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Significant panel decisions

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To view decisions, click on the PDF name of the decision (to the right of the date) and you will access the PDF file which contains the decision. Use of the California Compensation Cases citation is used for the community's information and convenience only with a recognition that the text and/or summary of the decisions may also appear in other publications.

2014 significant panel decisions

Christopher Torres
v.
Contra Costa Schools Insurance Group; State Compensation
Insurance Fund

Aug. 28, 2014 2014-SPD-3 acrobat image
Case No. ADJ3011154 (SAC 0309784) - ADJ3631113 (SAC 0309785)
79 Cal. Comp. Cases 1181
Where the injured worker filed an unverified petition appealing an Independent Medical Review (IMR) determination, the Appeals Board held that the petition is subject to dismissal because Labor Code section 4610.6(h) provides that such a determination “may be reviewed only by a verified appeal.” Further, Rule 10450(e) requires that any petition filed with the Workers’ Compensation Appeals Board “shall be verified under penalty of perjury in the manner required for verified pleadings in courts of record,” and it provides that a non-verified petition may be summarily dismissed or denied. While lack of verification does not automatically require dismissal of an unverified petition, an appeal may be dismissed for lack of verification if the appealing party does not within a reasonable time cure the defect after receiving notice of the defect.

Jennifer Patterson
v.
The Oak
s Farm; California Insurance Guarantee Association for California Compensation Insurance Company, in liquidation

July 24, 2014 2014-SPD-2 acrobat image
Case No. ADJ3905924 (ANA 0339374)
79 Cal. Comp. Cases 910

Where the defendant had unilaterally terminated nurse case manager services to the injured worker, the Appeals Board affirmed the WCJ’s award reinstating those services, holding as follows:

  1. The provision of a nurse case manager is a form of medical treatment under Labor Code section 4600;
  2. An employer may not unilaterally cease to provide approved nurse case manager services when there is no evidence of a change in the employee’s circumstances or condition showing that the services are no longer reasonably required to cure or relieve the injured worker from the effects of the industrial injury;
  3. Use of an expedited hearing to address the medical treatment issue in this case is expressly authorized by Labor Code section 5502(b)(1);
  4. It is not necessary for an injured worker to obtain a Request For Authorization to challenge the unilateral termination of the services of a nurse case manager.

Eun Jae Kim
v.
B.C.D. Tofu House, Inc.; Cypress Insurance Company, et. all

February 7, 2014 2014-SPD-1 acrobat image
Case No. ADJ9086333
79 Cal. Comp. Cases 140

The Appeals Board held that without regard to Court Administrator Rule 10252, which limits expedited hearings to specific issues in accepted claims, an expedited hearing may be requested and conducted under Labor Code section 5502(b)(2) and Administrative Director Rule 9767.6(c) to determine whether the employee must treat in the employer’s medical provider network during the 90-day delay period, under Labor Code section 5402(b), that the employer has to investigate and determine whether to accept or reject the claim.

2013 significant panel decisions

Maria Elena Mendez
v.
Le Chef Bakery; Pacific Compensation Insurance Co

April 25, 2013 2013-SPD-2 acrobat image
Case No. ADJ6509620 ADJ6509621
78 Cal. Comp. Cases 454

The Appeals Board panel held that under Labor Code section 4903.06, a lien claimant is not required to pay a lien activation fee prior to a 2013 lien trial where: (1) the declaration of readiness (DOR) is filed prior to January 1, 2013; (2) the lien conference takes place prior to January 1, 2013; and (3) the lien trial takes place in 2013, without any intervening 2013 lien conference.

Eliezer Figueroa
v.
B.C. Doering Co.: Employers Compensation Insurance Co.,

April 5, 2013 2013-SPD-1 acrobat image
2013-SPD-1 word image
Case No. ADJ3274228 (AHM 0120365)
78 Cal. Comp. Cases 336

Where the defendant had unilaterally terminated nurse case manager services to the injured worker, the Appeals Board affirmed the WCJ’s award reinstating those services, holding as follows:

  1. The provision of a nurse case manager is a form of medical treatment under Labor Code section 4600;
  2. An employer may not unilaterally cease to provide approved nurse case manager services when there is no evidence of a change in the employee’s circumstances or condition showing that the services are no longer reasonably required to cure or relieve the injured worker from the effects of the industrial injury;
  3. Use of an expedited hearing to address the medical treatment issue in this case is expressly authorized by Labor Code section 5502(b)(1);
  4. It is not necessary for an injured worker to obtain a Request For Authorization to challenge the unilateral termination of the services of a nurse case manager.

