Workers’ Compensation Appeals Board holds that a good faith personnel action is exempt from the 90 day limit

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

The applicant alleged a cumulative trauma to his psyche, brain, head and headaches. The parties stipulated that the defendant did not deny liability within 90 days pursuant to Labor Code section 5402 (b). The defendant contended that a good faith personnel action under Labor Code section 3208.3 (h) fell outside the scope of the 90 day limit pursuant to 5402 (b).

The Workers’ Compensation Judge (WCJ) ruled that the good faith personnel action was subject to 5402 (b) and could only be established by evidence that could have been obtained within 90 days of the filing.

Defendant filed a petition for reconsideration. The Workers’ Compensation Appeals Board (WCAB) reversed the WCJ decision. The WCAB looked at the language of both statutes.  It also reviewed the case of James v. WCAB. The Board determined that a good faith personnel defense obtained more than 90 days after the receipt of the claim form was permissible even if that evidence was obtainable with reasonable diligence within the 90 days of receipt of the claim form.

The Board looked at the language that indicated a higher threshold for compensability under Labor Code section 3208.3. This higher level of compensability applied not withstanding any other provisions of the code including the 90 day provision of Labor Code 5402 (b). Therefore, the 90 day was not applicable.


Workers’ Compensation Appeals Board rules doctrine of laches applies to deposition fees

This is a writ denied case

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

The applicant sustained an admitted injury.  The applicant’s deposition was taken on 2/8/2001 and 12/12/2001.  The case settled by way of Compromise and Release (C&R) in 2004. The language of the C&R indicated the defendants were to pay reasonable deposition fees within 20 days, and the balance subject to continuing jurisdiction.

The applicant first made a demand for deposition fees in 2005, four years after the depositions. Defendant first paid a deposition fee in 2010 and a second deposition fee in 2018.

The applicant attorney claimed deposition attorney fees in addition to what was paid and it went to hearing.  The applicant attorney also claimed penalties and sanctions.

The Workers’ Compensation Judge (WCJ) indicated deposition fees are discretionary, not mandatory. The WCJ noted that the request for deposition fees came four years after the first deposition, three and half years after the second deposition, and more than one year from the date of the C&R. Applicant’s attorney argued that the language of the C&R indicated the defendant must pay. The WCJ ruled that language was vague and ambiguous. The WCJ ruled that the inadequate and delayed request for attorney fees was prejudicial to defendant and barred by the doctrine of laches. On Petition for Reconsideration the WCAB agreed. No penalty was allowed.

Case: Shandler and Associates v WCAB


Workers’ Compensation Appeals Board rules applicant is permanently and totally disabled

This is a writ denied case

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

The applicant sustained an injury to her neck, lower back, right shoulder, psyche and headaches in 2007. The applicant was originally  awarded a 57 per cent permanent disability. The Workers’ Compensation Appeals Board (WCAB) rescinded the award on petition for reconsideration and returned the case to the trial level to develop the record pursuant to Oglivie. They wanted the record developed with vocational evidence of the applicant’s future earning capacity.

The parties agreed on a vocational expert. The vocational expert determined the applicant lost all earning capacity. The psychiatric Qualified Medical Examiner determined the applicant was unable to return to the open labor market based on a Global Assessment of Function test (GAF).

The Workers’ Compensation Judge (WCJ) determined the applicant had a 89% disability using the GAF in psychiatry. The WCJ combined this with a 27 % orthopedic disability and came up with an overall rating of 92% according to the AMA guides. However, based on vocational expert evidence there was substantial evidence to award the applicant 100 per cent, which the WCJ did.

The defendant filed a petition for reconsideration and the WCAB agreed with the WCJ. There was substantial evidence by the psychiatrist and vocational expert to award 100 per cent disability.

