONLABOR CODE § 5814MEDICAL TREATMENTDELAYREFUSALDECISION AFTER RECONSIDERATIONCORRECTINGDISMISSAL
References
1
Case No. ADJ818114 (FRE 0246252)
Regular
Nov 23, 2010

JOSE FLORES vs. STATE OF CALIFORNIA, CDCRCALIFORNIA SUSTANCE ABUSE TREATMENT, Legally Uninsured; STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior award, and remanded the case for further proceedings. The Board found no unreasonable delay in temporary disability payments but agreed there was an unreasonable delay in permanent disability payments. The Board also vacated the award of attorney's fees to the self-represented applicant, finding it impermissible. The case was returned for the judge to reconsider penalty calculations and explain the basis for any future awards.

Workers Compensation Appeals BoardLabor Code Section 5814PenaltiesUnreasonable DelayTemporary Disability BenefitsPermanent Disability BenefitsReconsiderationFindings of FactOrder and AwardMedical Treatment
References
13
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