WCPanelIQ
PanelGranted

Rodriguez, Maria

MARIA RODRIGUEZ, Applicant vs. GENESIS HC WASHINGTON CENTER; AIG INSURANCE, adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ12739899
Decision date
Apr 11, 2024
District office
San Jose
WCJ
—
Claim administrator
Sedgwick Claims Management Services (adjusting for AIG Insurance)
Commissioners
JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: low back

LC §4650LC §5800LC §5814LC §5814.5CCR §10700CCR §10870CCR §10882

Summary

Maria Rodriguez, a CNA, settled her low back claim via Compromise and Release for $55,000, with both paragraphs six and seven of the C&R stating that permanent disability advances were '0,' while paragraph nine contained boilerplate language that defendant would receive credit for 'all PD advances, subject to proof.' The WCJ approved the C&R via an OACR allowing credit for PD advances of '-0-', but defendant then issued a settlement check reflecting an $18,270 credit for PDAs paid in 2021-2022. Applicant filed a Petition for Penalties/Enforcement, which the WCJ denied based on a finding of mutual mistake. On reconsideration, the WCAB majority rescinded the F&O, holding that the specific zero-advance language controlled over the non-specific catch-all, that any ambiguity was construed against defendant as drafter, and that defendant failed to timely seek reconsideration of the unambiguous OACR. Commissioner Razo dissented, finding mutual mistake since all parties had written notice of the advances.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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