Case: International Capital Group v WCAB (Walter)


Workers’ Compensation Appeals Board rules on Special Risk Exception to Going and Coming rule

This is a writ denied case

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

The applicant claimed an injury in a head-on motor vehicle accident on the way home from work. The applicant was a nurse and claimed that he had to work a mandatory second shift and was injured on the way home. The employer said the shift was voluntary.

The Workers’ Compensation Judge (WCJ) ruled the injury was industrial and fell within the “special risk exception” to the “going and coming rule”. The Workers’ Compensation Appeals Board (WCAB) on petition for reconsideration rescinded the award and barred the claim. The WCAB reviewed General Ins. v WCAB (Chairez) and the two prong test. But for the employment, the applicant would not have been at the location where the injury occurred, and the risk was distinctive from that of the general public.

The WCAB decided the applicant was not exposed to any extraordinary risk in comparison to that of the general public. It was determined the applicant chose to work the second shift. It was not a requirement. The risks in his commute were no different than the general public.

It was determined his commute and motor vehicle accident fell within the “going and coming rule” and was not a compensable work injury.


Apportionment not granted when disability between two injuries cannot be separated

This is a writ denied case

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

The applicant had an admitted orthopedic, internal and psychiatric specific injury on 10/15/2002. The applicant also alleged a cumulative trauma from 10/15/2002 to 1/2/2003.

The applicant saw an Agreed Medical Examiners (AME) in orthopedics, internal medicine and psychiatry. All three provided opinions on apportionment between injuries.

At trial the Workers’ Compensation Judge (WCJ) awarded the applicant 39 percent permanent disability for the specific and 68 percent permanent disability for the cumulative trauma after apportionment between the injuries.

The applicant filed a petition for reconsideration. The Workers’ Compensation Appeals Board (WCAB) granted reconsideration and submitted new rating instructions to the rater. The rater came up with a combined rating of 83 percent for the specific and the cumulative trauma. The WCAB rescinded the award and issued a joint award for 83 percent.

The WCAB reviewed Labor Code section 4663 and Benson v. WCAB. They determined apportionment must be based on causation, except when the contribution of separate injuries cannot be parceled out by an evaluating physician. Here the disability was inextricably intertwined. Therefore, a combined PD award issued of 83 percent.


Applicant was found to have three injuries and two separate periods of cumulative trauma

This is a writ denied case

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

In most cases the applicant has only one cumulative trauma. This case was different in that more than one cumulative trauma was found.

The applicant filed a cumulative trauma against an employer for the period of 1985 to 1995. The date of injury under Labor Code section 5412 was found to be in 1995, with Labor Code section 5500.5 going back one year from that date.

A specific injury was filed for 1993. Then a separate cumulative trauma was field against a different employer for 1996 to 2007. A date of injury was found under Labor Code section 5412 of 2006 when the applicant first missed time from work. Then 5500.5 was applied for the last year of employment.

At trial the Workers’ Compensation Judge (WCJ) found two separate cumulative traumas rather than a single cumulative trauma indicating defendants failed to raise the issue of a single cumulative trauma at trial.

The Workers’ Compensation Appeals Board (WCAB) affirmed the WCJ indicating the issue was not timely raised.

Additionally, they indicated that separate cumulative trauma injuries cannot be treated as a single cumulative trauma where there are separate periods of disability and separate periods of need for medical treatment.


Court of Appeal overturns WCAB decision on apportionment in published case

This is a court of appeal case

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

The applicant had a work related injury. The applicant saw private physicians that did not believe the applicants vision loss was work related. The Qualified Medical Examiner (QME) believed it was work related. However, he apportioned disability to a pre-existing condition.

After the doctor’s deposition he apportioned 15% to industrial and 85% to non industrial.

At trial the Workers’ Compensation Judge (WCJ) found the apportionment was not supported by substantial evidence and did not allow any apportionment. The defendant filed a petition for reconsideration. The Workers’ Compensation Appeals Board (WCAB) agreed with the WCJ and indicated that the QME confused causation of injury with causation of disability. Therefore, no apportionment.