2011 significant panel decisions

Jose H. Hernandez
v.
AMS Staff Leasing

April 11, 2011 2011-SPD-1 acrobat image
2011-SPD-1 word image
Case No.
ADJ2182149 (LAO 0837423)
ADJ3329537 (ANA 0360928)
76 Cal. Comp.Cases 343

The Appeals Board panel determined that when a paper file, an electronic file in EAMS, or a combined paper and electronic file is sent to the Appeals Board after the filing of a petition for reconsideration, removal, or disqualification, (1) there must be a complete and properly organized record which includes all documents admitted in evidence, (2) it is the responsibility of the WCJ to ensure that all documents in the record are scanned into EAMS, or at least placed in the paper file in proper order, no later than transmission of the file(s) to the Appeals Board, and (3) without a proper record the matter may be returned to the WCJ to properly complete the record.

2007 significant panel decisions

Kimberly Stokes
vs.
Patton State Hospital / Department of Mental Health /
State of California, legally uninsured,
administered by State Compensation Insurance Fund
July 9, 2007 2007-SPD-2 acrobat image
2007-SPD-2 word image
Case No. SBR 0311485
72 Cal. Comp. Cases 996
The Board panel concluded that if an ambulatory surgery center is claiming to have provided medical treatment to applicant as a "clinic," it is required to have a fictitious-name permit and license from the Medical Board. However, if it is claiming to have provided services only as an "outpatient setting," it is not required to have a license or fictitious-name permit from the Medical Board if it is properly accredited by an agency recognized by the Medical Board.
Nelly Romero
vs.
Costco Wholesale, permissibly self-insured,
June 14, 2007 2007-SPD-1 acrobat image
2007-SPD-1 word image
Case No. OAK 0328271
72 Cal. Comp. Cases 824
The Board held that for purposes of Labor Code ??4062.1(e) and 4062.2(e), an employee has "received" a comprehensive medical-legal evaluation when the employee attends and participates in the medical evaluator's examination. In this case, because the applicant had not attended and participated in (i.e., not "received") an examination by a panel QME scheduled while the applicant was not represented by an attorney, the applicant was entitled to request a new QME panel when the applicant became represented by an attorney. The workers' compensation judge's order for a new QME panel was therefore affirmed.This opinion involved interpretation of additions to Labor Code ??4062.1 and 4062.2 by SB 899.

