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California Workers’ Compensation Practice

Handle workers' compensation matters with ease using this essential, practice-oriented guide.

“The keystone to any workers' compensation practitioner's library. It provides a thorough list of cases, statutes, and forms and is my go-to guide for the daily issues that come up in practice. I have visited and revisited its chapters often and don't doubt that I will continue to do so.”
Gregory Grinberg, Law Office of Gregory Grinberg, San Mateo

Handle workers’ compensation matters with ease using this essential, practice-oriented guide.

  • Includes changes enacted by SB 863 and its implementing regulations
  • Covers matters on behalf of applicants, employers, and insurers
  • Comprehensive discussion of temporary and permanent disability
  • Complete coverage from medical treatment through filing and review
  • Multiple time-saving forms and checklists
OnLAW WC94150

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$ 495.00
Print WC33150

4th edition, 2 looseleaf volumes, updated 3/19

 

$ 495.00
Add Forms CD to Print WC23157
$ 99.00
“The keystone to any workers' compensation practitioner's library. It provides a thorough list of cases, statutes, and forms and is my go-to guide for the daily issues that come up in practice. I have visited and revisited its chapters often and don't doubt that I will continue to do so.”
Gregory Grinberg, Law Office of Gregory Grinberg, San Mateo

Handle workers’ compensation matters with ease using this essential, practice-oriented guide.

  • Includes changes enacted by SB 863 and its implementing regulations
  • Covers matters on behalf of applicants, employers, and insurers
  • Comprehensive discussion of temporary and permanent disability
  • Complete coverage from medical treatment through filing and review
  • Multiple time-saving forms and checklists

1

Workers’ Compensation and Other Remedies

Charles Lawrence Swezey

  • I.  INTRODUCTION
    • A.  Scope of Chapter  1.1
    • B.  Historical Background of Workers’ Compensation Laws  1.2
  • II.  CALIFORNIA’S WORKERS’ COMPENSATION SYSTEM
    • A.  How the System Differs From Tort Law  1.3
      • 1.  Liability Without Fault  1.4
      • 2.  Compulsory Insurance  1.5
      • 3.  Automatic Payment; Notice  1.6
      • 4.  Limited Benefits  1.7
      • 5.  Expeditious Machinery for Resolving Disputes  1.8
        • a.  Mandatory Dispute Resolution Procedures
          • (1)  Compensability, Permanent Disability, and Medical Treatment  1.9
          • (2)  Supplemental Job Displacement Benefit  1.10
          • (3)  Arbitration  1.11
          • (4)  Negotiated Resolutions  1.12
        • b.  Information and Assistance Officers  1.13
          • (1)  Available Services  1.14
          • (2)  Tolling of Limitations Periods  1.15
        • c.  Dispute Resolution By WCAB  1.16
          • (1)  Board Proceedings Not Bound by Rules of Evidence or Procedure  1.17
          • (2)  Representation at Board Proceedings  1.18
          • (3)  Full Disclosure  1.19
    • B.  Antifraud Provisions  1.20
      • 1.  Activities Subject to Criminal or Civil Penalties  1.21
      • 2.  Effects of Fraud Violation  1.22
      • 3.  Reporting Fraud  1.23
    • C.  Employer’s Obligations
      • 1.  Duty to Give Notice  1.24
        • a.  Notices Before Injury  1.25
        • b.  Claim Form and Notice After Injury  1.26
        • c.  Continuing Duty to Give Notices  1.27
      • 2.  Duty to Respond to Claim Form
        • a.  Employee Files Claim Form  1.28
        • b.  Employer Response to Filing  1.29
        • c.  Acceptance or Rejection of Claim  1.30
      • 3.  First Payment of Temporary Disability Indemnity or Delay Notice  1.31
      • 4.  Additional Notices  1.32
      • 5.  Duty to Transmit Claims Data  1.33
  • III.  CIVIL DAMAGES
    • A.  Both Workers’ Compensation Benefits and Civil Damages May Be Available  1.34
    • B.  Workers’ Lawsuits
      • 1.  Lawsuits Against Third Parties  1.35
      • 2.  Lawsuits Against Employers
        • a.  Exclusive Remedy Rule  1.36
        • b.  Civil Damages or Workers’ Compensation?  1.37
        • c.  Uninsured Employer  1.38
        • d.  Statutory and Other Exceptions  1.39
      • 3.  Lawsuit Against Coemployees  1.40
      • 4.  Lawsuit Against Compensation Insurers  1.41
      • 5.  Lawsuit Against Independent Adjusting Agents  1.42
    • C.  Employer’s Reimbursement and Credit Rights  1.43
  • IV.  COLLATERAL BENEFITS
    • A.  State Disability Benefits
      • 1.  Unemployment Disability Compensation  1.44
      • 2.  Family Temporary Disability Insurance  1.45
    • B.  Other Disability Insurance  1.46
    • C.  Unemployment Insurance  1.47
    • D.  Sick Leave, Vacation Pay, Wages, and Fringe Benefits  1.48
    • E.  Medical Leave Acts  1.49
    • F.  Medical Insurance  1.50
    • G.  Protection for Disabled Workers  1.51
      • 1.  Americans with Disabilities Act  1.52
      • 2.  California Fair Employment and Housing Act  1.53
      • 3.  Further Information  1.54
    • H.  Social Security  1.55
    • I.  Veterans’ Benefits  1.56
    • J.  Uninsured Motorist Insurance  1.57
    • K.  Victim of Violent Crime Indemnification  1.58
    • L.  Welfare  1.59
  • V.  FEDERAL REMEDIES
    • A.  Longshore and Harbor Workers’ Compensation Act
      • 1.  Coverage
        • a.  Injured Worker Must Meet Both Status and Situs Tests  1.60
        • b.  State Law May Also Apply  1.61
      • 2.  Procedure  1.62
      • 3.  Third Party Suits  1.63
    • B.  Other Federal Compensation Acts
      • 1.  Federal Employees’ Compensation Act  1.64
      • 2.  Defense Base Act  1.65
      • 3.  Outer Continental Shelf Lands Act  1.66
      • 4.  Private Employees on Federal Lands and Buildings  1.67
    • C.  Seamen’s Remedies
      • 1.  Maintenance, Cure, and Wages  1.68
      • 2.  Unseaworthiness  1.69
      • 3.  Jones Act  1.70
        • a.  Jones Act Coverage  1.71
        • b.  Where to File; State Law May Also Apply  1.72
      • 4.  Death on the High Seas Act  1.73
    • D.  Federal Employers’ Liability Act  1.74

