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

Case No. ADJ954867 (SFO 0497953)
Regular
Dec 29, 2008

HERBERT BARRIOS vs. DEEP VAC, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board partially granted reconsideration, rescinding the award of attorney's fees for frivolous tactics but affirming the award for expert witness costs and a penalty for unreasonable refusal to pay. The Board found that while SCIF's refusal to pay for the diminished future earnings capacity expert was unreasonable, their actions did not rise to the level of bad faith or frivolous conduct required for sanctions. A dissenting opinion argued to affirm the original award of sanctions, finding SCIF's actions to be unreasonable and in bad faith based on prior unfavorable decisions and testimony from SCIF's claims adjustor.

Diminished Future Earnings CapacityVocational RehabilitationLabor Code section 5811Labor Code section 5814Labor Code section 5813Expert Witness FeesReconsiderationFindings and AwardSanctionsBad Faith Tactics
References
3
Case No. ADJ3905674 (SRO 0031254)
Regular
Feb 02, 2011

DAVID PELLETIER vs. UNITED STRUCTURES, INC., CIGA by its Servicing Facility CAMBRIDGE on behalf of FREMONT COMPENSATION, in liquidation

The Workers' Compensation Appeals Board denied reconsideration of its decision regarding attorney's fees. The applicant's attorney sought fees under Labor Code sections 4607 and 5814.5, arguing the defendant unreasonably failed to appoint a new case manager and pay prior bills. The Board affirmed the judge's finding that Labor Code § 4607 fees are inapplicable when the entire award is not terminated, and Labor Code § 5814.5 fees require an existing award and unreasonable refusal to pay. The Board found no evidence of unreasonable delay by the defendant in appointing a new case manager, thus denying the petition.

Workers' Compensation Appeals BoardReconsiderationAttorney's FeesLabor Code Section 4607Labor Code Section 5814.5Medical TreatmentCompromise and ReleasePetition for PenaltyNurse Case ManagerStipulations
References
2
Case No. ADJ6678537
Regular
Oct 07, 2011

DOTTIE BRANDON-LEGGET vs. SECURITAS SECURITY SERVICES, INC.

This case involves a security guard's claim for industrial injury to her shoulder and knee. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, affirming the findings of industrial injury and temporary total disability. However, the WCAB reversed the administrative law judge's (ALJ) penalty award under Labor Code §5814, finding that the defendant's delay in paying temporary disability was not unreasonable due to genuine doubt about its liability. The WCAB emphasized that a penalty under §5814 requires unreasonable delay or refusal, and here, the defendant's doubts were not unreasonable given the applicant's delayed treatment and lack of contemporaneous complaints.

Labor Code § 5814Unreasonable DelayTemporary Total DisabilityIndustrial InjuryRight ShoulderRight KneeReconsiderationWCJ FindingsGenuine DoubtMedical Treatment
References
13
Case No. MISSING
Regular Panel Decision

Raff v. Maggio

David Raff, an arbitrator, initiated an action against Maggio, an employer, to recover unpaid arbitration fees. Maggio had refused to pay his half of the fees stemming from a labor dispute arbitration, despite previous court affirmations of the arbitration award and advice from his own counsel to pay. Raff sought the arbitration fee, interest, and attorney's fees, contending that Maggio's prolonged refusal constituted bad faith. While Maggio eventually conceded his liability for the arbitration fee, interest, and court costs after his appeal to the Supreme Court was denied, he continued to dispute the payment of attorney's fees. The court determined that Maggio's initial and persistent refusal to pay the arbitration fee, based on a meritless defense, amounted to bad faith conduct. Consequently, the court partially granted Raff's motion for summary judgment, awarding him the arbitration fee, interest, court filing costs, and attorney's fees incurred up to the point Maggio filed his answer, marking the cessation of his bad faith actions concerning the fee itself. Maggio's cross-motion for summary judgment was denied.

