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Case Law Database

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

Case No. ADJ9066748
Regular
May 23, 2014

RAMATU KABBA vs. DAMERON HOSPITAL ASSOCIATION

Applicant Ramatu Kabba sought reconsideration of a finding that her psychiatric injury claim was not presumed compensable. The applicant argued the 90-day presumption period under Labor Code § 5402(b) began when the employer allegedly failed to provide a claim form promptly after receiving notice of injury. However, the Board denied reconsideration, adhering to the holding in *Honeywell v. Workers' Comp. Appeals Bd.* that the 90-day period runs from the filing of the claim form, not the employer's breach. Absent evidence of the employer misleading the applicant into not filing, the presumption did not arise.

Labor Code section 5402(b)presumption of compensabilitypetition for reconsiderationclaim formdenial of liabilityHoneywell v. Workers' Comp. Appeals Bd. (Wagner)estoppelDWC Form 1industrial injurypsyche
References
4
Case No. ADJ8642319
Regular
Apr 24, 2015

ISABEL RAMIREZ-RAMOS (spouse), ANGEL RAMIREZ (deceased) vs. OSTERIA COPPA, LLC, TRUCK INSURANCE EXCHANGE (FARMERS INSURANCE)

This case involves a deceased worker whose employer, Osteria Coppa, LLC, is challenging the Workers' Compensation Appeals Board's award of death benefits. The employer argued the WCJ erred by disallowing cross-examination and excluding a medical report. The Board denied reconsideration, affirming the original award because the employer failed to reject the claim within 90 days, thus triggering a presumption of compensability under Labor Code section 5402(b). Furthermore, the employer could not rebut this presumption with the excluded medical report, as the information it contained was discoverable within the 90-day period through reasonable diligence.

WCABIsabel Ramirez-RamosAngel RamirezOsteria CoppaLLCTruck Insurance ExchangeADJ8642319Opinion and Order Denying Petition for Reconsiderationindustrial injurydeath benefits
References
3
Case No. ADJ10908110
Regular
Mar 06, 2019

SHAKE KHACHATRIAN vs. STATE OF CALIFORNIA ATTORNEY GENERAL'S OFFICE, CALIFORNIA DEPARTMENT OF JUSTICE, Legally Uninsured, Adjusted by STATE COMPENSATION INSURANCE FUND

This case concerns an applicant's claim for psychiatric injury. The defendant did not deny liability within 90 days, creating a presumption of compensability under Labor Code section 5402(b). However, the Board held that this presumption does not preclude the defendant from presenting evidence to support a lawful, good faith personnel action defense under Labor Code section 3208.3(h). This defense is considered exempt from the 90-day investigatory limitation, allowing the defendant to present all competent evidence regardless of when it was obtained. The case is therefore returned to the trial level for a new decision on the merits of the personnel action defense.

Labor Code section 5402presumption of compensabilityLabor Code section 3208.3(h)good faith personnel actionreasonable diligencecumulative industrial injurypsychiatric injuryDWC-1 claim formsubstantial causejudicial interpretation
References
9
Case No. ADJ8741424
Regular
May 19, 2016

CHARLES LAUDERDALE (Dec'd), KATHLEEN LAUDERDALE (Widow) vs. CRISP ENTERPRISES, INC. dba C2 REPROGRAPHICS, GOLDEN EAGLE INSURANCE COMPANY

This case concerns a widow's claim for workers' compensation benefits after her husband's death. The initial ruling denied the claim, finding no injury arising out of employment. However, the Appeals Board granted reconsideration, finding the employer failed to deny the claim within the 90-day period required by Labor Code § 5402(b), thus creating a presumption of compensability. The Board determined the employer's evidence to rebut this presumption was insufficient because the witness testimony used was available and discoverable within the 90-day timeframe. Therefore, the Board found the decedent sustained an injury to his left foot arising out of and in the course of employment.

WCABPetition for ReconsiderationFindings and OrderLabor Code Section 5402(b)Presumed CompensableRebuttal of PresumptionReasonable DiligencePercipient WitnessSpecific InjuryLeft Foot
References
0
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. 2023 NY Slip Op 00704 [213 AD3d 1050]
Regular Panel Decision
Feb 09, 2023

Matter of Paka (Same Day Delivery Inc.--Commissioner of Labor)

The case involves Jacques Paka, a delivery driver, who applied for unemployment insurance benefits after working for Same Day Delivery Inc. The Department of Labor initially determined Paka was an employee, making Same Day liable for contributions. The Unemployment Insurance Appeal Board initially overruled this, finding Paka to be an independent contractor. However, upon reconsideration requested by the Commissioner of Labor, the Board rescinded its prior decision and sustained the Department's original determination, finding an employment relationship. The Appellate Division, Third Department, affirmed the Board's decision, rejecting Same Day's arguments against the reopening of the case and finding substantial evidence to support the Board's conclusion that Same Day exercised sufficient control over Paka to establish an employment relationship. The Court also affirmed that these findings apply to similarly situated individuals.

