Panel finds good cause to set aside Order Approving Compromise and Release

This is a Board panel decision

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

The applicant sustained an accepted cumulative trauma injury to the low back and hips while working as a maintenance worker. The applicant saw a primary treating doctor who did not discuss permanent disability in his report.

A claims adjuster offered the unrepresented applicant a $7500 settlement without negotiations and did not explain the applicant had a right to a Qualified Medical Examiner (QME).

The applicant did not know what permanent and stationary meant and signed a Compromise and Release (C&R) that stated applicant’s temporary disability was ongoing based on the primary treating doctor. The C&R stated the applicant was not permanent and stationary.

Defendant’s attorney got the C&R approved on a walk-through. Two days later the defendant sent applicant a letter indicated his temporary disability was discontinued and his right to dispute this.

The applicant retained counsel who filed a petition to set aside the C&R. The Workers’ Compensation Judge (WCJ) concluded there was no good cause to set aside the C&R. The applicant filed a petition for reconsideration.

The Workers’ Compensation Appeals Board (WCAB) reversed the WCJ. The panel ruled the applicant had not been given adequate notices of his rights before entering into the C&R.

Moreno v Hidden Valley Ranch


Ruling on cancer presumption under Labor Code section 3212.1 is upheld

This is an order denying appellate review

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

The applicant was employed as a probation officer. He was assigned to the
Narcotics Task Force under his employment for nearly two years. This was
through the State Bureau of Narcotics Enforcement. However, the County
where he was a probation officer paid his salary.

He was designated a Special Agent of the State and reported directly to the State. He had job duties that included incinerator operations and exposure to known carcinogens. The applicant later developed pancreatic cancer while employed by the County and filed a Workers’ Compensation claim asserting the cancer presumption of Labor Code section 3212.1.

The case went to trial and the Workers’ Compensation Judge (WCJ) found that there was substantial medical evidence supporting the applicant’s entitlement to the Labor Code section 3212.1 cancer presumption.
The applicant filed a petition for reconsideration and the Workers’ Compensation Appeals Board (WCAB) in a Board panel decision agreed with the WCJ.

This resulted in the defendant filing for a Writ of Review with the appellate court. The appellate denied defendant’s petition for writ of review, concluding that substantial medical evidence supported a finding of the cancer presumption.


Applicant is ruled Initial Physical Aggressor and the case is ruled Non Industrial

This is a Board Panel decision

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

The applicant was a school teacher. The teacher blocked a doorway to prevent students form leaving the classroom after class was over. He intended on telling several students they were failing the class.

A student attempted to exit the doorway. The teacher told the student to sit down. The student told the teacher to get out of his way. At that time some spit from the students mouth appeared to go toward the teacher. The teacher slapped the student in the face. The student them punched the teacher in the chest.

The teacher filed a workers’ compensation claim alleging a psychiatric injury with post traumatic stress. The case went to trial and the Workers’ Compensation Judge (WCJ) ruled the applicant suffered a psychiatric injury but compensation was denied by the initial physical aggressor rule. 3600 (a)(7). The applicant filed a petition for reconsideration. The Workers’ Compensation Appeals Board (WCAB) reviewed case law including Mathews v. WCAB and Gegic v. WCAB.

The WCAB reviewed the psychiatrist report that applicant had sustained a psychiatric injury. Even though he had a psychiatric injury he was denied compensation as the initial physical aggressor.

The Board determined the student did not deliberately spit on the teacher it was just liquid released from his mouth while he was talking.


Applicant established Special Mission Exception to Going and Coming Rule

This is a Board Panel decision

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

The applicant was a doctor. He worked five days a week, 40 hours a week unless his supervisor asked him to work overtime.

His supervisor emailed him asking him to prepare a presentation. He walked to work. He left the hospital at 8 p.m. to walk home carrying his computer with the presentation. His supervisor called him to discuss the presentation. As he was talking to the supervisor he stepped off the curb and was hit by a car. He filed a claim and the defendant denied the claim base on the Going and Coming Rule. The case went to trial and the Workers’ Compensation Judge (WCJ) found the applicant was on a special mission and therefore, the claim was compensable.

The defendant appealed. The Workers’ Compensation Appeals Board (WCAB) indicated that under the going and coming rule injuries do not normally arise out of and in the course of employment. However, there are numerous exceptions.

The special mission exception is where the employee is performing (1) an extraordinary duty in relation to the employees duties; (2) is within the course of employment: and (3) has undertaken the duty at the express of
implied request of the employer for the benefit of the employer.

Here it was ruled the applicant was providing a service to the employer within the special mission exception.


Board En Banc decision on supplemental job displacement benefit voucher

This is a Board En Banc panel decision

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

The applicant sustained an admitted injury. The parties resolved the injury by way of Stipulations with Request for Award. The award did not include a Supplemental Job Displacement (SJDB) voucher.

Prior to the settlement the defendant sent a Notice of Offer of Regular, Modified or Alternative Work. The letter accompanying the notice indicated that the applicant must verify that he is qualified to accept employment as an inmate laborer. You have voluntarily terminated your employment due to your release from prison.