The appellate court reviewed Brodie, Zemke, Escobedo, etc. They also reviewed Labor Code section 4663 and 4664. The appellate court indicated the QME understood the distinction between cause of injury and cause of disability. It is not required that an asymptomatic condition become symptomatic to receive apportionment. It is only required that substantial medical evidence state that an asymptomatic condition was a contributing factor of disability. Here there was substantial medical evidence to allow apportionment.


The statute of limitations is determined by Labor Code section 5412

This is a writ denied decision

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

The applicant filed an application for a cumulative trauma to his neck and spine that ended on July 11, 2012. The application was not filed until July 6, 2015. This was almost three years after his last date of employment.

The applicant had prior complaints of neck pain and indicated that he thought the pain was caused by work. However, he did not report an injury. He also did not have a medical opinion that the neck complaints were work related. The applicant then obtained a medical opinion on July 14, 2014. It was determined at that time he had a work-related injury and he had permanent disability.

This was applicants first medical knowledge that the injury was industrial. The case went to trial and the defendant raised the statute of limitations as a defense. The Workers’ Compensation Judge (WCJ) found that under Labor Code section 5412 the date of injury was not until July of 2012, and therefore, the statute of limitations did not apply.

In denying the petition for reconsideration the Workers’ Compensation Appeals Board (WCAB) noted that the applicant being aware of pain is not synonymous with knowledge of an industrial injury. The applicant is not charged with knowledge of the injury until they receive medical advice of the causal connection, unless the applicant has medical training or knowledge. This applicant did not. Therefore, the statute did not apply.


A psychiatric claim on a petition to reopen was allowed even though it was never raised on original claim

This is a writ denied decision

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

The applicant suffered a compensable injury to his left shoulder, hands and neck due to a cumulative trauma. The case went to trial and the Workers’ Compensation Judge (WCJ) issued a Findings and Award for 69% permanent disability.

Thereafter, the applicant filed a timely Petition to Reopen for New and Further disability. The applicant alleged a psychiatric disability for the first time as a compensable consequence of the original disability. There was substantial evidence of the psychiatric disability before the original trial, but no psychiatric claim was made.

The WCJ found the applicant was precluded from raising the psychiatric claim on the petition to reopen. The applicant filed a petition for reconsideration. The Workers’ Compensation Appeals Board (WCAB) found the applicant was not precluded from raising the psychiatric claim. They reasoned that even though applicant was aware of psychiatric symptoms there was no substantial evidence before the original trial establishing industrial causation.

Here, even though there was knowledge, there was no diagnosis using DSM III prior to the original trial.

The WCAB granted reconsideration. The Court of Appeal denied the writ that was filed. The court of appeal indicated that panel decisions are citable authority.


100 percent finding of permanent disability under Labor Code Section 4662 (b) overturned

This is a published court decision

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

The applicant suffered a compensable injury to his heart and psyche while employed as a correctional officer. The applicant received a 97 percent permanent disability rating for his heart. The rating for the psychiatric component was 71 percent. Combining the two ratings resulted in a 99 percent disability.

The case went to trial. The Workers’ Compensation Judge (WCJ) found the applicant 100 percent (permanent and total) disabled in accordance with Labor Code section 4662 (b). The WCJ did not mention or discuss the combined rating of 99 percent using the 2005 schedule of rating permanent disability.

The defendant filed a Petition for Reconsideration alleging the applicant was 99 percent disabled. The Workers’ Compensation Appeals Board (WCAB) reviewed Labor Code section 4660 and 4662 (b) and agreed with the WCJ that the applicant was 100 percent.

On review the Court of Appeal reviewed section 4660 and 4662. They also reviewed numerous cases. They reviewed Ogilvie, LeBoeuf, Jaramillo, among others. They concluded there was no basis for concluding section 4662 (b) provided a path to permanent disability. They indicated section 4660 is mandatory. The 2005 schedule is prima facie evidence of disability. In this case 99 percent. The case was remanded to the WCAB for further action.


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