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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ11425394
Regular
Sep 27, 2019

BOBBY BURTON vs. JINYA HOLDINGS, INC.; AMTRUST

This case involves a petition for reconsideration of a denied workers' compensation claim for a psychiatric injury. The Workers' Compensation Appeals Board denied reconsideration, adopting the administrative law judge's report. The decision hinges on Labor Code section 3208.3(d), which requires at least six months of employment for psychiatric injury claims unless caused by a "sudden and extraordinary" employment condition. The applicant failed to meet the burden of proving their injury resulted from such an event, as defined by case law to mean something uncommon, unusual, and unexpected.

Labor Code 3208.3(d)psychiatric injurysix months employmentsudden and extraordinary employment conditionuncommonunusualunexpectedWCJ reportpetition for reconsiderationdenial
References
Case No. ADJ3167944
Regular
Mar 21, 2011

NEFTALY HEREDIA vs. UNION TRANSPORTATION, INC., SEDGWICK CIAGA GLENDALE

This case involves a claim for workers' compensation benefits for a psychiatric injury allegedly sustained on June 18, 2001. The primary issue is whether the applicant's injury meets the "sudden and extraordinary employment condition" exception to the six-month employment requirement for psychiatric claims under Labor Code section 3208.3(d). The Appeals Board granted reconsideration, rescinded the previous award, and returned the matter for further proceedings. The Board found the Workers' Compensation Judge applied an incorrect "taint of fraud" standard and needs to re-evaluate whether the incident was truly uncommon, unusual, and unexpected. Furthermore, the Board directed the Judge to address issues of symptom magnification and malingering raised by the psychiatric reports.

Sudden and extraordinary employment conditionLabor Code section 3208.3(d)psychiatric injuryQualified Medical Evaluator (QME)symptom magnificationmalingeringpreponderance of the evidenceindustrial injuryamended findings and awardreconsideration
References
Case No. ADJ8202473
Regular
Jun 05, 2014

KEVIN COMPARAN vs. LDI TRUCKING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, ULLICO CASUALTY COMPANY, SEDGWICK

The Workers' Compensation Appeals Board denied reconsideration of a "take nothing" finding for Kevin Comparan. Comparan alleged injury while lifting a truck tire, but co-worker testimony contradicted his account. The employer's unusual practice of reimbursing non-industrial medical bills complicated the case. Ultimately, the applicant failed to meet his burden of proof that the injury occurred at work, leading to the denial of his petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ ReportGarza v. Workmen's Comp. Appeals Bd.LDI TruckingCalifornia Insurance Guarantee AssociationUllico Casualty CompanySedgwickDiesel MechanicLow Back Injury
References
Case No. ADJ271462 (SJO 0255768)
Regular
Apr 03, 2017

SHAWN LEWIS vs. TANEJA, INC dba PASSAGE TO INDIA, UNINSURED BENEFITS TRUST FUND OF THE STATE OF CALIFORNIA

This case involves an appeal of a $\$1,000$ sanction imposed on applicant's attorney for failing to appear at a hearing. The attorney argued he had arranged alternate representation, but the substitute attorney had a prior conflict with the applicant. The Workers' Compensation Appeals Board rescinded the sanction, finding the circumstances made imposition unjust, especially given opposing counsel's agreement to a continuance. The Board noted that while the attorney's planning was flawed, the judge should have granted the continuance due to these unusual circumstances.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOrder Imposing SanctionsWCJAttorney SanctionsFailure to AppearAlternate RepresentationPersonal ConflictContinuance RequestWCAB Rule 10561
References
Case No. ADJ7873790
Regular
Jun 27, 2013

LAURA BERNAL vs. RINCON TAURINO RESTAURANT, INC., CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for removal, overturning a prior ruling that allowed the applicant to refuse a Qualified Medical Evaluator (QME) examination based on the QME's refusal to allow audio recording. The WCAB found the applicant's attorney had made "unusual efforts to obstruct the QME process." Applicant is now ordered to attend the QME examination with a court reporter present at the defendant's expense. Failure to comply will result in suspension or barring of disability payments.

QMEAMEremovalreconsiderationtape recordingcourt reporterobstructionsanctionsLabor Code section 4062.2Labor Code section 5813
References
Case No. ADJ10472000, ADJ104801639
Regular
Feb 07, 2023

MANUEL DE JESUS GALDAMEZ VASQUEZ vs. JAN AL INNERPRIZES, INC., SECURITY NATIONAL INSURANCE COMPANY, INSURANCE COMPANY OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior decision, remanding the case for further development of the medical record. The Board found that the administrative law judge and medical evaluator may have applied an incorrect legal standard regarding industrial causation for the applicant's hypertension and stroke. Specifically, the focus on whether work stress was "unusual" or "severe" was misplaced; the correct standard requires determining if subjectively perceived work stress was a contributing factor to the physical injury. The Board emphasized its duty to ensure substantial justice and develop the record when medical evidence is insufficient.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and OrderIndustrial InjuryHypertensionStrokeWork StressCausation StandardQualified Medical EvaluatorMedical Record Development
References
Case No. ADJ2367528 (SFO 0509283)
Regular
Mar 22, 2011

GUILLERMO BAYLEY vs. YMCA OF THE EAST BAY, TRAVELERS INSURANCE

This case involves a dispute over the payment for a 15-day hospitalization for an industrial injury. Stanford University Medical Center, a lien claimant, sought additional payment beyond the amount calculated under the Official Medical Fee Schedule (OMFS). The Appeals Board granted reconsideration, finding that California Code of Regulations, title 8, section 9792(c) allows for fees exceeding the OMFS if extraordinary circumstances related to the unusual nature of services rendered are proven. The case was returned to the trial level for further development of evidence regarding these extraordinary circumstances and to determine if the claimed fee is reasonable.

Workers' Compensation Appeals BoardLien ClaimantReconsiderationInpatient Hospital Fee ScheduleOfficial Medical Fee Schedule (OMFS)Extraordinary CircumstancesDiagnosis-Related Group (DRG)Reasonable FeeLabor CodeMedical Treatment
References
Case No. ADJ7412203
Regular
Jul 15, 2011

RIGOBERTO GARCIA vs. COLE RANCH, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, upholding the finding that the applicant's industrial injury was caused by a "sudden and extraordinary" event, thereby exempting it from the six-month employment rule for psychiatric injuries under Labor Code section 3208.3(d). The Board corrected a clerical error in the citation of the relevant statute. While the defendant argued the event was an inherent risk of the job, the applicant's uncontradicted testimony provided the only evidence suggesting it was not routine. A dissenting opinion argued that a simple fall from a ladder, without more, should not qualify as extraordinary, especially given the short employment duration and lack of evidence for truly unusual circumstances.

Workers' Compensation Appeals BoardRigoberto GarciaCole RanchState Compensation Insurance FundADJ7412203Opinion and Order Denying Petition for ReconsiderationCorrecting Clerical ErrorFindings and Ordersavocado pickerhigh tree worker
References
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