2006 significant panel decisions

Caryl Erickson
vs.
Southern California Permanente Medical Group/Kaiser Permanente, Permissibly Self-Insured
December 28, 2006 2006-SPD-5 acrobat image
2006-SPD-5 word image
Case Nos. POM 246580, POM 2465824
72 Cal. Comp. Cases 103
The Board panel granted reconsideration and amended the WCJ?s decision to defer the issue of the calculation of the amount of the permanent disability indemnity due to applicant after apportionment, pending issuance of the Supreme Court?s decision(s) in Brodie v. Workers? Comp. Appeals Bd., review granted November 15, 2006, S146979 (2006 Cal. LEXIS 13527), in Welcher v. Workers? Comp. Appeals Bd., review granted November 15, 2006, S147030 (2006 Cal. LEXIS 13523), or in any other case in which the Supreme Court issues an opinion that resolves this issue. This deferral approach was a continuation of the approach previously being employed by the Appeals Board in light of the ongoing conflict and uncertainty in the appellate case law on this issue where multiple injuries and/or apportionment of permanent disability under new Labor Code sections 4663 and 4664 are involved.
Catherine Robbins
vs.
Sharp Healthcare; American Manufacturers Mutual Insurance Company; and Broadspire Services, Inc., Adjusting Agency
September 26, 2006 2006-SPD-4 acrobat image
2006-SPD-4 word image
Case No. SDO 0335934
71 Cal. Comp. Cases 1291
The Board panel concluded that bias or the appearance of bias solely against an attorney or law firm, as opposed to the party that the attorney or law firm represents, may be a valid ground for a petition for disqualification of a WCJ. In granting the defendant's petition for disqualification, it was determined that although there was no present actual bias by the judge toward the petitioning law firm, there was the appearance of bias sufficient to warrant disqualification.
Kathy Ward
vs.
City of Desert Hot Springs;
permissibly self-insured and administered by Hezelrigg Risk, Management Services
September 25, 2006 2006-SPD-3 acrobat image
2006-SPD-3 word image
Case No. RIV 0069499
71 Cal. Comp. Cases 1313
The Board panel held that for claimed industrial injuries occurring on or after January 1, 2005, in which the employee is represented by an attorney: (1) pursuant to section 4060(c), medical disputes regarding the compensability of the alleged industrial injury must be resolved solely by the procedure provided in section 4062.2; and (2) an evaluation regarding compensability may not be obtained pursuant to section 4064(d) - and, if obtained, it is not admissible.
J Deanna Brasher
vs.
Nationwide Studio Fund; and State Compensation Insurance Fund
September 5, 2006 2006-SPD-2 acrobat image
2006-SPD-2 word image
Case No. OAK 0296709
71 Cal. Comp. Cases 1282
The Board panel held that, in response to a treating physician's recommendation for spinal surgery, an employer has the following options: 1) authorize the surgery, 2) object to the surgery, pursuant to section 4062(b), by filing a DWC Form 233 within 10 days of receipt of the doctor's recommendation, 3) submit the recommendation to utilization review, or 4) pursue both options 2 and 3, either simultaneously or by filing an objection after a utilization review denial, meeting the timelines for each process. If the employer denies the surgery pursuant to its utilization review, the employee must object within 10 days of receipt by the employee of the employer's denial. The dispute will then be resolved under the second opinion procedures in section 4062(b).
In the Matter of John H. Hoffman Jr. May 17, 2006 2006-SPD-1 acrobat image
2006-SPD-1 word image
Case No. Misc. 250
71 Cal. Comp. Cases 609
The Board, in affirming the WCJ?s finding that Mr. Hoffman had violated the provisions of WCAB Rule 10779, concluded that (1) both Rule 10779 and the State Bar Act preclude any non-reinstated former attorney who has been disbarred or suspended by the Supreme Court (for reasons other than nonpayment of State Bar fees), who has been placed on involuntary inactive status by the State Bar, or who has resigned with disciplinary proceedings pending against him or her from appearing as a representative of any party before the WCAB (at least if they have not received permission under Rule 10779); (2) this preclusion against appearing as a representative of any ?party? extends to appearing on the behalf of any litigant, including but not limited to lien claimants; and (3) this preclusion against ?appearing as a representative? in WCAB proceedings extends to any activity that would constitute the practice of law.

