I appeared under the supervision of the handling attorney, Mr. Joseph C. Yrulegui, at the Mandatory Settlement Conference on April 27, 2017. Mr. Yrulegui and I were in constant communication. I arrived at the Board at approximately 1:30 p.m. and left at approximately 5:00 p.m. The applicant was present and represented by Mr. David Ibarra. Ms. Dora Canales provided the interpreting services. Ms. Annette Castanon appeared representing the interest of the Employment Development Department. This matter was originally set in front of the Honorable Judge William Gunn, but he is no longer in the Fresno Workers’ Compensation Appeals Board. As such, the Honorable Judge Thomas Heslin, presided over this matter.
Background
We have a finalized report from the following doctors: Agreed Medical Evaluator, Dr. Allen Sanders (orthopedic), Panel Qualified Medical Evaluator, Dr. Michael S. Kesselman (psyche), PQME, Dr. William M. Gabriel (dental), and PQME, Dr. Steven L. McIntire (neurology). Based on these doctor’s reports, we have a combined disability exposure at 60%, which has a monetary value of $101,862.50, payable at the maximum rate of $290.00 per week for 351.25 weeks. We also have an MSA amount of $90,575.00 as recommended by the CMS. Authority was given up to $220,000.00 to close out this entire claim, including the settlement of the serious and willful. The applicant will self-administer the MSA. Prior to this hearing, the applicant’s attorney made a demand of approximately $231,000.00. It is our intention to include all outstanding claims against J.G. Boswell Company from the applicant including the denied cumulative trauma claim through January 2, 2014 as well as a very old claim with a date of injury of January 18, 1994. Per your email dated April 27, 2017, the applicant had a right shoulder claim on January 18, 1994, which you paid indemnity of approximately $5,495.00 and has been closed on our end since May 19, 1997. Nonetheless, we believe it would be more prudent to include all outstanding claims in the Compromise and Release. Mandatory Settlement Conference Once I located the applicant’s attorney, we began to discuss all the issues on this case, the need to dismiss the serious and willful petition, the need for a voluntary resignation, the requirement of a self-administered MSA, and the inclusion of the January 18, 1994 date of injury. The applicant’s attorney was initially a little concerned with the inclusion of the January 18, 1994 claim, because he is not representing the applicant for that claim. Nonetheless, I asked him to check with his client to see if the applicant agreed with the inclusion of the January 18, 1994 date of injury. The applicant’s attorney returned and considered the old issue presented with exception of the settlement amount. Ultimately, the parties agreed to a settlement amount of $215,000.00 to include all issues. Frankly, I believe this is a very reasonable amount considering the inclusion of the serious and willful Petition as well as buying out of the potential risk of the case being re-opened if not resolved via Compromise and Release. The applicant’s permanent disability is close to 70%, thus it is much more prudent for us to shut this case down at this point. The parties then proceeded to draft the settlement agreement. …show more content…
Employment Development Department
We were initially under the impression that EDD would be providing us clearance at the Board based on our prior communication with another representative from EDD. Our argument to EDD was we are not responsible to pay applicant’s indemnity benefit during “off-season” work period from February 9, 2014 through July 6, 2014. We made a voluntary reimbursement of $10,684.38 with the intention to cover the “in-season” from July 7, 2014 through February 16, 2015.
Interestingly, Annette from EDD informed me even without considering the benefits paid during the “off-season” period, there remains to be a balance of $1,200.57. At first, she was under the impression that our temporary disability benefit rate was $445.21, which is higher than the rate we reimbursed the EDD voluntarily. Therefore, there is still a difference. However, I soon noticed that this is not the case. Annette returned to her office to look into this claim. Soon after she returned, we noticed were the balance came from. Apparently, also confirmed with
Background
We have a finalized report from the following doctors: Agreed Medical Evaluator, Dr. Allen Sanders (orthopedic), Panel Qualified Medical Evaluator, Dr. Michael S. Kesselman (psyche), PQME, Dr. William M. Gabriel (dental), and PQME, Dr. Steven L. McIntire (neurology). Based on these doctor’s reports, we have a combined disability exposure at 60%, which has a monetary value of $101,862.50, payable at the maximum rate of $290.00 per week for 351.25 weeks. We also have an MSA amount of $90,575.00 as recommended by the CMS. Authority was given up to $220,000.00 to close out this entire claim, including the settlement of the serious and willful. The applicant will self-administer the MSA. Prior to this hearing, the applicant’s attorney made a demand of approximately $231,000.00. It is our intention to include all outstanding claims against J.G. Boswell Company from the applicant including the denied cumulative trauma claim through January 2, 2014 as well as a very old claim with a date of injury of January 18, 1994. Per your email dated April 27, 2017, the applicant had a right shoulder claim on January 18, 1994, which you paid indemnity of approximately $5,495.00 and has been closed on our end since May 19, 1997. Nonetheless, we believe it would be more prudent to include all outstanding claims in the Compromise and Release. Mandatory Settlement Conference Once I located the applicant’s attorney, we began to discuss all the issues on this case, the need to dismiss the serious and willful petition, the need for a voluntary resignation, the requirement of a self-administered MSA, and the inclusion of the January 18, 1994 date of injury. The applicant’s attorney was initially a little concerned with the inclusion of the January 18, 1994 claim, because he is not representing the applicant for that claim. Nonetheless, I asked him to check with his client to see if the applicant agreed with the inclusion of the January 18, 1994 date of injury. The applicant’s attorney returned and considered the old issue presented with exception of the settlement amount. Ultimately, the parties agreed to a settlement amount of $215,000.00 to include all issues. Frankly, I believe this is a very reasonable amount considering the inclusion of the serious and willful Petition as well as buying out of the potential risk of the case being re-opened if not resolved via Compromise and Release. The applicant’s permanent disability is close to 70%, thus it is much more prudent for us to shut this case down at this point. The parties then proceeded to draft the settlement agreement. …show more content…
Employment Development Department
We were initially under the impression that EDD would be providing us clearance at the Board based on our prior communication with another representative from EDD. Our argument to EDD was we are not responsible to pay applicant’s indemnity benefit during “off-season” work period from February 9, 2014 through July 6, 2014. We made a voluntary reimbursement of $10,684.38 with the intention to cover the “in-season” from July 7, 2014 through February 16, 2015.
Interestingly, Annette from EDD informed me even without considering the benefits paid during the “off-season” period, there remains to be a balance of $1,200.57. At first, she was under the impression that our temporary disability benefit rate was $445.21, which is higher than the rate we reimbursed the EDD voluntarily. Therefore, there is still a difference. However, I soon noticed that this is not the case. Annette returned to her office to look into this claim. Soon after she returned, we noticed were the balance came from. Apparently, also confirmed with