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

Case No. ADJ14627934
Regular
Apr 21, 2023

ELSA GARCIA JOFFRE GARCIA (Deceased) vs. U.S. BANK, OLD REPUBLIC

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior finding, remanding the case for further proceedings. The Board determined that the statutory presumption of industrial injury for COVID-19 did not apply as there was insufficient evidence of an "outbreak" at the applicant's workplace. Therefore, the applicant must now prove industrial causation without the benefit of this presumption. This requires substantial medical evidence to establish that the applicant contracted COVID-19 during the course of employment.

COVID-19industrial basispresumptionoutbreakAOE/COEmedical-legal evaluationPQMErebuttalsubstantial evidencedeath claim
References
Case No. ADJ13713694
Regular
May 09, 2025

JOSE ORTEGA vs. CARDENAS MARKETS, LLC; SAFETY NATIONAL CASUALTY CORPORATION

Applicant Jose Ortega claimed a COVID-19 related injury from May 10, 2020, while employed by Cardenas Markets, LLC. The Workers' Compensation Administrative Law Judge (WCJ) initially found the injury compensable under Labor Code section 3212.86. Defendant sought reconsideration, arguing the presumption's repeal and questioning the Qualified Medical Evaluator's evidence and judicial impartiality. The Workers' Compensation Appeals Board granted reconsideration to further review the factual and legal issues, deferring a final decision on the merits of the petition.

COVID-19 presumptionLabor Code section 3212.86Petition for ReconsiderationQualified Medical Evaluator (QME)substantial medical evidencejudicial biasstatutory repealdate of injurycompensabilityrebuttal of presumption
References
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
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
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
Case No. ADJ7949972
Regular
Nov 07, 2013

DANIEL BIGELOW vs. CITY OF PASO ROBLES

This Workers' Compensation Appeals Board decision reverses a prior ruling and finds applicant's colon cancer industrially caused. The employer failed to rebut the Labor Code section 3212.1 presumption of industrial causation for peace officers exposed to carcinogens. The Appeals Board determined the defendant's medical expert did not sufficiently prove the cancer was "not reasonably linked" to the applicant's workplace exposure. Therefore, the presumption stands, and the case is returned for further proceedings.

Labor Code section 3212.1cancer presumptionpeace officeractive law enforcementindustrial injurycolon cancercarcinogen exposurerebuttable presumptionprimary site of cancerlatency period
References
Case No. SDO 244774
Significant
Dec 11, 2003

Walter Faust vs. City of San Diego

The Appeals Board held that under the amended Labor Code section 3212.1, a firefighter only needs to show exposure to a known carcinogen to establish a presumption of industrial cancer, shifting the burden to the defendant to prove no reasonable link.

Labor Code section 3212.1cumulative industrial injuryfirefightercancerpresumptionrebutting presumptionqualified medical evaluatorcarcinogencadmiumplating company fire
References
Case No. ADJ13523690; ADJ13523692
Regular
Jun 06, 2025

BERENICE TORRES vs. WALMART INC, ACE AMERICAN INSURANCE COMPANY, ADMINISTERED BY SEDGWICK

Lien claimant, Medland Medical, sought reconsideration of a Workers' Compensation Judge's decision which denied industrial injury for applicant Berenice Torres and disallowed reimbursement for most treatment services. Medland Medical argued the WCJ improperly relied on a Panel Qualified Medical Evaluator's report over the treating physician's findings. The Workers' Compensation Appeals Board granted the petition for reconsideration, noting the need for further study of factual and legal issues, specifically regarding the application of Labor Code section 3212.88 concerning COVID-19 compensability, and deferred a final decision on the merits.

Petition for ReconsiderationJoint Findings and AwardAOE/COELien ClaimantMedical-Legal ChargesPanel Qualified Medical Evaluator (PQME)Treating PhysicianCumulative Trauma ClaimSpecific Injury ClaimCOVID-19 Presumption
References
Case No. ADJ9312112
Regular
Apr 17, 2017

CUONG PHAN vs. CITY OF SANTA CLARA

In this case, the Workers' Compensation Appeals Board denied the defendant City of Santa Clara's petition for reconsideration. The Board upheld a prior finding that applicant Cuong Phan sustained industrial injuries to his lower back, resulting in 29% permanent disability. The key issue was the application of the "duty belt presumption" under Labor Code section 3213.2, which presumes lower back impairments in long-term peace officers required to wear duty belts arise from employment. The Board found the presumption applicable and not rebutted, deeming it a legislative intent to protect officers with these specific conditions.

Duty belt presumptionLabor Code section 3213.2police officerlower back impairmentpeace officerpermanent disabilityjoint findings and awardpetition for reconsiderationBenson apportionmentLabor Code section 4663(e)
References
Case No. ADJ9870999
Regular
Feb 13, 2017

ROBIN SMITH vs. CITY OF SUNNYVALE

This case involves a firefighter claiming breast cancer arose from employment exposure to carcinogens, triggering a statutory presumption of industrial causation under Labor Code section 3212.1. The employer sought to rebut this presumption by arguing a medical examiner found no studies linking applicant's specific exposures to breast cancer. However, the Appeals Board denied reconsideration, affirming that the employer failed to prove there is *no reasonable link* between workplace carcinogen exposure and the applicant's cancer, a higher bar than simply the absence of direct scientific studies. The Board reiterated that an employer must affirmatively demonstrate a lack of reasonable connection, not just highlight a lack of studies supporting causation.

Labor Code section 3212.1presumption of industrial causationpublic safety officerfirefightercarcinogen exposurebreast cancerdisputable presumptioncontroverted evidencereasonable linkburden of proof
References
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