The applicant filed a Request for Dispute Resolution and asked for resolution of the SJDB. The Administrative Director did not issue a determination and therefore, it was denied by operation of law.

The case went to trial and the Workers Compensation Judge (WCJ) indicated the appeal was untimely an denied the SJDB. The applicant filed a petition for reconsideration and the Workers Compensation Appeals Board (WCAB) ruled the applicant was entitled to a voucher. Defendant appealed.

The WCAB ruled AD rule 10133.54 invalid. They also ruled an employer must show a bona fide offer of regular work to avoid liability for a SJDB. Here there was no bona fide offer.


Applicant did not suffer a work related injury when he fell in a parking lot one block from work

This is a writ denied case

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

The applicant tripped and fell while walking after work from his place of employment to a parking lot one block away. The defendant denied the injury on the basis of AOE-COE raising the “Going and Coming’ rule. 

The employer did not provide parking for its employees. The supervisor gave suggestions as to different lots the employee could park. The lot the employee parked at was not on the employer’s premises. The employer did not own or control the parking lot.

The Workers’ Compensation Judge (WCJ) ruled the employee was not barred by the “going and coming” rule. The WCJ indicated the employer required the employees to park offsite and the employer benefitted from not having to provide parking for its employees. The WCJ indicated the employee was in the course of his employment while walking between his office and the parking lot.

The defendant filed a petition for reconsideration. The Workers’ Compensation Appeals Board (WCAB) rescinded the WCJ decision in a split panel decision.

The WCAB ruled the was not a “special risk”. The WCAB ruled the applicant was subject to the same risks of walking between parking lot and the employers’ premises as any other pedestrian. They evaluated whether this was a “borderline case” and determined it was not. The injury was non industrial.


Applicant cannot receive temporary disability for time lost for treatment medical appointments after return to work

This is an appellate court decision

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

The applicant had two specific injuries. The applicant was found permanent and stationary for one injury but not the other. The applicant returned work.

The applicant then missed time from work for medical treatment appointments and for appointments with the Qualified Medical Examiner. The applicant used sick time and vacation time for the appointments.

At a hearing the applicant claimed she was entitled to temporary disability (td) payments for the time missed from work. The Workers’ Compensation Judge (WCJ) ruled under section 4600 (e)(1) that that the applicant was not entitled to td for an appointment for medical treatment. The WCJ did not rule on the QME time lost.

The applicant filed for reconsideration. The WCJ on the report and recommendation again indicated the applicant is not allowed td for medical treatment but indicated the applicant can get one day of td for the QME exam. The Workers’ Compensation Appeals Board (WCAB) agreed with the WCJ. The appellate court reviewed Department of Rehabilitation v WCAB and determined the applicant is not entitled to temporary disability indemnity for missed time from work to attend appointments for medical treatment. The applicant is entitled to td for the missed time for a medical examination as opposed to treatment.

Case:Skelton v WCAB


Applicant convicted of attempted perjury for lying at deposition even though the transcript was never signed

This is an appellate court decision

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

The applicant claimed an ankle injury occurred on January 24, 2017 between 1 and 2 am. The applicant wrote a memo detailing the injury including the date and time. It was also reported to the supervisor and the insurance company as having occurred on that date at that time.

The employer had video evidence of that date and time and saved the footage. No evidence of an injury was visible in the video.

The applicant’s deposition was taken and the applicant testified to the injury occurring between 3 and 4 am. The applicant was asked if he previously reported the injury at 1 am and he testified he did not.

The parties stipulated that if the unsigned original transcript was not returned within 60 days, a certified copy could be used for all purposes. The applicant did not sign and return the transcript.

The applicant was referred for prosecution and charged with seven counts of insurance fraud and three counts of attempted perjury. The jury convicted the applicant of perjury but could not reach a verdict on all
other counts. The appellate court indicated that all elements of perjury were not met at trial but under People v Post, the crime of attempted perjury was met. Therefore, the applicant’s crime of attempted perjury was upheld on appeal.

Case: People v. Ibarra


Workers’ Compensation Appeals Board holds that you cannot claim credit for permanent disability advanced on wrong case

This is a Decision after reconsideration.

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

The applicant sustained a cumulative trauma to the cervical spine and lumbar spine.  The applicant also sustained a specific to the cervical spine.

The applicant was found to have a 28 percent permanent disability on the cumulative trauma. The applicant was found to have a 23 percent disability on the specific injury. The doctor had apportioned between the injuries.

The defendant made permanent disability advances of $36,000 on the specific injury. The defendant made no permanent disability advances on the cumulative trauma.

The case went to trial and the defendant claimed credit for overpayment of permanent disability advances on the specific injury. The defendant wanted those overpayments to be applied to the cumulative trauma.

The Workers’ Compensation Judge (WCJ) denied the credit indicating the defendant was not entitled to credit from one injury on to another. The defendant filed a petition for reconsideration contending that since it was a public entity this was an impermissible “gift” by a public entity.

The Workers’ Compensation Appeals Board  (WCAB) found no merit to this argument. The WCAB agreed with the WCJ that you can not take credit for permanent disability advances for a specific injury on a separate cumulative trauma injury.


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.


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