Case Summaries
Workers’ Comp Case Summaries
[10/24] Gholipour v. The Superior Court of San Diego County
Denying the petition for writ of mandate challenging an order by the trial court relating to the amount of petitioner’s restitution because although the case was transferred to the superior court of another county while her appeal from a workers’ compensation fraud conviction was pending, the trial court retained jurisdiction over restitution.
[10/13] American Cargo Express, Inc. v. Superior Court
In a workers’ compensation action, arising after the California Self-Insurers’ Security Fund (SISF) assumed the workers’ compensation obligations of Mainstay Business Solutions and sued it and its clients to recover costs and liabilities, the trial court’s grant of SISF’s motion on the pleadings is affirmed where Labor Code section 3744, subdivision (c) authorizes SISF to bring such an action in superior court.
[10/06] Ford v. Workers’ Compensation Appeals Board
In a workers’ compensation action, the petition for review of an award of benefits is denied where the worker suffered a compensable injury entitling him to benefits, independent of his committing three criminal workers’ fraud offenses.
[09/15] Ly v. County of Fresno
In a labor & employment action, brought by three Laotian correctional officers alleging racial discrimination in employment actions and retaliation after complaining about them, the trial court’s grant of summary judgment to defendant county is affirmed where the denial of plaintiffs’ separate workers’ compensation claims bar their claims in this action on res judicata grounds.
[07/28] Baker v. Workers Compensation Appeals Board
Affirming the decision of the Workers’ Compensation Appeals Board that the Subsequent Injuries Benefits Trust Fund benefits commence at the time the employer’s obligation to pay permanent disability benefits begin.
[07/21] Chugach Management Services Zurich American Insurance Co. v. Jetnil
Denying the petition for review of the award of disability benefits under the Defense Base Act and the application of a judicially-created ‘zone of special danger’ doctrine to a local national injured while employed by a government contractor overseas.
[06/20] Zhu v. Workers’ Comp. Appeals Bd.
In a case involving an in-home caretaker injured while traveling between worksites, the court annulled an earlier appeal dismissing the action and remanded for a new decision, where the facts of the case qualified for the required vehicle exception to the going and coming rule.
[05/22] Southern Ins. Co. v. WCAB
In an action involving a workers’ compensation insurance policy that was issued based on the express representation that the covered employer’s employees did not travel out of state, and after an employee was injured out of state, the insurer notified the employer that it was rescinding the policy because of the employer’s misrepresentation and returned the premium, the Workers’ Compensation Appeals Board’s decision affirming an arbitrator’s decision that, as a matter of law, the insurer could not rescind the policy and that the policy was in effect, is annulled where: 1) contrary to the arbitrator’s ruling, a workers’ compensation insurance policy may be rescinded; and 2) the arbitrator and the appeals board did not address and determine whether rescission was a meritorious defense to the employee’s claim.
[04/26] City of Jackson v. WCAB
In a workers’ compensation case, the Workers’ Compensation Appeals Board’s decision disregarding the apportionment determination of the qualified medical evaluator (QME) on the ground the determination was not substantial medical evidence and directing the workers’ compensation administrative law judge (ALJ) to make an award of unapportioned disability, is annulled where: 1) apportionment may be properly based on genetics/hereditability; 2) the QME properly apportioned disability; and 3) the QME’s opinion Is based on substantial medical evidence.
[03/29] Marin Community Services v. WCAB
In a writ proceeding seeking to set aside the decision of the Workers’ Compensation Appeals Board (WCAB) holding that firefighter-petitioner was entitled to the benefit of the rebuttable presumption under Labor Code section 3212.1 that his cancer arose out of his employment, the WCAB’s decision is affirmed where: 1) the WCAB’s determination that petitioner was an employee of Marinwood was based on a reasonable interpretation of the relevant statutes; and 2) the WCAB’s determination that the extension of the cancer presumption ran from the date petitioner last worked as a firefighter for any agency was based on a reasonable interpretation of the relevant statute.
[03/29] Ramirez v. WCAB
In a workers’ compensation writ proceeding, seeking review of worker-petitioner’s independent medical review on the ground the underlying utilization review was based on an incorrect standard, the order of the administrative law judge (ALJ) taking the matter off calendar is reversed and remanded for further proceedings where: 1) this is not a proper ground for appeal of a utilization review determination because it goes to the heart of the determination of medical necessity; 2) the independent medical reviewer is in the best position to determine whether the proper standard was used to evaluate the medical necessity of the requested treatment, and the statutory scheme requires the independent medical reviewer to use the proper standard in determining medical necessity; and 3) the Legislature’s plenary power over the workers’ compensation system precludes any separation of powers violation, and the process afforded workers under the system affords sufficient opportunity to present evidence and be heard.
