What the panel ordered
Petition for Reconsideration denied.
Defendant filed a Petition for Reconsideration which was denied by the WCAB panel.
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.
The WCJ found Sedgwick's lien for reimbursement timely filed and valid without a Petition for Reimbursement, and that Sedgwick is entitled to reimbursement from Hartford Insurance.
From the decision · page 13Accordingly, the undersigned finds that Sedgwick filed its lien timely, and there is no requirement for an accompanying Petition for reimbursement.
The WCAB panel adopted and incorporated the WCJ's report and opinion, finding no error in the original decision and denying the Petition for Reconsideration.
From the decision · page 1We have considered the allegations of the Petition for Reconsideration, the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto, and the contents of the WCJ's Opinion on Decision. Based on our review of the record, and for the reasons stated in the WCJ's report and opinion, which are both adopted and incorporated herein, we will deny reconsideration.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Sedgwick filed its lien for reimbursement timely and no Petition for Reimbursement is required.
Favours Applicant prevailed
This supported the validity of Sedgwick's lien and entitlement to reimbursement.
From the decision · page 13Accordingly, the undersigned finds that Sedgwick filed its lien timely, and there is no requirement for an accompanying Petition for reimbursement.
Applicant filed a timely claim form and employer did not reject it within 90 days, triggering presumption of compensability.
Favours Applicant prevailed
This supported the finding of industrial injury and entitlement to reimbursement.
From the decision · page 12Here, pursuant to Defendant's Exhibit A, it is indisputable that a claim form was timely filed with the employer. Further, Defendant has failed to provide any evidence that it properly rejected the claim within 90 days of the filing of the claim form. Therefore, the undersigned finds it appropriate to apply the presumption of compensability.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Found industrial injury to multiple parts including the left shoulder.
From the decision · page 11Based upon the medical reporting of QME Bill Yueng, M.D. dated August 29, 2015, and August 11, 2016, as well as reports of Dr. Julian Girod dated April 11, 2016, it is found that Applicant sustained industrial injury to her left shoulder as a result of the industrial injury of December 24, 2009.
Found industrial injury to the left shoulder and apportioned injury to the December 24, 2009 shoulder injury.
From the decision · page 11Based upon the medical reporting of QME Bill Yueng, M.D. dated August 29, 2015, and August 11, 2016, as well as reports of Dr. Julian Girod dated April 11, 2016, it is found that Applicant sustained industrial injury to her left shoulder as a result of the industrial injury of December 24, 2009.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 5401(d)
Labor Code section 5401(d) - Filing of claim form tolls statute of limitations until claim is denied or presumed compensable.
The WCJ applied this to find the presumption of compensability since the employer did not reject the claim within 90 days.
From the decision · page 11Pursuant to Labor Code § 5405, the application must be filed within one year of the last payment of benefits or the date of injury, whichever is later otherwise it is barred by the statute of limitations. However, the inquiry of whether the one-year period applies requires further analysis by the court. An employer's failure to provide required notices may in some instances, toll the statute of limitation. Labor Code § 5401(d) provides that the filing of a claim form tolls the statute of limitations until the claim is denied or is presumed compensable. A failure to serve the proper notices can have the effect of circumventing the one-year statute of limitations.
Labor Code section 5405
Labor Code section 5405 - Application must be filed within one year of last payment or date of injury, whichever is later, or barred by statute of limitations.
The WCJ analyzed the statute of limitations and found it tolled due to failure to provide proper notices.
From the decision · page 11Pursuant to Labor Code § 5405, the application must be filed within one year of the last payment of benefits or the date of injury, whichever is later otherwise it is barred by the statute of limitations. However, the inquiry of whether the one-year period applies requires further analysis by the court. An employer's failure to provide required notices may in some instances, toll the statute of limitation. Labor Code § 5401(d) provides that the filing of a claim form tolls the statute of limitations until the claim is denied or is presumed compensable. A failure to serve the proper notices can have the effect of circumventing the one-year statute of limitations.
Cal. Code Regs. tit. 8, 10759
Cal. Code Regs. tit. 8, 10759 - Method for filing and listing exhibits at Mandatory Settlement Conference.
The WCJ found the exhibits sufficiently identified and admissible despite missing dates.
From the decision · page 5In the Findings and Award ("F&A"), the undersigned noted that although exhibits five through thirty were admitted into evidence, they were not relevant to the F&A2. Consequently, even if these exhibits were deemed inadmissible, the record was sufficient to issue an F&A. Assuming, however, or the sake of argument, that the records were relied upon, the undersigned still finds that the exhibits were listed with sufficient specificity and are admissible. Cal. Code Regs. tit. 8, l 0759 establishes the method for filing and listing exhibits at the Mandatory Settlement Conference ("MSC"). Pursuant to the rules:
What proof carried it
The evidence the panel weighed, by kind.
Applicant's deposition testimony and medical reports supporting injury to left shoulder.
From the decision · page 4The Applicant did not testify at trial, but was deposed twice. In her first deposition, she testified to pushing a sofa and twisting her left arm/shoulder pursuant to the DWC-1. (L.C.'s Exhibit 3, Depo. of Applicant Vol. I, 9/26/2014, Pgs. 44:8-25; 45:1-12). Her employer sent her to the clinic. (Id. Pgs. 45: 16-25; 46: 1-2). At the clinic, she was treated with ice (Id. at Pg. 45:23-25), but the pain in her shoulder never went away. (Id. Pg. 46:3-6). In her Volume II deposition, Applicant testified that she missed a couple of days of work after the injury. (L.C.'s Exhibit 4, Depo. of Applicant Vol. III 0/3/2014, Pg. I 02:2-9). She again testified that she went to a clinic and got ice, and also gel and pills. (Id. at Pg. 104: 1-7).
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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