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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. VEN 104138
Regular
Jul 08, 2008

CHANDRA DOSHI vs. BLUE CROSS OF CALIFORNIA by BROADSPIRE CLAIMS SERVICES

This case involves a lien claimant seeking reconsideration of a decision that denied a psychological injury claim. The Workers' Compensation Appeals Board granted reconsideration due to uncertainty regarding the administrative law judge's application of Labor Code sections 5402(b) (presumption of compensability for timely denial) and 3208.3 (threshold for psychiatric injury). The Board remanded the case for further proceedings to clarify whether the section 5402 presumption applies and, if not, to re-evaluate the psychiatric injury claim under section 3208.3 with a clear explanation of the reasoning.

Labor Code section 5402(b)presumption of compensabilitypsychiatric injurythreshold of compensabilitypredominant causeactual events of employmentcompromise and releaselien claimantcumulative traumamedical treatment
References
1
Case No. VNO 400907, VNO 400906
Regular
Jan 24, 2008

JORGE ESCOBEDO vs. WESTLAKE INN RESTAURANT & HOTEL, CALIFORNIA INDEMNITY INSURANCE COMPANY, SIERRA INSURANCE GROUP

This Workers' Compensation Appeals Board case involves applicant Jorge Escobedo seeking benefits for injuries presumed compensable under Labor Code section 5402. The Appeals Board affirmed the Administrative Law Judge's (WCJ) decision, finding that the defendant failed to rebut the presumption of injury and that applicant's injuries did not require further medical treatment or result in temporary disability, largely based on the WCJ's adverse credibility finding. A dissenting opinion argued that the WCJ's findings on no treatment or disability improperly abrogated the 5402 presumption and suggested appointing a "regular physician" to resolve conflicting medical opinions.

ReconsiderationRebuttable presumptionCompensabilityLabor Code 5402Medical treatmentTemporary disabilityPermanent disabilityApportionmentAttorney's feesSubstantial evidence
References
4
Case No. ADJ967988 (VNO 0449090)
Regular
Jul 01, 2009

MARIA G. MAYA vs. LOS ANGELES UNIFIED SCHOOL DISTRICT, SEDGWICK CMS

The applicant sought reconsideration of a Workers' Compensation Appeals Board (WCAB) decision denying her claim for cumulative trauma injury to various body parts, arguing the employer failed to deny her claim within 90 days, thus triggering a presumption of compensability under Labor Code section 5402. The WCAB denied reconsideration, affirming the trial judge's finding that section 5402's 90-day period does not commence until a claim form is properly filed. The Board noted that the applicant did not provide proof of when the relevant claim form was received by the employer, and an earlier claim form pertained to a different, specific injury. Therefore, the applicant failed to establish the basis for the presumption of compensability.

Workers' Compensation Appeals BoardFindings and AwardPetition for ReconsiderationAdministrative Law JudgeIndustrial InjuryPermanent DisabilityFurther Medical TreatmentLabor Code Section 5402Presumed CompensableCumulative Trauma
References
2
Case No. ADJ885979 (LBO 0310057)
Regular
Feb 20, 2014

WALTER CERVANTES vs. UNITED AIRLINES INFLIGHT SERVICES, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal to address the WCJ's exclusion of the Labor Code section 5402 presumption of compensability. The Board held that this presumption can be raised for the first time at trial, even if not listed on the pre-trial conference statement. The case is returned to the trial level for the WCJ to consider the presumption, ensuring the defendant has an opportunity to present evidence and witnesses on the issue. This decision aligns with precedent allowing presumptions to be raised at trial under certain circumstances.

Petition for RemovalPresumption of CompensabilityLabor Code Section 5402Mandatory Settlement ConferencePretrial Conference StatementWorkers' Compensation Appeals BoardWCJOrder Granting PetitionDecision After RemovalDue Process
References
3
Case No. ADJ10569473
Regular
Sep 12, 2017

EDWIN RAQUEDAN (deceased), IMELDA RAQUEDAN vs. VIOLA, INC.; EVEREST NATIONAL INSURANCE COMPANY

This case concerns whether the presumption of compensability under Labor Code section 5402 applies to a deceased accountant's fatal car accident claim. The defendant employer contests the finding that this presumption was triggered because no DWC-1 claim form was ever filed by the applicant. The Appeals Board granted reconsideration, rescinded the trial judge's order, and returned the matter for further proceedings. The Board noted that under *Honeywell*, the 90-day presumption period runs only from the filing of a claim form, not from the employer's general knowledge of an injury.

