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Case Law Database

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

Case No. ADJ10301846 ADJ8235335
Regular
Feb 07, 2019

Jack Kessler vs. E. \u0026 J. Gallo Winery

Defendant E. & J. Gallo Winery sought reconsideration of a Workers' Compensation Appeals Board decision that found applicant Jack Kessler sustained a compensable psychiatric injury. The Board denied reconsideration, affirming the administrative law judge's finding that industrial factors were the predominant cause of the applicant's psyche injury. The defendant argued the applicant failed to meet the "predominant cause" standard for psychiatric injuries and that combining two separate injuries was impermissible. The Board clarified that the issue of injury causation is distinct from the apportionment of permanent disability, and the applicant's medical evidence met the predominant cause standard.

Workers' Compensation Appeals BoardPetition for ReconsiderationNew and Further DisabilityPsyche InjuryPredominant CauseLabor Code section 3208.2Labor Code section 3208.3Cumulative TraumaSpecific InjuryApportionment
References
5
Case No. ADJ10275361
Regular
Jan 27, 2020

RUSSELL MCFADDEN (deceased); RENEE MCFADDEN, JAZMINE MCFADDEN, and RUSSELL MCFADDEN, II vs. KEOLIS TRANSIT AMERICA; LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board affirmed a judge's decision denying a death benefit claim for Russell McFadden, who died by suicide. The applicant contended his death resulted from an industrial psychiatric injury due to occupational stress. Medical evidence indicated that industrial factors were only a 35% cause of the decedent's psychiatric disorder, with significant pre-existing conditions and drug use being the predominant causes. Furthermore, the Board found no evidence that the suicide was an irresistible impulse, distinguishing it from cases where an industrial injury directly causes a mental condition that prevents resistance to suicide. Therefore, the claim was denied based on the psychiatric injury not being predominantly industrially caused and the suicide not meeting the criteria for compensability.

Workers Compensation Appeals BoardRenee McFaddenKeolis Transit AmericaLiberty Mutual Insurance CompanyADJ10275361Opinion and Decision After ReconsiderationIndustrial Psychiatric InjuryOccupational Stress and StrainCompensable Death ClaimLabor Code Section 3600(a)(6)
References
6
Case No. MISSING
Regular Panel Decision
Oct 25, 2010

Viti v. Guardian Life Insurance Co. of America

Joseph Viti, suffering from post-traumatic stress due to 9/11, sued The Guardian Life Insurance Company of America under ERISA after his disability benefits claim was denied. Guardian denied the claim and Viti failed to appeal within the six-month administrative period. Viti also applied for and received Social Security disability benefits. The court granted Guardian's motion to dismiss the Third and Fourth Causes of Action, which concerned failure to provide documentation, concluding Guardian was not the proper defendant for those claims. The court denied without prejudice both parties' motions regarding the First and Second Causes of Action, which focused on the timeliness of Viti's lawsuit and the applicability of equitable tolling to contractual limitation periods, referring this matter to Magistrate Judge Dolinger for a hearing on equitable tolling.

ERISADisability BenefitsEquitable TollingStatute of LimitationsMental ImpairmentAdministrative RemediesContractual LimitationsSummary JudgmentMotion to DismissFiduciary Duty
References
41
Case No. ADJ10384186 MF ADJ10404193
Regular
Mar 25, 2019

SCOTT MITCHELL vs. DENIHANA, ZURICH NORTH AMERICA

This case concerns a claim for psychiatric injury where the applicant, Scott Mitchell, alleged actual employment events were the predominant cause. The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board affirmed the WCJ's findings, giving great weight to credibility determinations and finding no substantial evidence to reject them. Crucially, the Board concluded the injury was not substantially caused by lawful, nondiscriminatory, good faith personnel actions, as required by Labor Code section 3208.3. The Board relied on the agreed medical examiner's opinion that employment stress predominantly caused the aggravation of the applicant's pre-existing condition.

Labor Code 3208.3predominant causepsychiatric injurygood faith personnel actionsubstantial causecredibility determinationsaggravation of pre-existing conditionagreed medical examinercumulative traumaanxiety disorder not otherwise specified
References
6
Case No. ADJ7382041
Regular
May 11, 2012

Donna Larson vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS, Legally Uninsured, SCIF STATE EMPLOYEES ROHNERT PARK, Adjusting Agency

The Workers' Compensation Appeals Board granted reconsideration to clarify the Administrative Law Judge's (ALJ) findings on applicant Donna Larson's psychiatric injury. The ALJ found Larson sustained cumulative trauma injury to her circulatory system and psyche, with ongoing temporary disability. Defendant argued the psychiatric injury finding was unsubstantiated, particularly regarding whether actual employment events were the predominant cause and if lawful personnel actions were a substantial cause. The Board found the ALJ's analysis under Labor Code section 3208.3 and the *Rolda* case lacked sufficient clarity regarding the predominant cause of the psychiatric injury and the impact of lawful personnel actions, including the applicant's termination. Therefore, the case was remanded to the trial level for further proceedings and a new decision to clarify these critical legal standards.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardCumulative TraumaHypertensionPsycheTemporary DisabilityPredominantly CausedActual Events of EmploymentGood Faith Personnel Actions
References
4
Case No. ADJ8645491
Regular
Apr 28, 2015