2

Jurisdiction

Colleen S. Casey

  • I.  WORKERS’ COMPENSATION APPEALS BOARD
    • A.  Constitutional and Legislative Authority  2.1
    • B.  Composition  2.2
    • C.  Jurisdiction and Judicial Powers  2.3
    • D.  Basic Jurisdictional Limits
      • 1.  Compensable Injury Required  2.4
      • 2.  Jurisdiction Must Be Established  2.5
      • 3.  Limited Jurisdiction  2.6
      • 4.  Personal Jurisdiction Required  2.7
      • 5.  Cannot Declare Statute Unconstitutional  2.8
      • 6.  Termination and Reservation of Jurisdiction  2.9
      • 7.  Continuing Jurisdiction  2.10
      • 8.  Fraud Conviction  2.11
      • 9.  Carve-Out Programs  2.12
    • E.  Exclusive Jurisdiction  2.13
    • F.  Exclusive Remedy Rule  2.14
      • 1.  Acts Outside of Normal Employment Relationship  2.15
      • 2.  Violation of Public Policy  2.15A
      • 3.  Discrimination Claims  2.15B
      • 4.  Statutory Exceptions  2.15C
      • 5.  Administrative Director’s Powers  2.16
  • II.  PREREQUISITES FOR RECOVERY  2.17
    • A.  Specific Conditions of Compensability  2.18
      • 1.  Subject to Workers’ Compensation Laws  2.19
      • 2.  Performing Services Related to Employment  2.20
        • a.  Personal Comfort and Convenience  2.21
        • b.  Lunch and Coffee Breaks  2.22
        • c.  Bunkhouse Rule  2.23
      • 3.  Proximate Cause
        • a.  General Rules  2.24
        • b.  Examples of Injuries or Conditions Caused by Employment  2.24A
      • 4.  Intoxication  2.25
      • 5.  Self-lnflicted Injuries  2.26
      • 6.  Suicide  2.27
      • 7.  Initial Physical Aggressor  2.28
      • 8.  Felony Convictions  2.29
      • 9.  Restriction for Recreational, Social, and Athletic Activity  2.30
      • 10.  Posttermination or Layoff Claims
        • a.  Physical Injuries  2.31
        • b.  Posttermination Psychiatric Injuries  2.32
    • B.  Arising Out of Employment  2.33
      • 1.  Condition of Employer’s Premises or Equipment  2.34
      • 2.  Extraneous or Unknown Source: Positional Risk or Zone of Danger Rule  2.35
      • 3.  Employment Risks Versus Personal Risks  2.36
        • a.  Personal Risk  2.37
        • b.  Mixed Risk  2.38
        • c.  Neutral Risk  2.39
      • 4.  Employee’s Preexisting Conditions; Normal Bodily Movements  2.40
      • 5.  Horseplay  2.41
    • C.  Occurring in Course of Employment  2.42
      • 1.  Unauthorized or Forbidden Activities  2.43
      • 2.  Commercial Travelers; Travel Between Worksites  2.44
      • 3.  Dual Purpose Rule  2.44A
      • 4.  Before and After Work Hours  2.45
      • 5.  Going and Coming Rule  2.46
        • a.  Employer-Provided Transportation  2.47
        • b.  Special Mission or Errand Doctrine  2.48
        • c.  Special Risk Exception  2.49
        • d.  Restatement of Going and Coming Rule  2.50
      • 6.  Telecommuting  2.50A
      • 7.  Traveling to or From Medical Appointments  2.50B
    • D.  “Injury” Defined
      • 1.  Injury Versus Disability  2.51
      • 2.  Disease  2.52
      • 3.  Psychiatric Injury
        • a.  General Criteria (Lab C §3208.3)  2.53
          • (1)  6-Month Requirement  2.54
          • (2)  “Sudden and Extraordinary” Exception  2.54A
          • (3)  Physical-Mental Injuries  2.55
        • b.  Good Faith Personnel Action Defense  2.56
        • c.  Posttermination Psychiatric Injury Claims  2.57
        • d.  State Prison Inmates  2.58
      • 4.  Other Compensable Injuries  2.59
  • III.  ESTABLISHING EMPLOYMENT RELATIONSHIP
    • A.  “Employer” Defined; Exclusions  2.60
    • B.  “Employee” Defined  2.61
      • 1.  Presumption of Employee Status  2.62
      • 2.  Employees Included by Statute  2.63
      • 3.  Judicial Inclusions  2.64
      • 4.  Inclusion by Election  2.64A
    • C.  Excluded Persons and Occupations
      • 1.  Employees Excluded by Statute  2.65
        • a.  Residential and Personal Employees
          • (1)  Time and Salary Limitation (Lab C §3352(a)(8))  2.66
          • (2)  Family Member Limitation (Lab C §3352(a)(1))  2.67
          • (3)  Exception From Exclusion for Residential Worker Whose Employer Is Uninsured  2.68
        • b.  Athletic Activities: Participants and Officials  2.69
        • c.  Services for Charities  2.70
        • d.  Ski Resort and Recreational Camp Workers  2.71
        • e.  Deputies  2.72
        • f.  Disaster Workers  2.73
        • g.  Other Excluded Employees  2.74
        • h.  Employees Temporarily Working in California
          • (1)  General Rules  2.74A
          • (2)  Rules Applicable to Professional Athletes
            • (a)  Claims Filed on or After 9/15/2013  2.74B
            • (b)  Claims Filed Before 9/15/2013  2.74C
      • 2.  Independent Contractors
        • a.  Definition; Right to Control  2.75
        • b.  General Factors  2.76
        • c.  Rebuttable Presumptions  2.77
      • 3.  Volunteers  2.78
      • 4.  Employees Under Federal or Tribal Jurisdiction  2.79
    • D.  General and Special Employment  2.80
      • 1.  Evidence of Special Employment  2.81
      • 2.  Joint and Several Liability  2.82
      • 3.  Temporary Employees Assigned by Agency  2.83
      • 4.  Jurisdiction Over Workers’ Compensation Insurers  2.84
  • IV.  CONCURRENT JURISDICTION
    • A.  Uninsured Employer  2.85
    • B.  Jurisdiction to Determine Jurisdiction  2.86
      • 1.  Res Judicata  2.87
      • 2.  Collateral Estoppel  2.88
      • 3.  Forum Selection Clause  2.88A
  • V.  EXTRATERRITORIAL JURISDICTION
    • A.  Contract of Hire Made in California  2.89
    • B.  Contract of Hire Made Outside California  2.90
    • C.  Serious and Willful Violation  2.91
    • D.  Choice of Law  2.92
    • E.  Full Faith and Credit  2.93
    • F.  Ceding Jurisdiction
      • 1.  Statutory Reciprocal Cession  2.94
      • 2.  Inconvenient Forum  2.95
  • VI.  INCIDENTAL POWERS AND JURISDICTION
    • A.  General Powers  2.96
      • 1.  Contempt  2.97
      • 2.  Sanctions  2.98
      • 3.  Service of Process  2.99
    • B.  Subpoena Power  2.100
    • C.  Rule-Making Power  2.101
    • D.  Employers’ Injury Reports  2.102
    • E.  Guardians, Trustees, and Conservators; Payments to Minors  2.103
      • 1.  Appointment of Guardian  2.104
      • 2.  Appointment of Conservator  2.105
      • 3.  Appointment of Trustee  2.106
      • 4.  Supervision of Trusts  2.107
    • F.  City, County, and State Employees  2.108
      • 1.  Lab C §§4800–4800.5 Jurisdiction  2.109
      • 2.  Industrial Disability Leave Jurisdiction  2.110
      • 3.  Lab C §§4850–4850.7 Jurisdiction  2.111
      • 4.  Expansion of WCAB’s Jurisdiction  2.112
    • G.  Compromises and Releases  2.113
    • H.  Liens on Compensation  2.114
    • I.  Restitution of Overpayment  2.115
    • J.  Payment for Subsequent Injuries  2.116
    • K.  Contribution Among Employers or Insurers
      • 1.  Cumulative Injury; Occupational Disease  2.117
      • 2.  General and Special Employment  2.118
    • L.  Arbitrating Insurance Controversies  2.119
    • M.  Discrimination; Reinstatement With Back Pay  2.120
    • N.  Jurisdiction Over Representatives  2.121
    • O.  Administrative Appeals  2.122
    • P.  Longshore Act Disputes  2.123
    • Q.  Pension Plans; Labor Agreements  2.124
    • R.  Negligence and Damages Findings  2.125
    • S.  Other Powers and Restrictions  2.126
  • VII.  EQUITY JURISDICTION
    • A.  Reformation: Compromises, Insurance Policies  2.127
    • B.  Death Benefit Distribution  2.128
    • C.  General Principles; Laches  2.129

