June, 2018 - CompFox

Mario Ybarra vs. Reed’s Inc.; Travelers Property Casualty Company Of America

Leave a Comment / California, Long Beach / By Ashish

In this case, the California Insurance Guarantee Association (CIGA) sought reconsideration of the April 10, 2018 Findings of Fact wherein the workers’ compensation arbitrator found that CIGA remained liable for benefits to the applicant. The Appeals Board granted reconsideration and found that the Travelers Property Casualty Company of America policy issued to Reed’s Inc. provided coverage for employees of Reed’s, as the policy did not exclude special employees of Reed’s and there was no evidence of a valid and enforceable agreement pursuant to Labor Code Section 3602(d).

Sengathit Hansana vs. Homelegance, Inc. And Cypress Insurance Company, Administered By Berkshire Hathaway

Leave a Comment / California, Stockton / By Ashish

is a case involving Homelegance, Inc. and Cypress Insurance Company, Administered By Berkshire Hathaway. The Workers’ Compensation Appeals Board denied the Petition for Reconsideration filed by the applicant, Sengathit Hansana, after considering the allegations of the Petition and the contents of the report of the workers’ compensation administrative law judge. The Board found that the report of Amanpreet Dhillon, M.D. constituted substantial evidence and that the Petitioner had failed to provide any evidence that the findings of fact did not support the order, decision or award.

Hortencia Aguilar vs. Contra Costa County, Employment & Human Services, Permissibly Self-insured

Leave a Comment / California, Oakland / By Ashish

. This case is about Hortencia Aguilar’s workers’ compensation appeal against Contra Costa County, Employment & Human Services, which was permissibly self-insured. The appeals board denied the petition for reconsideration, finding that the employer had failed to follow the procedure outlined in the policy and procedure manual and that their actions were not taken in good faith. The court applied an “objective good faith standard” to assess whether the employer’s actions were taken in good faith, and found that the employer had not followed their own rules and had not allowed the employee to participate in the investigation or solution of the problem.

Larhonish Carey vs. Molina Healthcare; Travelers Property Casualty Company, Administered By Gallagher Bassett Services

Leave a Comment / California, Van Nuys / By Ashish

In this case, the Workers’ Compensation Appeals Board affirmed the Order Approving Compromise and Release issued by the workers’ compensation administrative law judge, except that it was amended to award the applicant’s counsel $1,350.00 in attorney’s fees as contemplated in the Compromise and Release. The Board granted reconsideration and issued a Notice of Intention to Affirm Order Approving Compromise and Release, and the applicant’s counsel filed a response with corrected versions of the documents. The Board then reviewed the documents and allowed the attorney’s fees to be awarded.

Michael Guillot vs. Albertsons Supervalue, Permissibly Self-insured, Administered By Sedgwick Cms

Leave a Comment / California, Long Beach / By Ashish

Albertsons Supervalue, permissibly self-insured, administered by Sedgwick CMS Michael Guillot WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAMICHAEL GUILLOT, Applicant,vs.ALBERTSONS SUPERV ALUE, permissibly self-insured, administered by SEDGWICK CMS, Defendants.Case Nos. ADJ9757218ADJ10058696 (Long Beach District Office)OPINION AND DECISION AFTER RECONSIDERATION We granted reconsideration in order to further study the factual and legal issues in this case. This is our …

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Francisco Marin vs. Merchants Of Tennis, Inc., Insured By Everest National Insurance Co., Administered By Sedgwick Cms

Leave a Comment / California, Santa Ana / By Ashish

In this case, Francisco Marin filed an application for adjudication alleging cumulative injury from January 1, 2011 to November 9, 2012 while working for Merchants of Tennis, Inc. The case was resolved through a Compromise and Release and a lien conference was set for November 30, 2017. On that date, lien claimant United Services Plus DBA Ronco Drug failed to appear and a Notice to Dismiss was issued. On March 30, 2018, the WCJ issued an order dismissing lien claimant for failing to object to the Notice to Dismiss. The Workers’ Compensation Appeals Board granted the Petition for Reconsideration, rescinded the Order Dismissing, and returned the matter to the lien trial WCJ for further proceedings.

Olivia Flores vs. April Ivette Lopez Dba Palomares Cleaning Services, Uninsured; Uninsured Employers Benefits Trust Fund

Leave a Comment / California, Santa Ana / By Ashish

April Ivette Lopez dba Palomares Cleaning Services, uninsured; Uninsured Employers Benefits Trust Fund Olivia Flores WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAOLIVIA FLORES, Applicant,vs.APRIL IVETTE LOPEZ dba PALOMARES CLEANING SERVICES, uninsured; UNINSURED EMPLOYERS BENEFITS TRUST FUND, Defendants.Case No. ADJ10810917 (Santa Ana District Office)OPINION AND ORDER GRANTING PETITION FOR RECONSIDERATION AND DECISION AFTER RECONSIDERATION Applicant Olivia Flores seeks …

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Salvador Cuevas vs. Del Monte Meat Company, Inc. And Companion Property And Casualty Insurance Company, Administered By Athens Administrators

Leave a Comment / California, Santa Rosa / By Ashish

In this case, Del Monte Meat Company, Inc. and Companion Property And Casualty Insurance Company, administered by Athens Administrators, appealed a Joint Findings and Award issued by the workers’ compensation administrative law judge (WCJ) on March 14, 2018, wherein the WCJ found that the applicant, Salvador Cuevas, sustained a specific injury to his low back and psyche on January 14, 2011, and a cumulative injury to his right shoulder during the period from April 4, 2012, through April 4, 2013. The Appeals Board granted the Petition for Reconsideration and rescinded the F&A, returning the matter to the WCJ to further develop the record and for additional proceedings. The issue of apportionment between the

Brandon Selvitella vs. Marinwood Community Services District

Leave a Comment / California, San Francisco / By Ashish

In this case, the Marinwood Community Services District was found to be liable for the workers’ compensation claim of Brandon Selvitella. The Workers’ Compensation Appeals Board granted the defendant’s petition for reconsideration and amended the decision to find that Selvitella’s predesignation of Dr. Jeffrey Stevenson was not valid and that Dr. Stevenson was not Selvitella’s primary treating physician. The Board found that Selvitella’s Kaiser Permanente physician would not agree to be predesignated and that Selvitella could not predesignate a physician who was not his regular physician or primary care physician.

Edwin Raquedan (deceased), Imelda Raquedan vs. Viola, Inc., Everest National Insurance Company

Leave a Comment / California, Oxnard / By Ashish

In this case, the Workers’ Compensation Appeals Board denied the Petition for Reconsideration filed by Imelda Raquedan, the spouse of the deceased Edwin Raquedan. The Board found that Edwin’s fatal injury was not industrially caused, as he was not performing any service to his employer at the time of the accident. The Board found that the personal comfort and dual purpose exceptions to the going and coming rule did not apply, as Edwin was not paid for his lunch break and was not required to perform his work at home.

June 2018