2005 significant panel decisions

Wilma Diggle
vs.
Sierra Sands Unified Schools District, Permissibly
Self-Insured; and Self-Insured Schools of California (Adjusting Agent),
October 7, 2005 2005-SPD-3 acrobat image
2005-SPD-3 word image
WCAB No. BAK 0138299)
70 Cal. Comp. Cases 1480
It was noted that en banc decisions of the Appeals Board are binding precedent on all Appeals Board panels and WCJs pursuant to WCAB Rule 10341. The Board concluded that this principle remains true where a petition for writ of review has been filed or even where a writ of review has been granted, either in the actual case in which the en banc decision issued or in a different case in which the en banc decision is directly implicated, unless and until either (1) the appellate court issues an opinion that explicitly or implicitly overrules the en banc decision or (2) the appellate court stays or suspends the operation of the en banc decision prior to the Court's issuance of an opinion.
Paul Hestehauge
vs.
Wayne Charkins; Laurie Charkins; California State
Automobile Association Inter-Insurance Bureau; and
Tri-Star Risk Management (adjusting agent),
September 23, 2005 2005-SPD-2
2004-SPD-2
(WCAB No. SFO 452026)
70 Cal.Comp.Cases 1294
NOTE: The Board held that applicant was not an "employee" of defendant homeowners under Labor Code sections 3351(d) and 3352(h) because, in the 90 days prior to his injury, he had not both worked at least 52 hours for them and earned at least $100 from them. Nevertheless, the Board also concluded applicant was an "employee" of defendant homeowners under Labor Code section 3715(b): (1) because it applies to all residential employees listed therein, including those employed by insured employers; (2) because it is the Legislature's express intent that the three types of residential employees listed therein are covered under the Workers' Compensation Act if they would have been covered by the law in effect prior to January 1, 1977; and (3) because the pre-1977 law covered residential employees if either the work being performed was contemplated to last more than 10 days or the total labor cost was at least $100.00, and here applicant's work met the latter requirement.
Jose Reyes
vs.
Hart Plastering
February 10, 2005 2005-SPD-1
2004-SPD-1
(WCAB No. POM 0261129)
70 Cal.Comp.Cases 223
NOTE: The Board held that the amendments to sections 4663 and 4664, which concern apportionment of permanent disability, have not affected the statutes governing the determination of whether an injury arises out of and occurs in the course of employment, i.e., sections 3600 and 3208.3, or the case law interpreting those statutes.
Kenneth Grom
vs.
Shasta Wood
December 8, 2004 2004-SPD-4
2004-SPD-4
(WCAB No. RDG 0091839)
69 Cal.Comp.Cases 1567
NOTE: The Board held that an applicant is entitled to such medical treatment as is reasonably required to "relieve" from the effects of an industrial injury, even if such treatment will not "cure" that injury. Thus, the phrases "cure and relieve" and "cure or relieve" are interchangeable.
Teresa Godinez
vs.
Buffets, Inc., permissibly self-insured
and Specialty Risk Services, adjusting agent,
October 4, 2004 2004-SPD-3
2004-SPD-3
(WCAB No. SJO 0225696)
69 Cal.Comp.Cases 1311
NOTE: The Board held that the timelines of an appeal from any determination or recommendation of the Administrative Director's vocational rehabilitation unit with reference to an injury occurring before January 1, 2004, is controlled by former Labor Code section 4645(d), and that defendant's appeal in this case was timely filed (i.e., filing of appeal with the Board within 20 days of service of the decision/recommendation, plus any additional time pursuant to WCAB Rule 10507).
Thomas Messinese
vs.
Automatic Heating and
State Compensation Insurance Fund
May 21, 2004 2004-SPD-2
2004-SPD-2
(WCAB No. RIV 055831)
69 Cal.Comp.Cases 480
NOTE: The Board concluded in essence that local child support agencies may issue valid and enforceable earning assignment orders without a signature by a judicial officer, that those assignment orders may include both future support obligations and arrearages, and that the local agencies are not required to obtain prior WCAB approval of these assignment orders.
John Lett
vs.
L.A.C.M.T.A;
The Travelers' Insurance Company
March 5, 2004 2004-SPD-1
2004-SPD-1
(WCAB No. VNO 0378504, VNO 0378505, VNO 0382578, VNO 0402513, VNO 0462718)
69 Cal.Comp.Cases 250 - Writ denied at 69 Cal.Comp.Cases 636
NOTE: The board held that applicant's signature on a deposition is not a condition precedent to the allowance of a deposition fee under Labor Code section 5710(b)(4).."

2003 significant panel decisions

Noe Vega
vs.
Taco Bell; California Indemnity Insurance Company
June 9, 2003 2003-SPD-3
2003-SPD-3
(WCAB No. VNO 458318)
68 Cal.Comp.Cases 921
NOTE: The board held "that an expedited hearing shall be set on a defendant's Declaration of Readiness to Proceed to Expedited Hearing under Section 5502(b) where the issue of a defendant's right to medical control within the scope of Section 4600.3, and concomitantly, an applicant's entitlement to medical treatment, is presented for decision."
Donna Yee Sanchez
vs.
Permanente Medical Group, and Athens
Administrators (Adjusting Agent), Natalie Piatt
vs
Eureka Union School District;
April 29 , 2003 *2003SPD-3

*2003SPD-3
)
(WCAB No. OAK 271713 & SAC 304854)
68 Cal.Comp. Cases 637
In summary fashion, the Board (1) opined that for pre and post window period injury cases, applications must be filed before hearings may be conducted, orders issued, or the Board's judicial process invoked to compel discovery; (2) recognized that non-compelled pre-application investigation is permissible; (3) outlined remedies for pre-application abuse of discovery procedures; and (4) outlined conditions requiring the filing of an application under Labor Code section sections 4061(m) and 4063.
Shahin Motallebi,
vs.
Astro Business Solutions, ICS.;
Canon USA; Yasuda Fire & Marine Insurance.
March 18 , 2003 *2003SPD-2

*2003SPD-2
(WCAB No. VNO368013; VNO368014, VNO368015;
VNO368016, VNO368017; VNO368018
68 Cal.Comp. Cases 445
The case sets forth the specific conditions under which it was found that the Board had no jurisdiction to determine an applicant's liability for repayment of UCD benefits to EDD.
Alfred Lee (Deceased)
Valerie L. Lee (Widow),
vs.
Miracle Ford; California Insurance Guarantee Association, administered
by Intercare Insurance Services for
HIH America Compensation (In Liquidation);
West Covina Toyota;
Universal Underwriters Insurance Company/Zurich North America.
February 18 , 2003 *2003SPD-1

*2003SPD-1
(WCAB No. LAO 781284)
68 Cal.Comp. Cases 213
The Board concluded that an applicant may not elect against CIGA when there are other viable carriers having liability during the alleged cumulative exposure period.