3

Medical Treatment

Colleen S. Casey

  • I.  MEDICAL TREATMENT BENEFITS
    • A.  All “Reasonably Required” Medical Services  3.1
    • B.  Medical Treatment May Be Unlimited  3.2
    • C.  Scope of Medical Treatment
      • 1.  Treating Physicians  3.3
      • 2.  Physician Assistants and Nurse Practitioners  3.4
      • 3.  Psychologists/Family Counselors  3.5
      • 4.  Home Health Care Services  3.6
        • a.  Who May Prescribe Services  3.7
        • b.  How Services May Be Prescribed  3.8
        • c.  Limits on Employer’s Liability for Services  3.9
        • d.  Services May Be Provided by Family Member  3.10
      • 5.  Housekeeping Services  3.11
      • 6.  Medical Rehabilitation  3.12
    • D.  Expenses Related to Medical Treatment
      • 1.  Transportation Expenses  3.13
      • 2.  Expenses for Requested Medical-Legal Examinations  3.14
  • II.  PROVISION OF MEDICAL TREATMENT
    • A.  Employer Obligated to Provide All Required Treatment  3.15
    • B.  Control of Medical Treatment
      • 1.  Employer Makes Initial Choice of Treating Physician  3.16
      • 2.  When Employee May Choose Treating Physician  3.17
        • a.  Must Be Within Reasonable Geographic Area  3.18
        • b.  Procedure for Choosing Treating Physician  3.19
        • c.  Not Limited to One Choice  3.20
      • 3.  Right to Request Change of Employer-Selected Physician  3.21
      • 4.  Predesignation of Personal Physician  3.22
        • a.  Conditions Under Which Employee Can Predesignate Physician  3.23
        • b.  Who Is Eligible to Be Designated as Personal Physician  3.24
        • c.  Procedure for Predesignation  3.25
        • d.  If Employer Has a Medical Provider Network (MPN)  3.26
        • e.  Claims Administrator’s Duties  3.27
        • f.  Provision of Emergency Medical Treatment  3.28
        • g.  No Prior Employer Contact With Predesignated Physician  3.29
        • h.  Resolution of Disputes  3.30
        • i.  When Predesignated Physician Is Unable to Provide Treatment  3.31
      • 5.  Changing Physician at Employer’s Request
        • a.  Must File Petition to Change Primary Treating Physician  3.32
        • b.  Must Show Good Cause  3.33
        • c.  Form and Contents of Petition  3.34
        • d.  Response to Petition  3.35
        • e.  Administrative Director’s Decision  3.36
        • f.  Review of Administrative Director’s Order  3.37
      • 6.  Transfer Into Newly Established MPN  3.38
      • 7.  Loss or Relinquishment of Medical Control  3.39
    • C.  Role of Primary Treating Physician
      • 1.  Primarily Responsible for Care of Injured Employee  3.40
      • 2.  Limitation on Chiropractor as Primary Treating Physician  3.41
      • 3.  Reporting Duties  3.42
        • a.  First Report of Injury (Form 5021)  3.43
        • b.  Progress Reports
          • (1)  When Required  3.44
          • (2)  Form and Contents  3.45
        • c.  Permanent and Stationary Reports
          • (1)  Existence and Extent of Permanent Disability  3.46
          • (2)  Return-to-Work and Voucher Report  3.47
    • D.  Secondary Physicians  3.48
    • E.  Medical Treatment Utilization Schedule (MTUS)
      • 1.  Medical Treatment Must Be Based on MTUS  3.49
      • 2.  Contents of MTUS
        • a.  ACOEM Guidelines  3.50
          • (1)  General Approaches  3.51
          • (2)  Clinical Topics  3.52
        • b.  AD’s Treatment Guidelines for Special Topics  3.53
        • c.  Drug Formulary  3.53A
      • 3.  Rebuttable Presumption that MTUS Is Correct  3.54
      • 4.  If MTUS Does Not Address Condition or Injury  3.55
      • 5.  Medical Evidence Search Sequence  3.56
        • a.  When MTUS Does Address Condition or Injury  3.57
        • b.  When Rebutting MTUS  3.58
        • c.  Format of Citations  3.59
    • F.  Utilization Review (UR)
      • 1.  Mandatory Process to Review Medical Treatment Requests  3.60
      • 2.  Establishing UR Process  3.61
        • a.  Written Policies and Procedures to Ensure Compliance With MTUS  3.62
        • b.  Description of UR Process  3.63
        • c.  Review and Approval by Administrative Director  3.64
        • d.  Active Accreditation Required  3.64A
        • e.  Modifications to UR Process  3.65
        • f.  Process Must Be Publicly Available  3.66
        • g.  Restrictions on Financial Interests  3.66A
      • 3.  Request for Authorization  3.67
        • a.  When Employer May Defer Submitting Request to UR  3.68
        • b.  Employer May Request Reasonably Necessary Additional Information  3.69
        • c.  When Treatment Is Automatically Approved
          • (1)  Required Conditions  3.69A
          • (2)  Physician Reporting Requirements  3.69B
          • (3)  Exceptions to Automatic-Approval Rule  3.69C
          • (4)  Retrospective UR to Ensure Compliance With MTUS  3.69D
      • 4.  Who May Make UR Decision  3.70
      • 5.  Deadlines for Making UR Decision  3.71
        • a.  Determining Date of Receipt  3.72
        • b.  Prospective or Concurrent Review
