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Case Summaries

Workers' Comp

[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in effect, is annulled where: 1) contrary to the arbitrator's ruling, a workers' compensation insurance policy may be rescinded; and 2) the arbitrator and the appeals board did not address and determine whether rescission was a meritorious defense to the employee's claim.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.

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