Arbitrator FeesLabor DisputeSummary JudgmentAttorneys' FeesBad Faith LitigationAmerican Rule (Attorneys' Fees)Collective Bargaining AgreementArbitration Award EnforcementFederal Rules of Civil Procedure Rule 56Contractual Obligation
References
17
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. MISSING
Regular Panel Decision
Sep 21, 1982

In re the Claim of Pankiewicz

Claimant was a customer service representative for New York Telephone Company who applied for unemployment benefits after his job terminated. He refused a subsequent temporary job offer from the employer, citing changes in union representation, decreased salary and benefits, and extensive travel requirements. An Administrative Law Judge initially ruled against him, but the Unemployment Insurance Appeal Board found good cause for refusal. The employer appealed. The appellate court affirmed the Board's decision, agreeing that the combination of extensive travel at an unreasonable distance and reduced pay and benefits constituted good cause, although it disagreed that the change in union representation alone was sufficient.

Unemployment BenefitsJob RefusalGood CauseLabor LawUnion MembershipSalary DecreaseTravel Requirements
References
5
Case No. MISSING
Regular Panel Decision

MHM Sponsors Co. v. Hirsch

Petitioner, Ogdan CAP Properties LLC, initiated a holdover proceeding against respondent, Paulette Hirsch, seeking possession of her apartment. The petitioner claimed Hirsch unreasonably refused access for necessary repairs to the wood flooring, a repair mandated by a housing code violation. Hirsch defended her refusal by citing severe allergies to the glue used for floor installation, fearing adverse health effects. The court, applying an objective standard, determined that Hirsch's refusal was unreasonable. It concluded that a prudent individual would accept a temporary health risk to mitigate a continuous safety hazard and could have avoided the risk by vacating the premises during repairs. Consequently, the court granted the petitioner a judgment of possession.

holdover proceedingunreasonable refusalaccess for repairshousing code violationlandlord-tenantallergic reactionglue fumesobjective standardjudgment of possessiontenant rights
References
9
Case No. MISSING
Regular Panel Decision

Claim of Wilkins v. New York Power Authority

The claimant, a lineman, sustained a shoulder injury in July 2007. Despite a diagnosis of biceps tendonitis and adhesive capsulitis, he declined prescribed medication and discontinued physical therapy, not missing work. He subsequently applied for workers’ compensation benefits based on a 45% schedule loss of use. A Workers’ Compensation Law Judge initially denied benefits, citing the claimant's unreasonable refusal of treatment. The Workers’ Compensation Board reversed, finding the refusal reasonable. However, the appellate court reversed the Board's decision, concluding that the Board’s determination was not supported by substantial evidence given the unanimous medical opinion that treatment was needed and claimant's refusal was unreasonable, remitting the matter for further proceedings.

Shoulder InjuryBiceps TendonitisAdhesive CapsulitisSchedule Loss of UseRefusal of Medical TreatmentUnreasonable RefusalWorkers' Compensation BenefitsMedical OpinionSubstantial EvidenceAppellate Review
References
3
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. ADJ6650899
Regular
Jan 04, 2013

IVAN MORENO vs. SOSA GRANITE & MARBLE, MAJESTIC INSURANCE COMPANY

In this workers' compensation case, the Board granted reconsideration to clarify an existing award. The administrative law judge had previously imposed a $10,000 penalty for unreasonable delay in paying permanent disability benefits, based on 25% of the overdue amount, capped as allowed by law. The defendants contended the penalty was improperly calculated on the total awarded benefits rather than the amount delayed. The Board affirmed the penalty and its amount, clarifying that it was based on the unpaid permanent disability indemnity due at the time of the award, not the total sum. This penalty was justified because the defendants unreasonably delayed paying any permanent disability advances for over three years after the applicant's condition became permanent and stationary.

permanent disabilityLabor Code section 5814penaltyunreasonable delayreconsiderationFindings of Fact and Awardadministrative law judgeSosa Granite & MarbleMajestic Insurance CompanyWCJ
References
0
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