Labor Code section 5402presumption of compensabilityPetition for ReconsiderationFindings and OrderIndustrial causationMotor vehicle accidentClaim formRebuttable presumptionHoneywell v. Workers' Compensation Appeals BoardOpinion on Decision
References
1
Case No. ADJ9373269, ADJ9373270
Regular
Dec 12, 2017

SOCORRO SALAZAR vs. MV TRANSPORTATION, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's finding that the applicant failed to prove her injury was presumptively compensable under Labor Code section 5402. The Board clarified that the 90-day presumption period begins when an employee files a claim form, not when the employer receives notice of injury. The Board affirmed that a claim form, not an Application for Adjudication of Claim, is the legally mandated method for initiating a workers' compensation claim. Therefore, the applicant did not meet her burden of proof for presumptive compensability.

WCABPetition for ReconsiderationLabor Code section 5402presumption of compensabilityclaim formdenial of liabilityApplication for Adjudication of Claimrebuttable presumptionfraudulent attemptsstatutory references
References
1
Case No. STK 0176810
Regular
Apr 22, 2008

YOLIOUS T. SHAHI vs. WEST AGRO, LUMBERMEN'S MUTUAL INSURANCE, BROADSPIRE CLAIMS SERVICES

This case involves an applicant seeking reconsideration of a decision that denied his workers' compensation claim. The applicant argued the presumption of industrial injury under Labor Code section 5402 applied, a point the judge initially claimed was not raised. The Appeals Board granted reconsideration, finding the issue was indeed raised at trial, and remanded the case for the judge to address the presumption's applicability.

Labor Code section 5402presumption of industrial injuryapplicant take nothingFindings and OrdersPetition for ReconsiderationWCJrescindedreturned to trial levelindustrial injurylaborer/chemical worker
References
0
Case No. ADJ8079708
Regular
May 06, 2013

JAMES AZBILL vs. FATORS MOTORCYCLES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to amend a prior finding, affirming the claim is not barred by the statute of limitations. However, the Board reversed the finding that the applicant was entitled to the presumption of compensability under Labor Code section 5402(b). This presumption requires the filing of a DWC-1 claim form, which was absent in this case. The Board will return the matter to the trial level for further proceedings on deferred issues.

Workers' Compensation Appeals BoardFators MotorcyclesState Compensation Insurance FundJames AzbillADJ8079708Opinion and OrderReconsiderationFindings and OrderWCJStatute of Limitations
References
0
Case No. ADJ8548222
Regular
Jun 08, 2015

YOLANDA MENDEZ SALAS vs. CARTER'S, INC., TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior finding of industrial injury to applicant's low back. The Board clarified that the 90-day presumption of compensability under Labor Code section 5402(b) is triggered only by the filing of a claim form, not by the employer's knowledge of an injury or the filing of an Application for Adjudication of Claim. The case was returned to the WCJ for further proceedings to determine industrial causation without the benefit of this presumption.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderIndustrial InjuryArising Out Of EmploymentCourse Of EmploymentAOE/COELabor Code section 5402Presumption of CompensabilityClaim Form
References
1
Case No. ADJ8396129
Regular
Mar 05, 2014

RENE HERNANDEZ vs. LBH HOTEL CORP., dba MR. C HOTEL, AMTRUST NORTH AMERICA

The Appeals Board granted reconsideration, rescinded the WCJ's finding that the applicant's claim was barred, and found the injury presumptively compensable. This was because the employer failed to deny the claim within the 90-day period required by Labor Code section 5402. The defendant did not present evidence to rebut this presumption or demonstrate they formed the intent to deny the claim within the statutory timeframe. The matter was returned to the WCJ for further proceedings regarding the nature and extent of the injury.

Labor Code § 5402ReconsiderationPresumption of CompensabilityNinety-Day RuleDenial of ClaimPost-Termination ClaimRebuttal of PresumptionPetition for ReconsiderationFindings and OrderWorkers' Compensation Appeals Board
References
4
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