[03/24] Co. of Riverside v. WCAB
In a workers’ compensation case involving a sheriff, the findings by the Workers’ Compensation Appeals Board are affirmed over a County’s challenge where: 1) plaintiff’s the application for adjudication of claim was timely filed; and 2) Labor Code section 5500.5(a), did not bar liability on the County’s part.
[03/23] People v. Riddles
Conviction of workers’ compensation insurance fraud in violation of Insurance Code section 11760(a) and restitution order are affirmed where: 1) a workers’ compensation insurer may recover, as restitution under Penal Code section 1202.4, the premiums it would have earned in the absence of misrepresentations by an insurance applicant; and 2) the court did not err in imposing a fine.
[01/20] Metro Machine Corporation v. DOWCP
In a petition for review of an order of the Benefits Review Board affirming decisions of an ALJ granting a claim for medical benefits under the Longshore and Harbor Workers’ Compensation Act, 33 U.S.C. section 907, the petition is denied where: 1) the only error the ALJ committed was in failing to apply the ‘naturally or unavoidably results’ standard to the fracture claim; and 2) remand for application of that standard would be a futile exercise, given that there was no issue presented regarding avoidability.
[11/22] Gage v. Workers’ Compensation Appeals Board
In a workers’ compensation action brought by petitioner, a deputy sheriff who sustained a job-related injury, the Workers’ Compensation Appeals Board’s decision denying penalties for the unreasonable delay of advance disability pension payments is annulled and remanded where: 1) such payments qualify as compensation under Labor Code section 3207; 2) such penalties available under Labor Code section 5814 are available for unreasonable delay or denial of the payment of compensation; and 3) no other provision of the Labor Code excludes such payments from the penalty provisions of section 5814.
[11/15] Lee v. West Kern Water Dist.
In a case involving the applicability of the workers’ compensation exclusivity rule, which governs the matter of when an injured worker can bring a civil action against the employer and when he or she is instead limited to the remedy of a workers’ compensation award, brought by a former employee against a water district and four co-employees, alleging assault and intentional infliction of emotional distress after the co-employees staged a mock robbery with plaintiff as the victim, the trial court’s judgment is: 1) reversed as to the grant of defendants’ motion for a new trial where the jury instructions were not erroneous, and alternative grounds for affirmance proposed by defendants lack merit; and 2) affirmed as to the order denying the motion for judgment notwithstanding the verdict.
[08/17] Kerrigan v. MSPB
In an appeal of a final decision of the Merit Systems Protection Board dismissing, for lack of jurisdiction, his claim that his workers’ compensation benefits were improperly terminated in retaliation for protected whistleblowing activity, the Board’s decision is affirmed where, although the Board incorrectly held that 5 U.S.C. section 8128(b) bars its review of petitioner’s appeal, petitioner failed to make a nonfrivolous allegation that his protected disclosure was a contributing factor in the agency’s action.
[08/11] Truck Insurance Exchange v. WCAB
In a worker’s comp case in which employer received notification of the injury the day after it happened by a workers compensation claim was not submitted to insurer until more than seven years later, the order excluding laches as an affirmative defense is affirmed where laces does not apply because notice to or knowledge of a workplace injury on the part of the employer is deemed to be notice to or knowledge of the insurer.
[06/22] State Compensation Insurance Fund v. WCAB
In an action seeking review of a decision of the Workers’ Compensation Appeals Board regarding the medical necessity of proposed treatment requested by an employee of the California Highway Patrol (CHP), involving Labor Code Section 4610.6, which created a new procedure–independent medical review (IMR)–that an injured worker may use to challenge an employer’s timely denial, delay or modification of a request for authorization of proposed medical treatment, the Board’s decision is reversed where the 30-day time limit in section 4610.6(d), is directory and, accordingly, an untimely IMR determination is valid and binding upon the parties as the final determination of the director.
[05/11] SSA Terminals and Homeport Ins. Co. v. Carrion
In an action brought by a claimant seeking disability benefits under the Longshore and Harbor Workers’ Compensation Act, an employer/insurer’s petition for review of a decision by the Benefits Review Board is denied where: 1) the claimant timely filed his claim against his employer; 2) claimant’s knee injury was a permanent, rather than a temporary, disability; and 3) the doctrines of exhaustion and waiver were inapplicable because claimant presented his claim of permanent disability well before the conclusion of the administrative process and neither the employer nor the agency was blindsided by the argument.
[05/02] Matthews v. Liberty Assignment Corp.
In a case dealing with the issue of whether a judgment, based on a structured settlement of an employee’s workers’ compensation claims against his employer and others, which was agreed upon by the parties and entered as an award in the workers’ compensation proceeding, may be assigned by the injured employee, the trial court’s denial of a motion for an order approving the assignment of plaintiff’s structured settlement payment judgement is affirmed where the assignment was prohibited by statute.