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

Case No. ADJ7014015, ADJ7585119
Regular
Oct 13, 2015

ARMANDO SANCHEZ vs. RICHARD I KORAL, dba JESSICA'S, CYPRESS INSURANCE COMPANY

This case consolidates two workers' compensation claims related to applicant Armando Sanchez's back injury. Lien claimants Monrovia Memorial Hospital, Los Angeles Orthopedics, and Dr. Satish Kadaba sought reconsideration of a decision awarding their liens in part, based on the defendant's bill review. The Appeals Board dismissed Monrovia Memorial Hospital's petition as untimely and denied Dr. Kadaba's and Los Angeles Orthopedics' petitions because the admissibility of the defendant's bill review was not raised earlier. Ultimately, the Board adopted the WCJ's findings and recommendations, denying the lien claimants' requests for reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationJoint Findings and AwardIndustrial InjuryWarehousemanBack InjuryLabor Code section 3208.3Lien ClaimantsBill ReviewAdmissibility of Evidence
References
Case No. ADJ8995821
Regular
Aug 31, 2015

FERNANDO REYNOSA vs. QUALITY ALUMINUM FORGE, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case concerns a workers' compensation applicant seeking reconsideration of a decision that denied additional temporary disability indemnity and a judicial determination of medical necessity for spine surgery. The Appeals Board granted reconsideration, amending the findings to state the applicant is not owed additional temporary disability at this time and is in need of future medical treatment. The case is returned to the trial level for further development of the record specifically regarding the timeliness of utilization reviews for the proposed spinal surgery. The Board found the original record lacked sufficient detail and organization to properly address these issues.

Petition for ReconsiderationFindings and OrdersTemporary Disability IndemnityMaximum Medical ImprovementUtilization ReviewIndependent Medical ReviewRequest for AuthorizationSpinal SurgeryLow Back InjuryNeck Injury
References
Case No. ADJ8319455
Regular
Aug 12, 2013

TRACY RANDALL vs. HOME CONSIGNMENT CENTER, TRUCK INSURANCE EXCHANGE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded the prior finding of industrial injury. The WCAB found that the medical evidence was not substantial to establish that the applicant's incisional hernias arose from employment. Therefore, the case was returned to the trial level for further development of the record and a new decision by the judge. The Board also noted procedural defects in the defendant's petition, including lack of verification and improper formatting.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings Award and OrderIndustrial InjuryHerniaStore ManagerWarehousemanPost-termination DefenseSubstantial EvidenceMedical Evidence
References
Case No. ADJ674968 (VNO 0539011)
Regular
Jun 29, 2009

DANIEL CORONADO vs. VALLEY STAFFING SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to modify an award. The original award found an applicant sustained an industrial injury to bilateral knees and was entitled to temporary disability. While affirming the injury finding, the Board limited temporary disability to a maximum of 104 weeks within two years of the injury date, as mandated by Labor Code section 4656(c)(1). This modification addresses the defendant's contention that the prior award exceeded statutory limits for temporary disability.

Workers' Compensation Appeals BoardReconsiderationFindings of FactAwardWarehousemanIndustrial InjuryBilateral KneesTemporary DisabilitySubstantial EvidenceDue Process
References
Case No. ADJ1970382 (SJO 0236621)
Regular
Nov 04, 2013

PAUL EUGENIO FELICIANO vs. FORWARD AIR, INC., GREAT WEST CASUALTY COMPANY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board affirmed the finding of total temporary disability for applicant Paul Eugenio Feliciano from January 15, 2010, to June 21, 2010, based on a subsequent surgery and the Board's continuing jurisdiction. Furthermore, the Board upheld the finding of 100% total permanent disability, finding substantial evidence in the vocational expert's report and the applicant's demeanor observed by the WCJ. The Board also confirmed that the permanent and stationary date was appropriately set at June 21, 2010, following the applicant's surgery.

Workers' Compensation Appeals BoardFindings and AwardReconsiderationWarehousemanIndustrial InjuryAmputationPsyche InjuryTotally Temporarily DisabledTemporary Disability IndemnityOverpayment
References
Case No. ADJ915762 (SFO 0490442)
Regular
Dec 16, 2009

RON NOVACHICK vs. PLANTIUM EQUITY LLC dba NEXTIRAONE, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The WCAB granted reconsideration and amended the WCJ's decision to defer the issue of EDD's lien because the period for which EDD paid benefits does not overlap any award of temporary or permanent disability benefits.

