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Case Law Database

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

Case No. ADJ4398201 (SAC 0290129)
Regular
Oct 29, 2008

OCTAVIO BAEZ vs. BARRETT BUSINESS SERVICES

This case concerns an employer's appeal of a temporary total disability award beyond the five-year statute of limitations for an industrial injury. The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further proceedings, finding that case law requires temporary disability to straddle the five-year anniversary of the injury. Specifically, a medical opinion is needed to determine if the applicant was temporarily disabled due to the industrial injury in January and February 2004, just before the five-year mark.

Temporary total disabilityStatute of LimitationsFive-year anniversaryNew and further disabilityTollingReconsiderationLabor Code section 5410Labor Code section 5803Labor Code section 5804Nickelsberg
References
Case No. ADJ3138312 (WCK 0059967)
Regular
Jul 05, 2011

GREGORY McBEE vs. AMERICAN DESIGN ROOFING, CIGA, LEGION INSURANCE COMPANY

The Appeals Board rescinded a prior award of temporary disability benefits because the applicant's period of temporary disability commenced more than five years after his date of injury. The Board found that Labor Code section 5410, which allows for claims of new and further disability within five years of injury, did not apply here. Jurisdiction to award temporary disability beyond five years is limited to continuous disability that began within that timeframe, which was not established. The case was returned for further proceedings on the issue of permanent disability.

Petition to reopennew and further disabilitytemporary disability indemnityjurisdictionfive-year limitationdate of injurystipulated awardAgreed Medical Evaluatorwrit deniedsubstantial medical evidence
References
Case No. ADJ10177344
Regular
May 16, 2016

DARRELL WOODS vs. NORTH COUNTY FIRE PROTECTION DISTRICT

Applicant Darrell Woods sought reconsideration of a WCJ's decision denying additional temporary disability indemnity beyond five years from his January 4, 2011 industrial injury. The WCJ correctly found that Labor Code section 4656(c)(2) limits temporary disability payments to 104 weeks within a five-year period from the date of injury. Unlike precedent cited by the applicant, no stipulation was made within the five-year window to continue discovery on temporary disability entitlement. Therefore, the Appeals Board denied the petition for reconsideration, affirming the WCJ's decision.

Labor Code section 4656(c)(2)temporary disability indemnitydate of injuryfive year limitationpetition for reconsiderationindustrial injuryheart injuryhypertensionparamedic/engineersalary continuation
References
Case No. ADJ7811907
Regular
Jul 10, 2017

KYLE PIKE vs. COUNTY OF SAN DIEGO

The Workers' Compensation Appeals Board denied the County of San Diego's petition for reconsideration, affirming an award of temporary disability and salary continuation benefits to Kyle Pike. Despite the benefits extending beyond five years from the injury date, the Board found applicant's temporary disability commenced within that period and was limited to 104 weeks. This decision aligns with a judicial interpretation that allows such awards when a timely petition to reopen is filed and benefits begin within the statutory five-year window. The dissenting opinion argued that Labor Code section 4656(c)(2) strictly prohibits temporary disability payments beyond five years from the injury date for injuries after January 1, 2008.

Labor Code section 4850temporary disability benefitsPetition to ReopenLabor Code section 4656(c)(2)five-year limitation104 weeksDeputy Sheriff Detentiondate of injurycontinuing jurisdictionnew and further disability
References
Case No. SBA 0083894; SBA 0099253
Regular
Jul 29, 2008

RAFAEL LOPEZ vs. SAN YSIDRO RANCH, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION For HIH AMERICA, In Liquidation

This case concerns an applicant's petition to amend a prior workers' compensation award to include the right shoulder as an injured body part. The Appeals Board denied reconsideration, holding that the omission of the right shoulder was not a clerical error and that Labor Code section 5804, which limits amendments to awards after five years from the date of injury, barred the requested modification. Since the applicant sought to add a new injury rather than enforce an existing award and the five-year jurisdictional limit had passed, the Board lacked the authority to grant the relief sought.

Workers' Compensation Appeals BoardPetition for ReconsiderationStipulated Awardclerical errorLabor Code § 5804continuing jurisdictiondate of injuryAgreed Medical Examiner (AME)permanent disabilitymedical treatment
References
Case No. ADJ8572033
Regular
Jan 23, 2017

NELLY MOLINA vs. MACY'S CORPORATE SERVICES, Permissibly Self-Insured, Administered By MACY'S

This case involves a lien claim by Industrial Healthcare for medical services provided to applicant Nelly Molina from November 6, 2012, to September 10, 2013. The Workers' Compensation Appeals Board (WCAB) denied reconsideration of an order dismissing the lien, upholding the administrative law judge's finding that the lien was untimely. The WCAB ruled that because the last date of service (September 10, 2013) was after July 1, 2013, the 18-month statute of limitations under Labor Code section 4903.5(a) applied, making the lien filed on September 2, 2015, tardy. A dissenting opinion argued that continuous services provided both before and after July 1, 2013, should be subject to the three-year statute of limitations, allowing for a single lien filing.

