Alleging Psychiatric injury for first time on Petition for New and Further Disability

This is an Opinion and Order Granting Reconsideration

This is a very significant case for workers’ compensation principles.

The applicant had an admitted injury. The applicant entered into a Stipulated Award for orthopedic body parts in 2011. Thereafter, the applicant filed a timely Petition to Reopen. The applicant alleged new and further disability, including the need for psychiatric care. This was the first time psychiatric care was alleged.

The case went to trial. The defendant alleged the claim was barred by the doctrine of res judicata. They also alleged that the injury is not a new and further disability. Defendant claimed the applicant knew of the psychiatric injury at the time of the original stipulation and there was not good cause to reopen.

The Workers’ Compensation Judge (WCJ) found the psychiatric injury compensable. Defendant filed a petition for reconsideration. This opinion is in response to that. The Workers” Compensation Appeals Board indicated that a psychiatric condition does not fall within the workers compensation system until it causes either disability or a need for treatment and it is diagnosed. It was error for the WCJ to find the psychiatric injury AOE-COE. Instead the psychiatric injury is a compensable consequence of the original injury. It was not a new and independent injury.


The Court of Appeal Issued a Non Published Decision on Apportionment

This is a very significant case for workers’ compensation principles in that it discusses the current case law.

The applicant had a specific injury in 2000. The applicant

also filed a cumulative trauma from 2002 to 2004. The applicant was seen by an Agreed Medical Examiner (AME) for both injuries. The AME determined the applicant was 100 percent disabled.

The AME determined it was all the result of the specific injury and the cumulative trauma was a compensable consequence of the specific injury.

At trial the workers’ compensation judge (WCJ) found the applicant 100 percent without apportionment. The AME indicated the Benson case was not applicable here because Benson dealt with successive injuries while this was a compensable consequence.

The Worker’s Compensation Appeals Board (WCAB) agreed with the WCJ and denied the petition for reconsideration filed by the defendant. The Court of Appeal looked at Labor Code sections 4663 and 4664 and the Benson case.

The Court of Appeal indicated that successive injuries to the same body part under Brodie and Benson can not be rated as a single injury, except where the physician cannot parcel out the causation of the disability. There must be apportionment. This case was remanded for apportionment.

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Editor: Harvey Brown

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Supreme Court Finally Decides Apportionment Case

The court looked at five different decisions of the Workers’ Compensation Appeals Board (WCAB). All of the cases had an apportionment issue. In each case there was either a previous industrial injury or a nonindustrial cause for the permanent disability. In each case the workers’ compensation judge (WCJ) applied the formula for apportionment used in Fuentes v. WCAB.

These cases went up on appeal resulting in differing appellate decisions. In Brodie v. WCAB the court did not adopt Fuentes. In Welcher v. WCAB the appellate court followed Fuentes.

In a very lengthy opinion the supreme court then went into the apportionment problem. In a great discussion they discussed the history and reasoning of the apportionment laws. In there analysis they discuss Labor Code sections 4658 and 4750.

The law was settled for 28 years until SB 899 was passed in 2004. Labor Code sections 4663 and 4750 were repealed. A revised section 4663 and a new 4664 section were enacted. This resulted in the court questioning whether Fuentes was still good law.

This resulted in three different approaches being applied by various Courts of Appeal and the WCAB. The Supreme Court needed to review to solidify opinion under one approach.

The Supreme Court reviewed SB 899 and its legislative history. They compared the old and new statutes. They asked the question whether the legislature intended to adopt a new and different formula and determined the answer was no.

Therefore, Fuentes is still the law for apportionment


Apportionment Application on Petition To Reopen

The applicant filed a claim for an injury March 22,1995. The claim was admitted and the case went to trial. The Workers’ Compensation Judge (WCJ) found permanent disability to the left ear, neck, and left upper extremity at 67%. This rating was determined by “baseball arbitration” under former Labor Code section 4065. There was no apportionment

The applicant filed a timely Petition To Reopen under Labor Code sections 5803, 5804 and 5410. The Petition To Reopen proceeded to trial March 2,2004. On April 19, 2004 SB 899 was passed. On April 23, 2004 the WCJ indicated the new law of apportionment would apply.

