ADJ18306857 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied.

Defendant seeks reconsideration of the WCJ's Findings and Award of July 25, 2024, denying reconsideration and affirming the award.

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What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

Statute of limitationsApplicant prevailedpsyche

The defendant's denial letter was equivocal and tolled the statute of limitations until a final unequivocal denial on October 7, 2022. The applicant filed the claim within one year of this denial, making the claim timely and compensable.

From the decision · page 3Here, the defendant did issue a denial letter on June 7, 2022, but the denial was too equivocal to stop the tolling of the limitations period. The letter states that the defendant is "denying all liability" but the very next paragraph says, "A Panel list of 3 doctors has been requested. Once the Panel QME list is obtained, please select one of the doctors on that list and schedule an appointment. The Panel QME will issue a report(s), and you will be notified of a decision regarding liability of your claim." (Emphasis added.)

The facts that decided it

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code section 5401(d)

The statute of limitations is tolled by filing a DWC-1 claim form until the claim is unequivocally denied by the employer or insurer.

Filing of the claim form tolled the statute until the June 7, 2022 denial was found equivocal and did not stop tolling.

From the decision · page 3However, regardless of when the statute of limitations starts to run, when a DWC-1 claim form is filed, the statute is tolled until the employer or insurer unequivocally denies the claim. "Filing of the claim form with the employer shall toll, for injuries occurring on or after January 1, 1994, the time limitations set forth in Sections 5405 and 5406 until the claim is denied by the employer or the injury becomes presumptively compensable pursuant to Section 5402." (Lab. Code, § 5401, subd. (d).)

Labor Code section 5412

The date of injury in cumulative injury cases is when the employee first suffered disability and knew or should have known it was work related.

Applicant's date of injury was March 31, 2022, when he filed the claim and knew of disability.

From the decision · page 3The date of injury in cumulative injury cases is "that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment." (Lab. Code, § 5412.) By March 31, 2022, applicant had sustained disability and, by actually claiming an industrial injury, knew or should have known that the disability was work related.1

McDaniel v. Workers' Comp. Appeals Bd. (1990) 218 Cal.App.3d 1011

The statute of limitations begins to run from the date of an unequivocal denial of liability by the employer or insurer.

The one-year statute began on October 7, 2022, the date of the final denial letter.

From the decision · page 5Later, on October 7, 2022, defendant issued a second denial letter where it finally completely disclaimed liability. We find that the one-year statute of limitations began to run from this date. Applicant did file an Application for Adjudication on October 6, 2023, within one year of the final, unequivocal denial, making the claim timely.

ADJ18306857 · October 15, 2024

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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The rules the panel named

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