Psychiatric injury is supported by substantial medical evidence and compensable as extraordinary event

This is a Board Panel decision

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

The applicant was a tree trimmer employed less than 6 months. A coworker inadvertently put applicant’s climbing rope in to  a wood chopper. This resulted in a left leg dislocation and later surgical amputation. The defendant accepted injury to multiple body parts but not to psychiatric injury.

At trial the Workers’ Compensation Judge (WCJ) found the orthopedic compensable but did not rule on whether the applicant’s injury resulted from a “sudden extraordinary employment condition.”

Defendant petitioned for reconsideration indicating there was no psychiatric injury under Labor Code section 3208.3 (d) because the applicant had not worked 6 months. and the “sudden extraordinary exception” to this code section did not apply.

The Workers’ Compensation Appeals Board (WCAB) reviewed Matea v WCAB and SCIF v WCAB (Garcia). They indicated the facts revolved whether the injury was “uncommon, unusual and unexpected and did not result from a routine and regular event.”

They ruled the applicant showed the manner in which his leg was amputated was from an “uncommon, unusual and unexpected event” and not from a “routine and regular employment event.”

Therefore, the psychiatric claim was compensable .


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.


This is a Board panel decision where a workplace cut or scrape led to an amputation that could become industrial

This is a Board panel decision

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

The applicant suffered a cut or scrape at work.  He also got a blister on his left toe.  The toe turned gangrene.  The applicant had new onset diabetes. His left foot progressively got worse.  The applicant first had an amputation to the low shin.  The condition spread and then he had an above-the-knee amputation.

The applicant saw an orthopedist who found the left toe gangrene was industrial.  The applicant then saw an internist that indicated the injury was not industrial.

The Workers’ Compensation Judge (WCJ) did not find applicant credible.  The applicant did not report any wounds to his foot to the employer.  The applicant filed a petition for reconsideration.

The Board reviewed the liberal construction code section 3202.  They also reviewed the case of Kimbol v IAC.  Then they reviewed McAllister v WCAB.  The Board indicated the question is whether there is a reasonable inference to support the claim for injury.

They looked at the existing medical opinions.  They concluded that the record was insufficient to determine causation. They suggested that the current physicians address the issue and if they cannot make a determination the WCJ should appoint a physician.

Therefore, they rescinded the decision and remanded for a determination on causation.


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.


Board En Banc decision finds Administrative Director Rule 10133.54 Invalid

This is a Board En Banc panel decision

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

The applicant sustained an injury to his right wrist. The parties settled the case by Stipulations with Request for Award. The settlement did not include a supplemental job displacement benefits voucher (SJDB).

Defendant sent applicant a Notice of Offer of Regular, Modified or Alternative Work. Applicant filed a Request for Dispute Resolution Before Administrative Director requesting that the applicant be given a SJDB and objected to the offer of regular, modified, or alternative work.  The Administrative Director did not issue a determination pursuant to AD rule 10133.54 (f). The request was deemed denied.

The applicant filed a Declaration of Readiness to proceed on request for SJDB. The Workers’ Compensation Appeals Judge (WCJ) issued a decision that the applicant’s appeal was untimely. The applicant filed a Petition for Reconsideration contending he  was entitled to the SJDB.

The Workers’ Compensation Appeals Board (WCAB) issued a decision rescinding the WCJ and concluding the WCAB has exclusive jurisdiction over SJDB irrespective of AD rule 10133.54. Defendant sought reconsideration of that decision.

The WCAB ruled AD rule 10133.54 is invalid because it exceeds statutory authority. The WCAB has exclusive jurisdiction. It also ruled an employer must make a bona fide offer of employment.


Lien Claimants liens are deemed satisfied with no further payment due for failing to follow required procedures

This is an order denying reconsideration case

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

The applicant was standing on a curb using a shovel. A car struck the shovel
which flew into his shoulder injuring his shoulder. The car came within a foot of hitting him. The applicant was taken to the hospital where he was in shock about the accident.

The defendant admitted the neck and left shoulder injury but denied the psychiatric claim. The applicant received psychiatric treatment. A psychiatrist diagnosed the applicant with post traumatic stress disorder and an adjustment disorder with depressed mood.

At trial the applicant testified to nightmares and paranoia with cars backing up. The Workers’ Compensation Judge (WCJ) found the psychiatric case compensable. The WCJ found that the psychiatric injury was a direct result of the work incident itself. The WCJ reasoned that Labor Code section 4660.1 (c ) (1) did not apply to the facts. This only applies when the psychiatric injury is a compensable consequence of the original injury.

The Workers’ Compensation Appeals Board (WCAB) reviewed on reconsideration. They reviewed the statute and the Wilson case. The panel concluded that there was substantial medical evidence that there was a compensable direct psychiatric injury. Therefore, 4660 did not apply.


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.


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