The applicant filed a Petition for Removal to the Workers’ Compensation Appeals Board (WCAB) contending apportionment under SB 899 could not be applied. The WCAB invited briefs from the workers’ compensation community.

The WCAB issued an en banc decision in this case. The WCAB indicated that when you file a Petition To Reopen you have reopened the issue of permanent disability. This may now include disability that could not be apportioned prior to SB 899. Therefore, on the Petition To Reopen you can now apportion to pathology, asymptomatic prior conditions, retroactive prophylactic conditions, etc. If the new number is lower that does not change the original award.

However, defendants should consider whether they should do a simultaneous Petition To Reduce.


Decision On Apportionment That Is Published

The applicant filed a claim alleging a specific injury to his back in 2002. The claim was apparently admitted as industrial

The applicant had a previous back injury at the same employer in 1996. The case was settled for 20.5 permanent disability by Stipulation with Request for Award. This was equal to $11,680 for the 1996 date of injury.

The 2002 injury was submitted to a Workers’ Compensation Judge (WCJ). The WCJ found the applicant 73 per cent permanently disabled. From this overall rating the WCJ subtracted $11,680, not the 20.5 per cent. The defendant filed a petition for reconsideration contending that the percentage needs to be subtracted, not the dollar amount. The Workers’ Compensation Appeals Board (WCAB) denied reconsideration and agreed with the WCJ

The court of appeal stated that the long standing case of Fuentes v. WCAB did not apply to the new legislation of SB 899

The court of appeals indicated that there are three formulas that could be used. Formula A would subtract the prior percent of disability, as in Fuentes. Formula B looks to the number of weeks that are paid. This formula was rejected also

Formula C was adopted(which was rejected in Fuentes) which subtracts the dollar amount of the previous award. There reasoning was that Fuentes relied on Labor Code section 4750, which is repealed, and replaced with section 4664

They also awarded the applicant a life pension because his overall disability was 73 per cent. This really does not make sense and appears to be totally contrary to all legislative intent. This should be appealed to the Supreme Court.


New Apportionment Decision Under Section 4664

This is an important decision that will surely be vigorously fought at the appellate level.

The applicant sustained an injury to his left knee in 1995. The applicant stipulated to a 34 per cent permanent disability based on a restriction of no heavy lifting.

The applicant had a second injury in 1999 to the left shoulder, left knee, left ankle and right wrist. There was a stipulation to 42 percent permanent disability based on limitation to light work. There was apportionment to the prior restriction of no heavy lifting.

The current case involves a back injury and a limitation to semi-sedentary work. The Workers’ Compensation Judge (WCJ) subtracted the rating for the light work and gave the applicant a 10 percent disability after apportionment. The applicant petitioned for reconsideration.

The Workers’ Compensation Appeals Board (WCAB) determined that Labor Code section 4664 still requires the apportionment of overlapping disabilities. This includes the situation where you have a new area of the body. In this case the new area was the back, which was not included in either of the prior awards. Apportionment was still appropriate
.
The defendant has the burden of proving the existence of a prior award. The defendant must offer into evidence a copy of the prior award or ask the WCJ to take judicial notice of the prior award. If not available, it can also be shown by secondary evidence.

This is a conclusive presumption and applicant can not contend they rehabilitated themself. Once shown the prior award will be subtracted from the current award. Overlap will be determined using the principles that were in existence prior to the new legislation.


Appellate Court Issues Published Apportionment Decision

The applicant sustained an industrial injury to his back. The parties stipulated to a 46 % permanent disability. This was based on an agreed medical examiner opinion. The stipulation was approved in March 2001, before the new apportionment law went into effect.

In November 2001, the applicant filed a petition to reopen for new and further disability.

The case was presented to a Workers’ Compensation Judge (WCJ) in February 2004. The WCJ found the applicant was entitled to 70 % permanent disability without apportionment.

Apportionment was considered under the old apportionment law prior to April 19,2004. The defendant petitioned the Workers’ Compensation Appeals Board (WCAB) for review because the new apportionment law was passed 10 days after the WCJ’s decision. The WCAB remanded for the WCJ to determine whether SB 899 applied. The applicant preempted the WCJ by immediately filing a WRIT.

The appellate court discussed the conclusive presumption of Labor Code section 4664 (b). They further discussed the WCAB’s continuing jurisdiction under Labor Code sections 5410, 5803, and 5804.