Unemployment InsuranceIndependent ContractorEmployment RelationshipControl TestAppellate ReviewUnemployment Insurance Appeal BoardLabor LawUnemployment BenefitsDelivery DriverSubstantial Evidence
References
11
Case No. ADJ7807150
Regular
Jun 02, 2014

SCOTT WARWICK vs. CITY OF SANTA BARBARA, JT2 INTEGRATED RESOURCES

This case concerns an applicant's workers' compensation claim that was initially denied. The applicant sought reconsideration, arguing the claim should be presumed compensable under Labor Code section 5402(b) due to the employer's failure to deny the claim within 90 days. The Board granted reconsideration, rescinded the prior decision, and found the injury presumed compensable. This presumption stands because the employer provided medical treatment for 2.5 years and failed to present evidence of a timely denial or evidence discovered outside the 90-day window.

Workers' Compensation Appeals BoardLabor Code section 5402(b)Presumption of CompensabilityPetition for ReconsiderationFindings of Fact and OrderDWC-1 Claim FormIndustrial InjuryCourse of EmploymentRebuttable PresumptionMedical Treatment
References
1
Case No. AD.J9949974, AD.J9950384
Regular
Apr 21, 2016

KAREN HERCULES vs. BODEGA LATINA CORPORATION dba EI SUPER, YORK RISK SERVICES GROUP

This case involves Karen Hercules' workers' compensation claim against Bodega Latina Corporation. The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The denial was based on the employer's failure to reject the claim within 90 days of filing, creating a presumption of compensability under Labor Code section 5402(b). The employer's subsequent denial on June 18, 2015, was untimely as it occurred 132 days after the claim form dated February 5, 2015. Therefore, the injury is presumed compensable, and the employer failed to rebut this presumption.

Workers' Compensation Appeals BoardBodega Latina CorporationYork Risk Services GroupPetition for ReconsiderationLabor Code section 5402presumption of compensabilityclaim formdenial of claimadministrative law judgespecific injury
References
0
Case No. MISSING
Regular Panel Decision

Johnson v. St. Barnabas Nursing Home

Plaintiff Felicia Pickett Johnson, pro se, brought an action against her former employer, St. Barnabas Nursing Home, and co-worker, Ronald Granger, under Title VII, the ADA, and New York Human Rights Laws. Claims against Granger were dismissed without prejudice. St. Barnabas moved for judgment on the pleadings, asserting that Johnson's federal claims were time-barred because she failed to file within 90 days of receiving her EEOC right-to-sue letter. The court determined that Johnson's filing on February 7, 2008, was beyond the 90-day period, whether calculated from the presumptive receipt date of November 3, 2007, or her claimed receipt date of November 14, 2007 (or even November 8, 2008, based on a fax confirmation). Finding no extraordinary circumstances to warrant equitable tolling, the court dismissed the federal claims as time-barred and declined to exercise supplemental jurisdiction over the remaining state law claims. Consequently, St. Barnabas's motion for judgment on the pleadings was granted.

Title VIIADAEmployment DiscriminationStatute of LimitationsEquitable TollingRight-to-Sue LetterJudgment on the PleadingsSupplemental JurisdictionCivil Rights ActAmericans with Disabilities Act
References
8
Case No. MISSING
Regular Panel Decision

Spira v. Ethical Culture School

Bernard R. Spira, a plaintiff, sued his former employer, Ethical Culture School, and three individuals for age discrimination. He filed the complaint with the EEOC in September 1992 and received a 'Right-to-Sue' letter on November 8, 1994, which stated a 90-day period to file suit. Spira filed suit on March 7, 1995, approximately 114 calendar days after receipt. He argued that an EEOC worker orally misinformed him that the 90-day period was in working days, not calendar days. The defendants moved to dismiss based on the failure to comply with the 90-day limitations period. The court granted the motion, finding no extraordinary circumstances or affirmative misconduct by the EEOC to warrant equitable tolling of the limitations period.

Age DiscriminationEmployment LawStatute of LimitationsEquitable TollingEEOC ProceduresRight-to-Sue LetterMotion to DismissRule 12(b)(6)Affirmative MisconductFederal Courts
References
7
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