Labor Code section 4903.5(a)statute of limitationslien claimreconsiderationOrder Dismissing Lienworkers' compensation administrative law judgeIndustrial HealthcareInnovative Medical ManagementMacy's Corporate Servicescontinuous treatment
References
Case No. ADJ87-41561
Regular
Mar 18, 2016

OMAYRA GUERRERO vs. EASY STAFFING, LUMBERMEN'S UNDERWRITING ALLIANCE

This case concerns a lien claim filed by Advance Care Specialist Medical Clinic (ACSMC) for services provided to an injured worker. The Workers' Compensation Appeals Board denied ACSMC's petition for reconsideration, affirming a prior order that barred the lien as untimely filed under Labor Code section 4903.5(a). The majority found that since the last date of service was September 23, 2013, after the July 1, 2013 amendment, the 18-month filing limitation applied, and ACSMC's August 19, 2015 filing was too late. The dissenting opinion argued that for continuously provided services spanning before and after July 1, 2013, the three-year limitation should apply to avoid requiring multiple lien filings and prevent absurd results.

Workers' Compensation Appeals BoardLabor Code 4903.5(a)Statute of LimitationsLien ClaimReconsiderationLast Date of Service18-month limitation period3-year limitation periodRetroactive applicationReasonable time
References
Case No. ADJ2523054 (POM 2523054) ADJ8607480 ADJ9435881
Regular
Feb 18, 2020

JOSE SALAZAR vs. JAMES JONES COMPANY, INC.; MUELLER GROUP C/O SEDGWICK

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior administrative law judge's decision. The Board held that the applicant failed to demonstrate extrinsic fraud or mistake to set aside a 2004 stipulated award, as the petition was filed over fifteen years after the award, well beyond the five-year statutory limit. The applicant's claim of not understanding the settlement documents, even if accepted, did not show he was prevented from presenting his case or that he diligently pursued relief. Therefore, the applicant's petition to set aside the stipulated award was denied.

Workers' Compensation Appeals Boardpetition for reconsiderationextrinsic fraudstipulated awardset asideLabor Code section 5803Labor Code section 5804five-year periodgood causeequitable relief
References
Case No. ADJ9 088743
Regular
Jan 26, 2016

LEO ESTRELLA vs. MILWAUKEE BREWERS, SAN FRANCISCO GIANTS, ACE USA

The Workers' Compensation Appeals Board denied Leo Estrella's petition for reconsideration, upholding the administrative law judge's finding that his cumulative injury claim against the Milwaukee Brewers and San Francisco Giants was time-barred by the one-year statute of limitations. The Board found that applicant knew or should have known of his right to file a claim more than one year prior to filing, precluding application of the five-year "new and further disability" statute. Applicant's contention that the statute of limitations was tolled due to lack of knowledge was rejected, as the evidence indicated he was aware of the industrial causation of his injuries by 2009. One commissioner dissented, arguing the date of injury should be 2013 and that defendants failed to prove applicant's knowledge of his rights or the statute of limitations.

Workers' Compensation Appeals BoardCumulative InjuryStatute of LimitationsLabor Code Section 5405Labor Code Section 5410New and Further DisabilityTollingDate of InjuryIndustrial CausationProfessional Baseball Player
References
Case No. ADJ9972218
Regular
May 30, 2025

Andres Hernandez vs. Pearce Services, Inc.; Sparta Insurance Company

This case concerns Andres Hernandez's Petition for Reconsideration regarding a workers' compensation administrative law judge's finding that his Petition to Reopen was time-barred by Labor Code section 5410. The applicant sustained an industrial injury to his left knee in December 2013, leading to a stipulated Award in May 2015. Following left knee surgery in October 2018, he filed a Petition to Reopen in February 2019, claiming new and further disability. The Workers' Compensation Appeals Board affirmed the WCJ's decision, concluding that the five-year statute of limitations was not tolled by the defendant's provision of benefits or notices, as the applicant did not prove receipt or reliance on any affirmative statement to delay filing before the limitation period expired. Thus, the claim for new and further permanent disability was barred.

Petition to ReopenFive-Year Statute of LimitationsLabor Code Section 5410New and Further DisabilityStipulated AwardTemporary DisabilityPermanent DisabilityNotice of Ending BenefitsTollingEstoppel
References
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