They concluded that reopening discovery and further developing the record may be required to consider apportionment. They indicated it was not relevant that many cases in the pipeline may have been blind sided by the new legislation.

The important concept with this case is that even if there was no apportionment in the first stipulation you may get apportionment on reopening.


WCAB Issues Apportionment Decision

The applicant sustained an industrial injury to his low back. The major issue at the time of trial was permanent disability and apportionment. The applicant had a prior injury at the same employer to the same part of the body. The applicant received a stipulated Award on the prior injury of 49%.

The current injury went to trial. The Workers’ Compensation Judge (WCJ) took judicial notice of the prior 49% award. The WCJ then issued rating instructions to the Disability Evaluation Unit which yielded an overall rating of 80%.

The disability evaluator recommended a rating of 31%. This was the subtraction method of subtracting the prior 49% award from the current 80 % rating. The WCJ agreed and issued a Findings and Award for 31%.

The applicant attorney filed a petition for reconsideration asking that the percentage not be subtracted but rather the dollar value be subtracted. The applicant argued that Fuentes was no longer controlling because of the passage of SB 899.

The Workers’ Compensation Appeals Board (WCAB) issued this en banc decision stating that Labor Code sections 4663 (c) and 4664 (a) mandate that the
percentage of disability (not the dollar amount) be subtracted.

The WCAB indicates the fact that Fuentes was an analysis of the apportionment law under Labor Code section 4750, which was repealed, does not change the legislative intent in adopting the new apportionment statutes.

They indicated you find the overall permanent disability. You then subtract the percentage of permanent disability caused by other factors under section 4663 (c) or previously awarded under section 4664 (b).


Appeals Board Reviews Apportionment Under The New Law

The applicant had an industrial injury to her left knee. The applicant alleged as a compensable consequence of that a right knee problem. The applicant had surgery to the left knee.

The defense doctor apportioned the applicant’s disability on the fact that the applicant had significant degenerative arthritis in both knees. This was based on reasonable medical probability.

The Workers’ Compensation Judge (WCJ) agreed with the defense doctor and apportioned. The applicant filed a petition for reconsideration.

The Workers’ Compensation Appeals Board ( WCAB) issued a n En Banc decision. They reviewed SB 899.

They indicated that Labor Code section 4663 (a)’s apportionment of permanent disability is based on causation of permanent disability , not causation of injury.

Section 4663 (c) indicates what standards the WCAB must use for this determination and how to determine what percentage of permanent disability was caused by other factors.

The applicant has the burden of determining the percentage of
disability caused by the injury while the defendant has the burden of what disability was caused by other factors.

Disability can be apportioned to pathology, asymptomatic prior conditions, and a retroactive prophylactic work preclusion, even though this had been disallowed in the past under prior case law. There must be substantial medical evidence of the apportionment. The doctor must state the reasons for the opinions and that it is based on reasonable medical probability.


New Apportionment Law Reviewed In Key Case by WCAB

The applicant had an industrial injury on February 12, 2002. The applicant had a prior injury to the same body part in 1997. The applicant had continuing problems up until the current injury. In fact, the applicant was still receiving treatment on January 31, 2002 for the 1997 injury.

The Mandatory settlement conference was held on November 13, 2003. A trial was held on February 18, 2004. The Workers’ Compensation Judge (WCJ) referred the case to the Disability Evaluation Unit. The case was deemed submitted.

On April 19, 2004 SB 899 was enacted and created new apportionment legislation.

ON April 23, 2004 the WCJ found the applicant had a 34%disability without apportionment. Defendant filed a petition for reconsideration which resulted in this opinion.

The Workers’ Compensation Appeals Board (WCAB) issued an en banc decision that included a concurring and dissenting opinion. They could not reach a unanimous decision on this important issue. This case is going to an appellate court for review.

The WCAB first dealt with what an existing order, decision or award dealt with under Labor Code section 4663. If the new statute applied the decision of the WCJ would have to be rescinded. They held in this case that the case was submitted prior to April 19, 2004.

They further held where there is no existing order, decision, or award, the apportionment provisions of SB 899 apply to all cases irrespective of the date of injury.

The concurring opinion indicated orders of submission were not sufficient. The dissent indicated the majority’s decision was contrary to legislative intent.


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