At the 2019 California Self-Insurer Association Annual Conference, Bill Armstrong from the Armstrong Law Firm highlighted some important recent California workers’ compensation case law.
Young vs Splash Studio
WCAB panel majority ruled that applicants home was employer authorized second job site and therefore injuries sustained traveling between home and other fixed work site was considered to be in course and scope of employment. There was a dissent around the issue that the injury was sustained in a road rage incident and the dissenting judge felt this took the worker out of the course of employment.
Pearson Ford vs WCAB (Hernandez)
The carrier hired a private investigator to see if the workers’ arm injury was as significant as stated. Video was obtained showing him removing his sling after the doctor appointment and performing normal activities. He subsequently pled guilty to workers’ compensation fraud and was sentenced. Later in the claim, the AME found the worker did have impairment as a result of the injury. In fact, the AME indicated the impairment had gotten worse since the video evidence of fraud was obtained. The courts allowed the award of PD benefits and ruled that even after a fraud conviction the worker is eligible to receive additional workers’ comp benefits as long as those benefits are not stemming from the actual fraudulent act. They also ruled the claimant’s credibility is not destroyed because of a fraud conviction.
Department of Correction & Rehabilitation vs WCAB (Fitzpatrick)
The employee had both a physical and psychiatric injury. The combined value of the ratings was 99%. At trial the employee was awarded 100% disability. The Appeals Board overturned this decision and ruled the only way for the employee to receive an award of permanent total disability was if they met the specific conditions provided in the statutes or there was substantial evidence to show the permanent disability rating was inappropriate. This is an important decision for employers because a ruling in the opposite would have allowed judges to award permanent total disability at their discretion.
Hikida vs WCAB
This is a 2017 decision that ruled that where the underlying condition is both occupational and non-occupational, the employer is responsible for 100% of the permanent disability when the treatment received was entirely for the work-related condition regardless.
Gault vs Americana Vacation Clubs
This case took asbestos case law and applied it to physical injuries. It ruled that if you have an underlying condition that is expected to worsen in the future, the WCAB could maintain jurisdiction and increase the PD award in then future based on the worsening of the condition.
City of Petaluma vs WCAB (Lindh)
The employee had a significant underlying congenital condition and suffered a work injury that eventually lead to blindness in one eye. The employee tried to argue that he was asymptomatic before the workplace injury therefore no apportionment should apply. The courts ruled that apportionment to the prior condition was appropriate even though it had not caused symptoms until the workplace injury.
Belinda Go vs Sutter Solano Medical Center
Spinal surgery was denied by UR/IMR. The employee pursued surgery on her own. The Courts later awarded the injured worker back TD and PD benefits relating to the surgery even though that was properly denied under the IMR process. They indicated the IMR process is separate from issues pertaining to TD and PD.
Camacho vs Target
Essentially this case ruled that you cannot close out issues outside of the workers’ compensation statutes with a C&R agreement on a worker’s compensation claim. Other potential claims (wage/hour, discrimination, etc) must be closed out under a separate agreement.
Morales vs Universal Furniture
A C&R was executed for CT claims involving orthopedic and psychiatric injuries. Immediately after the settlement they filed a CT claim for internal injuries involving the same time period. The courts ruled this claim was not barrier because it was not expressly listed in the C&R agreement. Lesson here is make sure you C&R leaves no holes for additional claims to be filed during the same time period.