          • (1)  Definitions  3.73
          • (2)  General Rule: 5 Days/14 Days  3.74
          • (3)  Deadline Extensions
            • (a)  Additional Information Needed  3.75
            • (b)  Additional Examination, Test, or Consultation Needed  3.76
          • (4)  Expedited Review  3.77
        • c.  Retrospective Review  3.78
      • 6.  Deadlines for Communicating UR Decision  3.79
        • a.  When Request for Authorization Is Approved  3.80
        • b.  When Request for Authorization Is Not Approved in Full  3.81
      • 7.  Procedure When UR Decision Is Untimely  3.82
      • 8.  Required Form and Contents of UR Decision
        • a.  When Request for Authorization Is Approved  3.83
        • b.  When Request for Authorization Is Not Approved in Full  3.84
      • 9.  Duration of UR Decisions  3.85
      • 10.  Violations and Penalties  3.86
    • G.  Disputes Regarding UR Decision or Provision of Medical Treatment  3.87
  • III.  MEDICAL PROVIDER NETWORKS (MPNs)  3.88
    • A.  MPN Approval  3.89
    • B.  Access Standards for Medical Treatment  3.90
      • 1.  MPN Must Propose Alternative When Standards Cannot Be Met  3.91
      • 2.  Treatment Outside MPN When Standards Are Not Met  3.92
      • 3.  Policy for Employees Outside Service Area  3.93
      • 4.  When Emergency Medical Treatment Is Needed  3.94
      • 5.  Referrals to Specialists  3.95
      • 6.  Availability of Medical Access Assistants  3.96
    • C.  Probation, Suspension, or Revocation of MPN
      • 1.  Grounds  3.97
      • 2.  Opportunity to Cure Violation; Notice of Action  3.98
      • 3.  Request for Reevaluation  3.99
      • 4.  Administrative Director’s Decision  3.100
      • 5.  Appeal of Decision  3.101
    • D.  MPN Complaints and Petitions for Suspension or Revocation
      • 1.  Complaint Procedures  3.102
        • a.  Required Contents of Complaint  3.103
        • b.  MPN Response to Complaint  3.104
        • c.  When MPN Fails to Remedy Violation or Disputes Complaint  3.105
          • (1)  Investigation by Administrative Director  3.106
          • (2)  Procedure If Violation Is Found  3.107
      • 2.  Petition for Suspension or Revocation
        • a.  Grounds for Petition  3.108
        • b.  Form and Contents of Petition  3.109
        • c.  MPN Response to Petition  3.110
        • d.  Administrative Director’s Request for Information or Evidence  3.111
        • e.  Administrative Director’s Decision  3.112
    • E.  Administrative Penalties  3.113
      • 1.  Schedule of Penalties
        • a.  Violations of MPN Filing Requirements  3.114
        • b.  Violations of MPN Access Requirements  3.115
        • c.  Failure to Respond to DWC Requests  3.116
        • d.  Notice Violations  3.117
      • 2.  Procedures for Imposition of Penalty
        • a.  Notice of Action and Opportunity to Correct  3.118
        • b.  Mitigation of Penalty  3.119
        • c.  Request for Reevaluation  3.120
        • d.  Appeal of Notice of Action  3.121
    • F.  Notice Requirements
      • 1.  When Industrial Injury Occurs  3.122
      • 2.  When MPN Coverage Ends  3.123
      • 3.  Failure to Provide Required Notices  3.124
    • G.  Medical Treatment Within MPN  3.125
      • 1.  Employer Arranges Initial Evaluation  3.126
      • 2.  Employee’s Right to Change Physician  3.127
      • 3.  When Employee Has Predesignated Personal Physician  3.128
      • 4.  Treatment by Non-MPN Specialist  3.129
  • IV.  HEALTH CARE ORGANIZATIONS  3.130
  • V.  SELF-PROCURED MEDICAL TREATMENT  3.131
    • A.  Reimbursability for Self-Procured Treatment  3.132
    • B.  Notice to Employer  3.133
    • C.  When Failure to Give Notice Is Excusable  3.134
    • D.  Reasonable Value of Services  3.135
      • 1.  Effect of Fee Schedule  3.136
      • 2.  When Services Not Covered by Fee Schedule  3.137
      • 3.  Lien Claims  3.138
      • 4.  Finance Charges  3.139
  • VI.  REFUSAL TO SUBMIT TO TREATMENT OR SURGERY  3.140
  • VII.  PAYMENT OF MEDICAL TREATMENT EXPENSES
    • A.  Jurisdiction  3.141
    • B.  Billing and Payment/Explanation of Review  3.142
    • C.  Contesting Billings  3.143
    • D.  Second Bill Review  3.144
    • E.  Independent Bill Review (IBR)  3.145
      • 1.  When IBR Is Appropriate  3.146
      • 2.  Consolidation of IBR Requests  3.147
      • 3.  Deadline to Request IBR  3.148
      • 4.  How to Make IBR Request  3.149
      • 5.  Preliminary Review and Assignment to IBR Organization  3.150
      • 6.  Withdrawal of IBR Request  3.151
      • 7.  Review and Determination  3.152
      • 8.  Appeal  3.153
      • 9.  Petition to Enforce IBR Decision  3.154
    • F.  Official Medical Fee Schedule  3.155
    • G.  Physicians Barred From Collecting Fees From Injured Workers  3.156
    • H.  Effect of Accepting Medi-Cal Payments  3.157
  • VIII.  APPORTIONMENT OF LIABILITY FOR MEDICAL TREATMENT
    • A.  Combined Industrial and Nonindustrial Causes  3.158
    • B.  Out-of-State Injury  3.159
    • C.  Apportionment Among Carriers  3.160