LEOPOLD VASQUEZ vs. G&K MANAGEMENT COMPANY, CHUBB INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings because the Agreed Medical Examiner's psychiatric opinion regarding the predominant cause of the applicant's injury was unclear, contradictory, and lacked substantial evidence. The AME confused causation of injury with apportionment of disability, and did not definitively state that industrial factors were the predominant cause of the psychiatric injury. The Board determined the medical record required further development to properly adjudicate the claim.

Workers' Compensation Appeals BoardIndustrial InjuryPsyche InjuryAgreed Medical ExaminerCausationApportionmentPersonnel Action DefenseLabor Code Section 3208.3Liberal ConstructionPreponderance of Evidence
References
13
Case No. ADJ9550103, ADJ9214819, ADJ9206482, ADJ9206483, ADJ9356685
Regular
Sep 04, 2014

NATHAN JACKSON vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board denied reconsideration of an applicant's psychiatric injury claim against the City of Los Angeles. The applicant failed to demonstrate by a preponderance of the evidence that actual employment events were the predominant cause of his psychiatric injury. Even if predominant cause were established, the Board found that lawful, nondiscriminatory, good faith personnel actions by the employer substantially contributed to the injury and barred compensation. The Board's decision was based on the reasoning in the arbitrator's report, which it adopted and incorporated.

Workers' Compensation Appeals BoardPetition for ReconsiderationPsychiatric InjuryPredominant CauseActual Events of EmploymentLabor Code Section 3208.3Affirmative DefenseLawful Nondiscriminatory Good Faith Personnel ActionSubstantial CauseTreating Physician Report
References
2
Case No. ADJ1936437 (RIV 0070095) ADJ211616 (RIV 0073390)
Regular
Jun 20, 2011

ROSE MARIE RODRIGUEZ vs. HI-DESERT MEMORIAL, ALPHA FUND

In this case, the Workers' Compensation Appeals Board (WCAB) denied reconsideration of a supplemental award. The WCAB affirmed the finding that lien claimants were entitled to reimbursement for psychiatric treatment provided to the applicant. This treatment was deemed a compensable consequence of the applicant's industrial left thumb injury, with medical experts opining the psychiatric condition was predominantly caused by the orthopedic disability. The WCAB found that the industrial physical injury was the predominant cause of the applicant's psychiatric condition, making the treatment necessary.

Workers' Compensation Appeals BoardRose Marie RodriguezHi-Desert MemorialAlpha Fundlicensed vocational nurseorthopedic injurypsyche injurycompensable consequenceLabor Code section 3208.3(b)(1)psychiatric treatment
References
6
Case No. ADJ2062277 (LAO0881144)
Regular
May 10, 2010

CARLOS BUENAVISTA vs. ALL AMERICAN WASH COMPANY, INC., PREFERRED EMPLOYERS INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the previous award. The Board found the WCJ erred in applying Labor Code section 3208.3 to psychiatric injury claims, as it requires demonstrating predominant cause from employment events for post-termination claims. Furthermore, the Board ruled that a medical report was not substantial evidence as it lacked sufficient reasoning. The case is remanded for further proceedings to develop the record on the issue of predominant cause and clarify injury dates.

WCABReconsiderationFindings and AwardIndustrial InjuryAOE/COELabor Code 3208.3Psychiatric InjuryPost-Termination ClaimSubstantial EvidenceDue Process
References
7
Case No. ADJ7847320
Regular
Nov 25, 2014

KAREN ROTAN vs. CITY OF LONG BEACH

This case concerns a psychiatric injury claim where the applicant argued that employment events were the predominant cause. The Workers' Compensation Appeals Board (WCAB) granted reconsideration, finding that the Agreed Medical Evaluator's opinions supported the applicant's contention. The WCAB rescinded the original decision and substituted new findings. This establishes that the actual events of employment were the predominant cause of the applicant's psyche injury. The case is returned to the WCJ for further proceedings, specifically to determine if a good faith personnel action defense applies.

Workers' Compensation Appeals BoardPSYCHE INJURYARISING OUT OF AND OCCURRING IN THE COURSE OF EMPLOYMENT (AOE/COE)PREDOMINANT CAUSEAGGREED MEDICAL EVALUATOR (AME)GOOD FAITH PERSONNEL ACTIONLABOR CODE SECTION 3208.3RECONSIDERATIONFINDINGS OF FACT AND ORDERS (F&O)SUBSTANTIAL EVIDENCE
References
4
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