2002 significant panel decisions

Les Hall,
vs.
Valley Media and Legion Insurance Company.
September 12, 2002 *2002SPD-2

*2002SPD-2
(WCAB No. SAC 309589)
67 Cal.Comp. Cases 1147
The case deals with whether and under what circumstances Legion Insurance Company, now in rehabilitation, can be excused from an obligation to make lump-sum payments and can receive a stay on future hearings if a settlement is not reached in denied or disputed cases.
Manuel Manzano vs. Flavurence Corporation; Fremont Compensation Insurance
-and -
Sarojini Singh vs. American Shower Door; Republic Indemnity Company
July 10, 2002 *2002SPD-1

*2002SPD-1

(WCAB No. LAO 778749 - Manzano)
(WCAB No AHM 075204 -Singh )
67 Cal.Comp. Cases 914
The cases deal with the issue of at what point in case proceedings may CIGA be appropriately dismissed.

2000 significant panel decisions

Isidoro A. Lucena
Diablo Auto Body: Liberty: Mutual Insurance;
Sun Valley Ford; Great States Insurance                     
December 20, 2000 *2000SPD-1                                   
(WCAB No. WCK 037874)
65 Cal. Comp. Cases 1425

1998 significant panel decisions

Jeffrey Mabe vs. Mike's Trucking
California Indemnity Indurance Company                                                                      
October 28, 1998 *1998-SPD-8
(WCAB No. VEN 105613)
63 Cal. Comp. Cases 1394
Daniel Kaiser vs. California Electric
California Casualty Indemnity Exchange                                                       
October 26, 1998 *1998-SPD-7
(WCAB No. WCK 0039701)
63 Cal. Comp. Cases 1391
Louis Jones vs. Target Stores
Constitution State Services,                                                                                
October 26, 1998 *1998-SPD-6
(WCAB No. PAS 0040032)
63 Cal. Comp. Cases 1385
George Wilson vs. Centinela Hospital
Medical Center                                                                                                     
September 4, 1998 *1998-SPD-5
(WCAB No. LAO 726063, LAO 726064, LAO 727783)
63 Cal. Comp. Cases 1048 NOTE:Order Correcting for Clerical Error
George Wilson vs. Centinela Hospital
Medical Center                                                                                                     
August 31, 1998 *1998-SPD-4
(WCAB Nos. LAO 726063, LAO 726064, LAO 727783)
63 Cal. Comp. Cases 1048
Stockman vs. State of California,
Department of Corrections
July 24, 1998 *1998-SPD-3
(WCAB No. BAK 123730, BAK 123079, BAK 123080)
63 Cal. Comp. Cases 1042
Larch (Fleming) vs. Contra Costa County July 10, 1998 *1998-SPD-2
(WCAB No. WCK 21372)
63 Cal. Comp. Cases 831
Writ of review denied 8/12/99 -- 64 CCC 1098
Supreme Court denied review 10/20/99 NOTE:Petition for Writ of Review filed August 21, 1998.
Czarnecki vs. Golden Eagle
Insurance Company
May 26, 1998 *1998-SPD-1
(WCAB No. SDO 0217617, SDO 0217759)
63 Cal. Comp. Cases 742

1997 significant panel decisions

Becerra v. Eastside Reservoir
Project/Advanco Constructors
                                                                                                     
July 17, 1997 *1997-SPD-1
(WCAB No. AHM 51304)
62 Cal.Comp.Cases 937
Green-Rhoads v. Gran Teasley                                                                             July 17, 1997 *1997-SPD-2
(WCAB No. RDG 0060772)
62 Cal.Comp.Cases 943
Gubbins v. Metropolitan
Insurance Companies                                                                                          
July 17, 1997 *1997-SPD-3
(WCAB No. SAL 227062)
62 Cal.Comp.Cases 946
Cedeno v. American National
Insurance Company                                                                                            
July 21, 1997 *1997-SPD-4
(WCAB No. LAO 729720)
62 Cal.Comp.Cases 939

March 2013