4

Temporary Disability

Andrew K. Shaffer

Brett A. Borah

  • I.  INTRODUCTION; DEFINITIONS  4.1
    • A.  Temporary Disability May Be Total or Partial  4.2
    • B.  Availability of Alternative Work and “Odd Lot” Doctrine  4.3
    • C.  No Apportionment of Temporary Disability  4.4
    • D.  Subsequent Nonindustrial Injury  4.5
  • II.  PROCEDURE
    • A.  Entitlement to Temporary Disability Indemnity  4.6
    • B.  When Liability for Temporary Disability Payments Begins
      • 1.  General Rule: 3-Day Waiting Period  4.7
      • 2.  Exceptions to 3-Day Waiting Period  4.8
    • C.  When Liability for Disability Payments Ends
      • 1.  Statutory Time Limits  4.9
        • a.  Effect of Payments Under Lab C §4850  4.10
        • b.  Longer Period for Certain Serious Injuries or Conditions  4.11
      • 2.  Employee Returns to Work, Is Cleared to Return to Work, or Condition Becomes Permanent and Stationary  4.12
      • 3.  Employee Dies or Retires  4.13
    • D.  Timing of Temporary Disability Payments
      • 1.  First Payment Within 14 Days  4.14
      • 2.  Subsequent Payments; Penalty for Late Payment  4.15
      • 3.  If Employer Denies Liability  4.16
        • a.  Unrepresented Employee  4.17
        • b.  Represented Employee  4.18
      • 4.  If Liability Determination Is Delayed  4.19
        • a.  Unrepresented Employees  4.20
        • b.  Represented Employee  4.21
    • E.  Manner of Payment  4.22
    • F.  When WCAB Loses Jurisdiction  4.23
  • III.  CALCULATING AVERAGE WEEKLY EARNINGS (AWE)
    • A.  Importance of AWE  4.24
    • B.  Chart: Minimum and Maximum AWE  4.25
    • C.  What Constitutes Earnings
      • 1.  Allowable Items
        • a.  Wages or Salary, and Overtime  4.26
        • b.  Board, Lodging, and Fuel as Remuneration  4.27
        • c.  “Other Advantages”  4.28
      • 2.  Excluded Items
        • a.  Special Expenses  4.29
        • b.  Other Exclusions  4.30
    • D.  Four Methods of Calculating AWE  4.31
      • 1.  Method Used Must Reflect Employee’s Earning Capacity  4.32
      • 2.  Method #1: Full-Time Work (Lab C §4453(c)(1))  4.33
        • a.  Earnings at Time of Injury  4.34
        • b.  Inclusion of Overtime  4.35
        • c.  New or Seasonal Employment  4.36
      • 3.  Method #2: Two or More Employers (Lab C §4453(c)(2))  4.37
      • 4.  Method #3: Earnings at Irregular Rate (Lab C §4453(c)(3))  4.38
      • 5.  Method #4: Part-Time Work or When Other Methods Do Not Produce Fair and Reasonable Result (Lab C §4453(c)(4))  4.39
        • a.  Factors for Determining Earning Capacity  4.40
        • b.  Postinjury Earnings  4.41
        • c.  Effect of Postinjury Education or Training on Earning Capacity  4.41A
        • d.  Part-Time Employees  4.42
        • e.  Seasonal Employees  4.43
        • f.  Intermittent Employment  4.43A
    • E.  Calculating AWE for Special Classes
      • 1.  Retired Public Safety Employees  4.44
      • 2.  Minors  4.44A
      • 3.  Other Special Classes  4.45
  • IV.  CALCULATING TEMPORARY DISABILITY PAYMENTS
    • A.  Rate on Date of Injury Controls  4.46
    • B.  Exception: TTD Payments Made More Than 2 Years From Date of Injury  4.47
    • C.  TTD Payments
      • 1.  Two-Thirds of Injured Worker’s AWE  4.48
    • D.  TPD Payments = 2/3 of Loss in Injured Worker’s AWE  4.49
      • 1.  Maximum Partial Disability Payment  4.50
      • 2.  Obtaining New Employment During Temporary Disability  4.51
    • E.  When Temporary Disability Is Both Partial and Total  4.52
  • V.  SPECIAL PAYMENTS
    • A.  Voluntary Continuation of Regular Wages or Salary  4.53
    • B.  State Disability Indemnity  4.54
    • C.  Lab C §4850 Benefits for Public Safety Officers  4.55
      • 1.  Determining Eligibility for Lab C §4850 Benefits  4.56
      • 2.  California Highway Patrol Officers  4.57
      • 3.  Leave of Absence and Temporary Disability Benefits After Retirement  4.58
    • D.  Paid Leave for School Employees  4.59
    • E.  Benefits for California State University Personnel  4.60
    • F.  Industrial Disability Leave for State Officers and Employees  4.61
  • VI.  INDEMNITY RATE ADJUSTMENTS
    • A.  Adjustment for Subsequent Increase in Earnings  4.62
    • B.  Amendments to Labor Code §4453  4.63
    • C.  Procedure  4.64
  • VII.  TERMINATION OF TEMPORARY DISABILITY BENEFITS
    • A.  Termination Procedure
      • 1.  Petition to Terminate Liability for Temporary Disability Indemnity  4.65
      • 2.  Content of Petition  4.66
      • 3.  Objection to Petition  4.67
    • B.  Notice of Termination  4.68
      • 1.  Unrepresented Employee  4.69
      • 2.  Represented Employee  4.70
    • C.  Resumption of Temporary Disability Indemnity Payments  4.71