Workers' Compensation Appeals BoardReconsiderationEDD LienTemporary Disability IndemnityPermanent DisabilityLabor Code 4904Unemployment Compensation Disability BenefitsOverlapAward of CompensationStipulations
References
Case No. ADJ10281805
Regular
Oct 05, 2018

JOHN ROSA vs. PERSONNEL STAFFING GROUP, ZURICH AMERICAN INSURANCE

The applicant sought reconsideration of a Compromise and Release agreement approved by the WCJ, which settled his injury claim for $40,000. The applicant argued he did not consent to the settlement, his wages were miscalculated, and his back and knee injuries were unaddressed. The Appeals Board dismissed the petition as premature because no evidence or testimony was presented to support these claims under oath. The Board recommended the WCJ hold a hearing for the applicant to present evidence, after which a new decision can be issued and potentially reconsidered.

Workers' Compensation Appeals BoardPetition for ReconsiderationCompromise and ReleaseAmended Order ApprovingWCJPetition to Set AsidePremature DismissalGood CauseStipulationsDue Process
References
Case No. ADJ7299248
Regular
Aug 04, 2011

JUAN GARCIA vs. CORNERSTONE STAFFING SOLUTIONS, INC., CASTLEPOINT NATIONAL INSURANCE COMPANY, TOWER SELECT

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration, upholding the Administrative Law Judge's (ALJ) decision. The ALJ found the applicant not credible and concluded the claim was barred by Labor Code Section 3600(a)(10) as it was filed post-termination. The Board also adopted the ALJ's reasoning that the submitted EEOC settlement was not newly discovered evidence and irrelevant to proving the workers' compensation claim. Ultimately, the applicant failed to meet his burden of proof for his claimed low back and psyche injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationWCJ reportcredibility findingGarza v. Workmen's Comp. Appeals Bd.Petition for Reconsideration deniedClaimed Date of InjuryWarehousemanLow back and psychein Persona Propria
References
Case No. LBO 0307401
Regular
Jun 09, 2008

WILLIAM MUNOZ vs. THE BOEING COMPANY, CIGA BY ITS SERVICING FACILITY, CAMBRIDGE INTEGRATED SERVICES FOR FREMONT INDEMNITY COMPANY, IN LIQUIDATION

This case concerns the denial of a petition for reconsideration by the California Workers' Compensation Appeals Board (WCAB). The defendant, CIGA, sought to overturn a finding that the applicant was entitled to low back surgery recommended by his treating physician. The WCAB denied CIGA's petition because it failed to follow the statutory procedures for objecting to a spinal surgery recommendation, specifically by not timely filing for a second medical opinion. CIGA's arguments regarding administrative duties of another entity and reliance on an outdated medical report were also insufficient to warrant reconsideration.

Workers' Compensation Appeals BoardCIGAPetition for ReconsiderationFindings of FactLow Back SurgeryIndustrial InjuryWarehousemanRepetitive TraumaStipulationCompromise and Release
References
Case No. ADJ3387478 (SAC 0297421)
Regular
Dec 01, 2008

MIGHAEL THAO vs. COCA COLA BOTTLING COMPANY, SELECT PERSONNEL SERVICES, ZURICH NORTH AMERICA INSURANCE COMPANY, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, LEGION INSURANCE COMPANY, CAMBRIDGE INTEGRATED GROUP

This case involves a workers' compensation claim where CIGA seeks reconsideration of a finding that its liability for an injured applicant's spine and head injury was not absolved by other insurance. The Appeals Board granted reconsideration, rescinded the previous findings, and returned the matter for further proceedings. The Board held that Coca Cola's Zurich insurance policy constituted "other insurance" as per Insurance Code § 1063.1(c)(9), thereby relieving CIGA of liability for the claim.

CIGAspecial employmentgeneral employmentother insurancecovered claimsInsurance Code 1063.1(c)(9)joint and several liabilityemployer liabilityrescindedreconsideration
References
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