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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. 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. ADJ7186657
Regular
Sep 30, 2011

Sergio Marquez vs. Alan's Lawnmower and Garden Center; INC, STAR INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of a decision that found Sergio Marquez did not sustain an industrial injury. The applicant argued the employer's post-termination defense under Labor Code section 3600(a)(10) was inapplicable and that the presumption of injury under Labor Code section 5402 should apply. However, the Board adopted the WCJ's findings that neither the presumption nor an exception to the defense was established. The WCJ's report, which was incorporated by the Board, detailed why these arguments failed based on the evidence presented.

Workers Compensation Appeals BoardSergio MarquezAlan's Lawnmower and Garden CenterStar Insurance CompanyIllinois Midwest Insurance AgencyADJ7186657Order Denying Reconsiderationindustrial injuryLabor Code section 5402presumption of industrial injury
References
0
Case No. ADJ4433104 (ANA 0381115) ADJ4664599 (ANA 0381113)
Regular
Feb 02, 2016

JOSE CHONG (deceased) vs. SPORTS GRILL, EVEREST NATIONAL INSURANCE COMPANY, AMERICAN COMMERCIAL CLAIMS ADMINISTRATORS, INC., ZENITH INSURANCE COMPANY

This case involves a lien claimant seeking reconsideration of a decision denying applicant's cumulative and specific injury claims, finding a lack of medical evidence and credibility issues with the deceased applicant. The Workers' Compensation Appeals Board granted reconsideration to amend the original order concerning Labor Code section 5402. The Board affirmed the denial of the presumption of compensability, finding the lien claimant failed to meet its burden of proof regarding timely denial by the insurer Zenith. Issues related to Labor Code section 5402(c) were deferred.

WCABLien claimantPetition for ReconsiderationJoint Findings and OrderCumulative InjurySpecific InjuryAOE/COELabor Code section 5402Presumption of CompensabilityApplicant's Credibility
References
0
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. 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. 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. ADJ10553459
Regular
Feb 23, 2018

JAMES CRAIG SILLERS vs. CITY OF PLEASANT HILL, MUNICIPAL POOLING AUTHORITY

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration, affirming the administrative law judge's award of 47% permanent disability benefits to applicant James Sillers. The central dispute concerned whether Sillers was entitled to the maximum disability indemnity rate under Labor Code section 4458.5. The Board majority held that Sillers, a retired police officer with orthopedic injuries, qualified for the maximum rate, interpreting section 4458.5 to apply to any public safety member injured within the timeframes specified in listed presumption statutes, not solely to injuries covered by those specific presumptions. A dissenting opinion argued that only injuries falling under the explicitly enumerated presumptions in section 4458.5 qualified for the maximum rate, citing precedent that non-listed presumptions, like cancer under section 3212.1, did not grant this benefit.

Workers' Compensation Appeals BoardCity of Pleasant HillMunicipal Pooling AuthorityCumulative Trauma InjuryCervical SpineLumbar SpineBilateral Cubital TunnelsPolice OfficerStatute of LimitationsLabor Code Section 4458.5
References
4
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
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