5

Permanent Disability

Charles Lawrence Swezey

  • I.  OVERVIEW OF PERMANENT DISABILITY
    • A.  Definition of Permanent Disability  5.1
    • B.  Disability Considered Permanent and Stationary
      • 1.  No Major Changes Expected  5.2
      • 2.  When Disease Is Progressive  5.3
      • 3.  How Permanency Is Established  5.4
    • C.  Permanent Disability May Be Total or Partial  5.5
      • 1.  Impairments Conclusively Presumed to Be Totally Disabling  5.6
      • 2.  Proving Permanent Total Disability Based on Facts  5.7
  • II.  RATING PERMANENT DISABILITY
    • A.  Disability Evaluation Schedules
      • 1.  Nature and Function of Schedules in General  5.8
      • 2.  California’s Schedules
        • a.  Historical Development  5.9
        • b.  Adoption and Amendment by Administrative Director  5.10
        • c.  Adjustments for Occupation and Age  5.11
      • 3.  Schedule as Prima Facie Evidence  5.12
      • 4.  Determining Which Schedule Applies  5.13
        • a.  Use of Age and Occupational Modifiers in 2005 Schedule for Injuries Occurring On or After January 1, 2013  5.14
        • b.  When 2005 Schedule Applies to Compensable Claims Arising Before January 1, 2005  5.15
    • B.  Rating Permanent Disability Using 1997 Schedule
      • 1.  Identifying Factors of Disability
        • a.  Ratable Factors  5.16
        • b.  Objective Factors  5.17
        • c.  Subjective Factors; Permanent Rating Schedule Adopted Before January 1, 2005  5.18
        • d.  Work Limitations  5.19
        • e.  Cosmetic Defects  5.20
        • f.  Psychiatric Factors  5.21
      • 2.  Applying the 1997 Schedule to Disability Factors
        • a.  Scheduled Ratings  5.22
          • (1)  Formula for Determining Percentages  5.23
          • (2)  Examples of Formulas  5.24
      • 3.  Multiple Disabilities and Avoiding Pyramiding  5.25
    • C.  Rating Permanent Disability Using 2005 Schedule
      • 1.  Overview of Procedures  5.26
      • 2.  Determining Impairment Number and Whole Person Impairment Rating
        • a.  Use of AMA Guides  5.27
        • b.  Impairment Number  5.28
        • c.  Whole Person Impairment (WPI) Rating  5.29
          • (1)  Combining Multiple Impairments
            • (a)  Rules for Combining  5.30
            • (b)  Using the Combined Values Chart  5.31
          • (2)  Increase in WPI for Pain  5.32
          • (3)  Psychiatric Impairments  5.33
          • (4)  Unlisted Impairments  5.34
      • 3.  Adjustment for Diminished Future Earning Capacity (DFEC)  5.35
      • 4.  Adjustment for Employee's Occupation  5.36
        • a.  Occupational Group Number  5.37
          • (1)  Unlisted Occupations  5.38
          • (2)  Multiple Employers With Differing Duties  5.39
          • (3)  Cumulative Trauma  5.40
        • b.  Occupational Variant  5.41
        • c.  Occupational Adjustment  5.42
      • 5.  Adjustment for Employee's Age  5.43
      • 6.  Combining Multiple Permanent Disabilities  5.44
      • 7.  Example of Rating String  5.45
      • 8.  Step-by-Step Calculation of Rating  5.46
    • D.  Rating Permanent Disability Using 2013 Schedule
      • 1.  Administrative Director May Formulate New Schedule of Occupation and Age Modifiers  5.47
      • 2.  Elements of Rating  5.48
        • a.  Elimination of DFEC Component  5.49
        • b.  Continued Use of 2005 Schedule’s Occupation and Age Modifiers   5.50
        • c.  Elimination of Increases for Sleep, Sexual Dysfunction, and Psychiatric Disorders  5.51
      • 3.  Steps for Rating Permanent Disability Under 2013 Schedule  5.52
  • III.  REBUTTING A PERMANENT DISABILITY RATING  5.53
    • A.  Rebutting the Diminished Future Earning Capacity (DFEC) Component  5.54
      • 1.  Method One  5.55
      • 2.  Method Two  5.56
      • 3.  Method Three  5.57
    • B.  Rebutting the Whole Person Impairment (WPI) Rating  5.58
  • IV.  CALCULATING AND PAYING PERMANENT DISABILITY INDEMNITY
    • A.  Permanent Partial Disability  5.59
      • 1.  Compensation Rate
        • a.  Two-Thirds of Injured Employee’s AWE  5.60
        • b.  Chart: Statutory Minimum and Maximum AWE  5.61
      • 2.  Duration of Payments  5.62
        • a.  Injuries Occurring From January 1, 1992, to December 31, 2003  5.63
        • b.  Injuries Occurring From January 1, 2004, to December 31, 2004  5.64
        • c.  Injuries Occurring From January 1, 2005, to December 31, 2012  5.65
        • d.  Injuries Occurring On or After January 1, 2013  5.66
        • e.   Calculating Number of Weeks of Payments That Are Due  5.67
      • 3.  Increase or Reduction in Amount of Payments Based on Offer of Work  5.68
        • a.  15-Percent Increase  5.69
        • b.  15-Percent Reduction  5.70
          • (1)  What Constitutes Regular, Modified, or Alternative Work  5.71
          • (2)  Offer of Seasonal Work  5.72
        • c.  Procedures Relating to Offers of Work  5.73
        • d.  When the Parties Dispute Employee’s Permanent and Stationary Status  5.74
      • 4.  Life Pension for Serious Permanent Partial Disabilities
        • a.  When Life Pension Begins; Rate of Compensation  5.75
        • b.  When Life Pension Rate May Be Increased (COLAs)  5.76
    • B.  Permanent Total Disability
      • 1.  Duration and Rate of Compensation  5.77
      • 2.  Chart: Minimum and Maximum AWE  5.78
      • 3.  When Compensation Rate May Be Modified
        • a.  Cost of Living Adjustments (COLAs)  5.79
        • b.  No Increase Under Lab C §4661.5  5.80
    • C.  Payment of Permanent Disability Indemnity
      • 1.  Timing and Manner of Payment  5.81
      • 2.  If Injury Causes No Permanent Disability  5.82
      • 3.  If Employee Dies  5.83
      • 4.  When Extent of Permanent Disability Remains Undetermined  5.84
      • 5.  Delay in Payment on Offer of Employment  5.85
      • 6.  Commutation of Award of Permanent Disability  5.86
      • 7.  When Employee Self-Procures Medical Treatment  5.87
    • D.  Apportionment of Permanent Disability
      • 1.  Definition and Nature of Concept  5.88
      • 2.  History of Apportionment Law  5.89
      • 3.  Apportionment Standards
        • a.  SB 899 Applies to All Pending Cases  5.90
        • b.  Apportionment Analysis Involves Causation of Disability, Not Injury  5.91
        • c.  Allocation of Burdens  5.92
        • d.  Physician and WCAB Must Make Apportionment Determination  5.93
        • e.  Sufficiency of Medical Evidence  5.94
      • 4.  Benefits for Which No Apportionment Is Permitted  5.95
      • 5.  Preexisting Permanent Disability
        • a.  Issue of Overlap  5.96
        • b.  When There Is a Prior Award of Permanent Disability
          • (1)  Conclusive Presumption of Continued Existence of Prior Permanent Disability  5.97
          • (2)  If Prior Permanent Disability Was Rated Under Different Schedule  5.98
          • (3)  Permanent Disability Awards May Not Exceed 100 Percent for Any One Body Region  5.99
        • c.  When There Is Preexisting Permanent Disability, But No Prior Award  5.100
      • 6.  Preexisting Disease or Condition
        • a.  Pre-SB 899 Rules  5.101
        • b.  Post-SB 899 Rules  5.102
        • c.  No Apportionment When Disease Is Presumed Compensable  5.103
      • 7.  Cumulative Injury and Occupational Disease Cases  5.104
      • 8.  Successive Industrial Injuries That Become Permanent and Stationary at Same Time  5.105
      • 9.  Effect of Later Nonindustrial Injuries  5.106
      • 10.  Calculating Compensation in Apportioned Cases (Fuentes Rule)  5.107
    • E.  Payment for Subsequent Injuries
      • 1.  Subsequent Injuries Benefits Trust Fund (SIBTF)  5.108
      • 2.  Eligibility Requirements  5.109
        • a.  Prior Disability Must Have Been Labor Disabling (Ratable)  5.110
        • b.  When Prior Disability Is Total  5.111
        • c.  Combined Disabilities Must Be Greater Than Subsequent Disability Alone  5.112
        • d.  Combined Effect of Disabilities Must Be 70 Percent or More  5.113
        • e.  Subsequent Injury Must Meet 5 or 35 Percent Threshold  5.114
      • 3.  Compensation Payments  5.115
      • 4.  Reduction for Other Benefits  5.116
      • 5.  Procedures
        • a.  File Written Application With WCAB  5.117
        • b.  Deadline to File Application  5.118
        • c.  Joining the SIBTF
          • (1)  When Existence of Prior Disability Becomes Apparent  5.119
          • (2)  When the SIBTF Is Not Joined  5.120
        • d.  Hearing  5.121
      • 6.  Compromise  5.122
  • V.  PERMANENT DISABILITY RATING PROCEDURES
    • A.  Disability Evaluation Unit (DEU) Raters  5.123
    • B.  Formal Rating Determinations  5.124
      • 1.  Requesting a Formal Rating (Rating Instructions)  5.125
      • 2.  Preparation and Service of Formal Rating  5.126
      • 3.  Objection to Formal Rating  5.127
      • 4.  Cross-Examination of Rater  5.128
    • C.  Summary Rating Determinations  5.129
      • 1.  Summary Rating Based on Physician’s Evaluation  5.130
      • 2.  Summary Rating Based on QME Evaluation  5.131
        • a.  Components of Request for Summary Rating  5.132
        • b.  Request for Rating of Supplemental QME Evaluation  5.133
        • c.  Consideration of Corrected Evaluation  5.134
        • d.  If Evaluation Indicates That Apportionment May Be Appropriate  5.135
        • e.  Service of Summary Rating and Notice of Options  5.136
      • 3.  Reconsideration of Summary Rating  5.137
    • D.  Consultative Rating Determinations  5.138
    • E.  Pretrial Evaluations  5.139
    • F.  Informal Ratings  5.140
    • G.  Other Services  5.141

