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

Case No. MISSING
Regular Panel Decision

Svensson v. Securian Life Insurance

Plaintiff Paul Svensson sued Securian Life Insurance Company to claim a $200,000 accidental death benefit for his wife, Providencia R. Svensson, who died from bronchopneumonia after inhaling a community-spread Group A streptococcus bacterial pathogen. The accidental death policy covered deaths resulting from 'accidental injury' but excluded illness or disease, and infections unless occurring simultaneously with and as a result of an 'accidental injury.' The Court, presided over by Judge Kenneth M. Karas, granted Defendant's motion to dismiss, finding that contracting an infection through normal means, like airborne transmission, does not constitute an 'accidental injury' under New York law or the policy's terms. The court distinguished this from cases where infection results from a separate, traumatic injury, concluding that the policy was not drafted to cover pneumonia contracted from the ambient air.

Accidental Death InsuranceInsurance Policy InterpretationContract LawAccidental Injury DefinitionInfection Exclusion ClauseDisease CoverageWorkers' Compensation Law ComparisonNew York LawMotion to DismissSummary Judgment
References
60
Case No. ADJ8689638
Regular
Dec 01, 2016

AVI AZOULAY vs. CITY OF ORANGE, YORK SERVICES

The Appeals Board denied the defendant's Petition for Reconsideration, upholding its prior decision that applicant Avi Azoulay sustained an industrial injury. The Board found that Azoulay's bacterial infection, which spread to his bloodstream from his colon, qualified as a "blood-borne infectious disease" under Labor Code section 3212.8. This presumption of industrial causation applied despite the infection originating internally, as the statute's language and purpose encompass such conditions. Consequently, the defendant failed to overcome the presumption and provide evidence that the condition existed prior to employment.

Labor Code section 3212.8presumption of industrial causationblood-borne infectious diseasejuvenile correction officerPetition for Reconsiderationbacterial infectionpathogenic microorganismsanti-attribution clausedivericulitisscar
References
2
Case No. ADJ10807559, ADJ11213172
Regular
Mar 04, 2019

KIM JOHNSTON JIMENEZ vs. ARROYO GRANDE COMMUNITY HOSPITAL

The WCAB granted reconsideration and rescinded the WCJ's decision, finding the medical record needed further development. The applicant sustained a left knee injury, and subsequently developed a severe infection requiring extensive treatment. Defendant argued the infection and treatment were not industrially caused, as an infection can arise independently of prior injury. The Board remanded for further proceedings to determine if the recommended treatment is necessary for the industrial condition or if it's independent of the injury.

Arroyo Grande Community HospitalSedgwick Claims ManagementPetition for ReconsiderationFindings of FactDr. Ferroindustrial basisstipulated Awardpermanent disabilitymedical treatmentrevision left knee arthroplasty
References
16
Case No. ADJ13344359
Regular
Mar 10, 2023

ANGELA DAWSON vs. PATTON STATE HOSPITAL, STATE COMPENSATION INSURANCE FUND

This case involves an applicant claiming a psyche and internal system injury due to COVID-19 infection sustained at work. The WCAB rescinded the prior decision, finding the trial judge erred by disregarding differing medical opinions on causation and by improperly applying a strict latency period calculation. The Board found the medical record undeveloped, necessitating further proceedings to establish a probable date of infection and work-related exposure. The matter was returned to the trial level for further development of evidence and a new decision.

COVID-19industrial causationmedical evidencelatency periodreasonable medical probabilitysubstantial evidenceworkers' compensationvocational rehabscope of employmentworkplace exposure
References
20
Case No. MISSING
Regular Panel Decision
Aug 02, 1996

Claim of Dongarra v. Village of Ossining

This case involves an appeal from a Workers' Compensation Board decision that found a clerical worker for the Village of Ossining sustained a compensable injury. The claimant developed acute endometritis and an E-coli infection, which was linked to her workspace in a converted sewage treatment plant where raw sewage pumps were located under her desk. The employer challenged the sufficiency of proof regarding the causal connection between the claimant's employment and her illness. The court affirmed the Board's decision, determining that there was substantial evidence to support the finding of a causally related E-coli infection. It emphasized that medical opinions only require a probable cause supported by a rational basis, not absolute certainty.

