February, 2015 - CompFox

Jose Soto, vs. Coca Cola Enterprises, Permissibly Self-insured, Administered By Sedgwick Claims Management Services, Inc.,

Leave a Comment / California, Long Beach / By Ashish

This case involves two claims of injury by Jose Soto while employed as a merchandiser by Coca Cola Enterprises. The Workers’ Compensation Appeals Board granted the defendant’s petition for reconsideration and deferred the finding regarding temporary disability indemnity benefits, returning the matter to the trial level for further proceedings and a new decision by the WCJ. The WCJ’s decision was found to not be supported by substantial evidence due to inadequate medical histories and examinations, incorrect legal theories, and surmise, speculation, conjecture, or guess.

Karen Segroves, vs. Burger Barn/paula’s Pancake House; The Hartford,

Leave a Comment / California, Santa Barbara / By Ashish

(SBA 0086539) is a case in which Karen Segraves, a waitress employed by Burger Barn/Paula’s Pancake House, sought workers’ compensation for injuries to her bilateral shoulders, cervical spine, and dental. The Workers’ Compensation Appeals Board denied her petition for reconsideration, finding that she did not sustain an injury arising out of and in the course of her employment. The Board found that the medical opinion of Dr. McDavid, the Agreed Medical Evaluator, was not substantial evidence and that the medical opinions of Dr. Weingarten and Dr. Webb did not support the conclusion that she sustained a cumulative trauma injury during the period in question. The Board also found that the applicant failed to address the

Jerusalina Figueira, vs. The Regents Of The University Of California Riverside; Sedgwick Claims Management Services,

Leave a Comment / California, Riverside / By Ashish

is a case in which Jerusalina Figueira, an employee of the University of California at Riverside, filed a petition for reconsideration after the Workers’ Compensation Appeals Board denied her petition for penalties. Figueira argued that the employer should have paid a 10% penalty under Labor Code 4650(d) and a 25% penalty under Labor Code 5814 for the remaining permanent disability award. The Board denied the petition for reconsideration, citing the unanimous en bane determination in Leinon v. Fishennen’s Grotto, Mid-Century Insurance Company, which held that no penalty applies when injury, disability, or indemnity rate is disputed. The Board also admonished Figueira’s attorney for not properly labeling the

Josediaz, vs. Timber Works Construction, Berkshire Hathaway,

Leave a Comment / California, Stockton / By Ashish

. In this case, Jose Diaz, an employee of Timber Works Construction, Inc., sought reconsideration of a decision by the Workers’ Compensation Appeals Board that the Medical Provider Network (MPN) of his employer was valid if it contained three physicians in the appropriate specialty within 15 miles/30 minutes of either applicant’s “workplace” or residence. The Board granted reconsideration, rescinded the WCJ’s Order, and remanded the matter for a decision regarding treatment and the MPN consistent with the opinion.

Gwendolyn Cox, vs. Wellpoint, Inc.; Zurich North America,

Leave a Comment / California, Long Beach / By Ashish

This case involves lien claimants Comprehensive Outpatient Surgery Center, California Urgent Care Centers, and Technical Surgery Support who filed a Joint Petition for Reconsideration from orders issued at a lien conference on December 5, 2014, in which a workers’ compensation administrative law judge dismissed each of their liens for appearing in court without paying the lien filing fee. The WCJ lacked subject matter jurisdiction to dismiss the liens because none of the lien claimants had filed a lien in this matter as of the date of the lien conference. The WCAB granted the Petition for Reconsideration and rescinded the orders dismissing the liens.

Jacinto Catillo, vs. Santa Clarita Interiors; Zurich American Insurance Co,

Leave a Comment / California, Marina del Rey / By Ashish

In this case, Santa Clarita Interiors and Zurich American Insurance Co. are defendants in a workers’ compensation case brought by Jacinto Catillo. Catillo was found to have sustained an industrial injury to his lumbar spine causing 22% permanent disability without apportionment. The Workers’ Compensation Appeals Board granted reconsideration of the defendant’s petition for reconsideration, which was found to be untimely. The Board issued a Notice of Intention to Dismiss the petition for reconsideration, ordering the defendant to produce documentation showing the date and time that the petition was filed at the Appeals Board or on the Electronic Adjudication Management System, including the EAMS Batch ID and/or any other documentation that demonstrates that the petition was timely

Damon Bagley, vs. City Of Clovis Police Department, Permissibly Self-insured, Administered By Aims,

Leave a Comment / California, Fresno / By Ashish

This case is about Damon Bagley, an employee of the City of Clovis Police Department, who was injured on December 16, 2011. He filed a workers’ compensation claim, which was granted by the workers’ compensation judge on December 31, 2013. The City of Clovis Police Department appealed the decision and the Workers’ Compensation Appeals Board rescinded the Findings and Order issued by the WCJ and substituted their finding that Bagley did not sustain an injury arising out of and in the course of his employment. Bagley then filed a petition for reconsideration, which was denied by the Appeals Board.

Brock Macon, vs. The Salvation Army, Permissibly Self-insured, Administered By Sedgwick,

Leave a Comment / California, Oxnard / By Ashish

The Salvation Army, permissibly self-insured, administered by Sedgwick, was the defendant in a case before the Workers’ Compensation Appeals Board in California. The Petition for Reconsideration was dismissed and the Petition for Removal was denied as the decision was an intermediate procedural or evidentiary issue and did not determine any substantive right or liability. Removal was denied as the petitioner did not demonstrate that substantial prejudice or irreparable harm would result if removal was not granted and that reconsideration would not be an adequate remedy if a final decision adverse to the petitioner ultimately issued.

Ellen Reed, vs. State Of California, Cdcr- California Correctional Center, legally Uninsured; State Compensation Insurance Fund/state Contract Services, Adjusting Agency,

Leave a Comment / California, Redding / By Ashish

is a case in which the Workers’ Compensation Appeals Board granted reconsideration of the December 15, 2015 Order wherein the workers’ compensation administrative law judge (WCJ) dismissed with prejudice applicant’s petition for an increased award. The WCJ dismissed the petition due to failure to verify the petition for an increased award, which is a valid ground for summary dismissal or denial of the petition. The Appeals Board rescinded the WCJ’s decision and remanded the matter to the trial level for the WCJ to consider the merits of applicant’s petition for increased benefits due to serious and willful misconduct by the employer. The Appeals Board also admonished applicant’s attorney for their apparent ignorance of the Appeals Board Rules of Practice and Procedure.

Douglas Pink, vs. Campora Propane Service; Crum & Foster Insurance,

Leave a Comment / California, Sacramento / By Ashish

In this case, Douglas Pink filed a Petition for Removal with the Workers’ Compensation Appeals Board, seeking to remove the case from the jurisdiction of the workers’ compensation administrative law judge. The Appeals Board denied the Petition for Removal, finding that the petitioner had not demonstrated that substantial prejudice or irreparable harm would result if removal was not granted, and that reconsideration would be an adequate remedy if a final decision adverse to the petitioner ultimately issued. The Appeals Board also noted that there was no indication that the applicant had requested an evidentiary hearing on the issue of whether he should be required to attend the examination by Dr. Levine.

February 2015