6

Supplemental Job Displacement Benefit and Return-to-Work Supplement Program

Sally M. Harms

Deborah Lieberman

  • I.  BENEFIT FOR RETRAINING AND SKILLS ENHANCEMENT  6.1
  • II.  REPEAL OF VOCATIONAL REHABILITATION BENEFIT  6.2
  • III.  SJDB FOR INJURIES OCCURRING ON OR AFTER 1/1/2004 AND BEFORE 1/1/2013
    • A.  Requirements for Receipt of Benefit  6.3
    • B.  When Employer Is Not Liable for SJDB  6.4
      • 1.  Definitions of “Modified” and “Alternative” Work  6.5
      • 2.  Waiver of Objection to Work’s Location  6.6
      • 3.  Seasonal Employees  6.7
    • C.  Notice of Right to SJDB  6.8
    • D.  Amount of Voucher  6.9
    • E.  Permissible Uses, Approved Schools, and VRTWCs  6.10
    • F.  Procedure for Delivery and Use of Voucher  6.11
    • G.  Deadline to Use Voucher  6.12
  • IV.  SJDB FOR INJURIES OCCURRING ON OR AFTER 1/1/2013
    • A.  Requirements for Receipt of Benefit  6.13
      • 1.  When No Time Has Been Lost or Employee Returns to Same Job  6.14
      • 2.  Equivalency of Wages and Compensation  6.15
      • 3.  Waiver of Objection to Work’s Location  6.16
      • 4.  Offer of Seasonal Work  6.17
      • 5.  Employer Liability for Injuries While Using Voucher  6.17A
      • 6.  Employee Not Limited to One SJDB  6.17B
    • B.  Notice of Right to SJDB  6.18
    • C.  Deadline to Offer SJDB  6.19
    • D.  Amount of Voucher; Permissible Uses  6.20
    • E.  Procedure for Delivery and Use of Voucher  6.21
    • F.  Deadline to Use Voucher  6.22
    • G.  Dispute Resolution  6.23
    • H.  Prohibition on Settling or Commuting Claim for SJDB  6.23A
  • V.  ATTORNEY FEES MAY BE AWARDED BASED ON SJDB  6.24
  • VI.  RETURN-TO-WORK SUPPLEMENT PROGRAM  6.25
    • A.  Eligibility to Receive Supplemental Payment  6.26
    • B.  Notice of Eligibility  6.27
    • C.  Amount  6.28
    • D.  Procedures for Applying for Supplemental Payment
      • 1.  Deadline for Application  6.29
      • 2.  Application Must Be Submitted Electronically; Contents  6.30
      • 3.  Decision on Application  6.31
      • 4.  Appeal to WCAB  6.32

7

Death Benefits, Dependency, and Burial Expenses

Dennis J. Hannigan

  • I.  INTRODUCTION AND GENERAL CONCEPTS  7.1
    • A.  Death Resulting from Suicide  7.1A
    • B.  Death Resulting From Mysterious Circumstances  7.1B
    • C.  Autopsy and Exhumation  7.1C
    • D.  Time Limitations  7.1D
  • II.  DETERMINING DEPENDENCY
    • A.  Dependency Determined at Time of Injury  7.2
    • B.  Individuals Who Can Qualify As Dependents  7.3
      • 1.  Good Faith Member of Household  7.4
      • 2.  Spouse  7.4A
    • C.  Dependents May Be Total or Partial  7.4B
      • 1.  Who Are Total Dependents?
        • a.  Conclusive Presumption of Total Dependency  7.5
          • (1)  Child  7.6
          • (2)  Spouse  7.7
        • b.  Factual Total Dependency Determination  7.8
      • 2.  Who Are Partial Dependents?  7.9
        • a.  Without Decedent, Can Claimant Maintain Living Standard?  7.10
        • b.  What Amount Did Decedent Devote Annually to Applicant’s Support?  7.11
    • D.  Employer Notice Requirements
      • 1.  Claim Form; Notice of Status of Benefits  7.11A
      • 2.  Notice of Denial of Benefits  7.11B
      • 3.  Notice Regarding Delay in Determining Benefits  7.11C
      • 4.  Notice of Change in Benefits  7.11D
  • III.  IF NO DEPENDENTS
    • A.  Payment to Department of Industrial Relations  7.12
    • B.  Payment to Estate No Longer Required  7.12A
    • C.  Employer Notice Requirements  7.13
    • D.  Payment Procedures and Reimbursement  7.14
    • E.  Disputes Regarding Existence or Extent of Dependency  7.15
  • IV.  METHOD OF PAYMENT AND AMOUNT OF DEATH BENEFIT
    • A.  Benefit Paid in Same Manner and Amounts as Temporary Total Disability Benefits  7.16
    • B.  Amount Depends on Date of Injury  7.17
      • 1.  One Total Dependent and No Partial Dependents  7.18
      • 2.  One Total Dependent and One or More Partial Dependents  7.19
      • 3.  Two Total Dependents  7.20
      • 4.  Three or More Total Dependents  7.21
      • 5.  No Total But One or More Partial Dependents  7.22
      • 6.  Special Death Benefits to Totally Dependent Children  7.23
      • 7.  No Dependents  7.24
      • 8.  Table of Death Benefits  7.25
    • C.  Distribution of Death Benefit Among Dependents
      • 1.  Dependents’ Right to Death Benefits  7.26
      • 2.  Workers’ Compensation Appeals Board May Assign Benefits Equitably  7.27
      • 3.  If a Dependent Dies  7.28
    • D.  No Apportionment of Death Benefits  7.29
    • E.  Increase in Death Benefit Due to Unreasonable Delay; Penalties  7.29A
  • V.  SPECIAL PUBLIC EMPLOYEE DEATH BENEFITS
    • A.  Assassinated Public Officials  7.30
    • B.  Certain Members of California Public Employees’ Retirement System (CalPERS)  7.31
  • VI.  BURIAL EXPENSES  7.32