Workers' CompensationE-coli InfectionOccupational DiseaseCausal RelationshipMedical CertaintySubstantial EvidenceAppellate ReviewGynecological ProblemsOffice EnvironmentSewage Exposure
References
3
Case No. 536047
Regular Panel Decision
Nov 16, 2023

In the Matter of the Claim of Frank Aungst

Frank Aungst, a store manager, sought workers' compensation benefits after contracting COVID-19 and suffering a consequential stroke. The Workers' Compensation Board determined that his COVID-19 infection was an accidental injury arising from his employment, citing his elevated risk as an essential public-facing worker. Furthermore, the Board found a causal link between the COVID-19 infection and his subsequent stroke, relying on medical testimony. The employer and carrier appealed this decision. The Supreme Court, Appellate Division, Third Judicial Department, affirmed the Board's findings, concluding that substantial evidence supported both the work-related COVID-19 contraction and the causally-related consequential stroke.

COVID-19Workers' Compensation BenefitsAccidental InjuryConsequential InjuryStrokeCausationElevated RiskStore ManagerEssential WorkerAppellate Review
References
22
Case No. ADJ16211996
Regular
Apr 07, 2025

Mauricio Garcia vs. Kern High School District, Self-Insured Schools of California

Defendant sought reconsideration of a Findings and Order by the WCJ which found that the applicant sustained an industrial COVID-19 infection. Defendant contended the presumption of compensability was rebutted and the medical opinions were not substantial evidence. The Workers' Compensation Appeals Board granted the petition for reconsideration to allow for further review of the factual and legal issues. The Board noted its continuing jurisdiction and that this order is not a final decision on the merits.

COVID-19Labor Code section 3212.88presumptionrebuttalsubstantial medical evidencePQMEStewart A. LonkyM.D.Petition for ReconsiderationAOE/COE
References
13
Case No. BAK 0141141
Regular
Mar 07, 2008

Briant Certuche vs. TRANS-SYSTEMS, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board rescinded the previous decision, finding insufficient consideration of whether the applicant's Valley Fever infection was industrially caused or solely due to living in the San Joaquin Valley. The case is returned to the trial level for further development of the medical record, specifically to address the relative likelihood of environmental versus occupational exposure. This decision acknowledges that employment need only be a contributory cause for injury compensability.

Workers' Compensation Appeals Boardindustrial injuryValley Fevercoccidiomycosisproximate causeoccupational exposuregeographic endemicmedical-legal expertsubstantial evidencecontributing cause
References
2
Case No. MON 297119
Regular
Apr 01, 2008

EDMUND BURNS, Jr. vs. CITY OF LOS ANGELES

This case concerns a police officer who sustained an industrial injury to his right foot after stepping on a foreign object, which, due to his pre-existing diabetes, led to a gangrenous infection and amputation. The defendant argued for apportionment of the permanent disability to the applicant's diabetes, but the Appeals Board affirmed the WCJ's decision. The medical evidence indicated that the amputation would not have occurred absent the industrial injury, thus establishing industrial causation for the entire permanent disability.

Workers' Compensation Appeals BoardIndustrial InjuryPermanent DisabilityApportionmentPre-existing DiabetesCausationEscobedo v. MarshallsSenate Bill 899Qualified Medical ExaminerTreating Physician
References
8
Case No. ADJ13511723
Regular
Mar 29, 2023

SOFIA SEVILLANO vs. STATE OF CALIFORNIA, IHSS, LEGALLY UNINSURED, ADMINISTERED BY YORK RISK SERVICES GROUP, A SEDGWICK COMPANY

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration, upholding a prior decision that found COVID-19 related illness to be industrially caused. The Board found the employer failed to rebut the statutory presumption of industrial causation under Labor Code section 3212.86 with sufficient "other evidence." Arguments regarding mask use, lack of proof of employer infection, and alleged roommate illness were deemed insufficient to overcome the presumption.

Labor Code 3212.86presumption of industrial causationCOVID-19 illnessrebuttal burdenaffirmative burden of proofnon-occupational risksclose interpersonal contactSan Antonio Regional Hospitalcredibility determinationsADJ13511723
References
7
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