8

Penalties

Sally M. Harms

Deborah Lieberman

  • I.  OVERVIEW
    • A.  Penalties and Other Remedies  8.1
    • B.  Who Can Claim a WCAB Penalty  8.2
  • II.  STRICT LIABILITY PENALTIES FOR LATE PAYMENT OF COMPENSATION (LAB C §4650)  8.3
    • A.  Penalty Applies Only to Periodic and Accrued Disability Payments  8.4
    • B.  Statutory Exceptions to Imposition of Lab C §4650 Penalty
      • 1.  No Penalty When Employer Continues to Pay Wages  8.5
      • 2.  No Penalty for Payment Due Before Submission of Claim Form  8.6
      • 3.  No Penalty While Employer Determines Compensability  8.7
    • C.  When Liability for Injury, Disability, or Indemnity Rate Is Disputed  8.8
    • D.  When No Temporary Disability Has Been Paid  8.9
    • E.  Interaction With Lab C §5814 Penalties for Unreasonable Delay  8.10
  • III.  UNREASONABLE DELAY OR REFUSAL TO PROVIDE BENEFITS (LAB C §5814)  8.11
    • A.  Determining Whether Refusal or Delay Was Unreasonable
      • 1.  Allocation of Burdens of Proof  8.12
      • 2.  Considerations in Making Reasonableness Determination  8.13
        • a.  Genuine Doubt Regarding Liability  8.14
        • b.  Defendant Acted With Due Diligence  8.15
    • B.  Calculation of Penalty Amount
      • 1.  Amount Is Discretionary  8.16
      • 2.  Factors Considered in Determining Penalty Amount  8.17
      • 3.  Credit for Amount Paid Under Lab C §4650(d)  8.18
    • C.  Safe-Harbor Provision  8.19
    • D.  Conclusive Presumption That Accrued Lab C §5814 Penalties Have Been Resolved  8.20
    • E.  Statute of Limitations  8.21
    • F.  Attorney Fees Under Lab C §5814.5  8.22
    • G.  Types of Benefits Affected
      • 1.  Temporary Disability  8.23
      • 2.  Permanent Disability  8.24
      • 3.  Supplemental Job Displacement Benefit; Return-to-Work Supplement Payment  8.25
      • 4.  Interest  8.26
      • 5.  Medical Expenses  8.27
      • 6.  Payment of Penalties  8.28
      • 7.  Postsettlement Benefits  8.29
      • 8.  Immediately Negotiable Written Instrument  8.30
      • 9.  Death Benefits  8.31
    • H.  Parties Liable Under Lab C §5814  8.32
    • I.  Jointly Liable Employers  8.33
    • J.  Multiple Penalties Under Lab C §5814  8.34
      • 1.  Example of Legally Significant Acts  8.35
      • 2.  Examples of Legally Insignificant Acts  8.36
  • IV.  UNREASONABLE DELAY OR REFUSAL UNDER LAB C §§5814.1 AND 5814.6  8.37
  • V.  EMPLOYER’S SERIOUS AND WILLFUL MISCONDUCT UNDER LAB C §4553
    • A.  Increased Compensation (Lab C §4553)  8.38
    • B.  Types of Benefits Affected  8.39
    • C.  Determining Serious and Willful Misconduct
      • 1.  Definition  8.40
      • 2.  Burden of Proof, Proximate Cause, and Procedure  8.41
      • 3.  Statute of Limitations  8.42
    • D.  Whose Misconduct Results in Increased Compensation Under Lab C §4553?  8.43
    • E.  Common Allegations of Serious and Willful Misconduct  8.44
      • 1.  Failure to Provide Safe Place to Work  8.45
        • a.  Knowledge of Dangerous Condition  8.46
        • b.  Knowledge of Probable Consequence  8.47
        • c.  Employer’s Action or Inaction  8.48
      • 2.  Failure to Comply With Safety Order
        • a.  Nature of Safety Order  8.49
        • b.  Required Elements  8.50
          • (1)  Knowledge of Safety Order and Its Applicability  8.51
          • (2)  Obvious Condition Made Safety Order Applicable  8.52
    • F.  Defenses
      • 1.  Proximate Cause  8.53
      • 2.  Good Faith Attempt to Abate Danger  8.54
      • 3.  Vague and Ambiguous Safety Order; Alternative Methods of Complying  8.55
      • 4.  Defective Pleading  8.56
      • 5.  Other  8.57
  • VI.  EMPLOYEE’S SERIOUS AND WILLFUL MISCONDUCT (LAB C §4551)  8.58
  • VII.  DISCRIMINATION AGAINST INJURED WORKER (LAB C §132a)  8.59
    • A.  Prohibited Acts
      • 1.  Violation of Express Lab C §132a Provisions  8.60
      • 2.  Penalizing Worker for Work Injury  8.61
    • B.  Determining Discrimination Under Lab C §132a  8.62
      • 1.  Employee’s Burden of Proof  8.63
      • 2.  Detrimental Conduct Justified by Business Realities  8.64
      • 3.  Examples
        • a.  Lab C §132a Violations Found  8.65
        • b.  No Lab C §132a Violation Found  8.66
      • 4.  Procedure; Statute of Limitations  8.67
    • C.  Parties Liable Under Lab C §132a  8.68
    • D.  Remedies  8.69
      • 1.  Reinstatement  8.70
      • 2.  Reimbursement for Lost Wages and Work Benefits  8.71
      • 3.  Misdemeanor Charge  8.72
  • VIII.  EMPLOYER’S FAILURE TO INSURE
    • A.  Duty to Insure  8.73
    • B.  Penalties
      • 1.  Increased Compensation Award and Attorney Fees (Lab C §§4554–4555)  8.74
      • 2.  Criminal Penalties (Lab C §3700.5)  8.75
      • 3.  Stop Orders (Lab C §§3710.1–3710.3)  8.76
      • 4.  Civil Penalties (Lab C §3722)  8.77
      • 5.  Exception: Residential Owners and Occupants  8.78
    • C.  Procedure  8.79
  • IX.  AUDITS AND PENALTIES UNDER LAB C §§129, 129.5  8.80
  • X.  ILLEGALLY EMPLOYING MINOR UNDER 16 YEARS OF AGE  8.81
  • XI.  ATTORNEY AND PARTY SANCTIONS UNDER LAB C §5813  8.82
    • A.  Who Is Subject to Sanctions  8.83
    • B.  Grounds for Sanctions in 8 Cal Code Regs §10561(b)  8.84
    • C.  Additional Regulatory Grounds for Sanctions  8.85
    • D.  Examples of Actions That Resulted in Imposition of Sanctions  8.86
    • E.  Procedures for Requesting Sanctions  8.87
  • XII.  PHYSICIAN’S FAILURE TO MEET MEDICAL-LEGAL REPORTING REQUIREMENTS  8.88
  • XIII.  REMEDIES OUTSIDE WORKERS’ COMPENSATION SYSTEM
    • A.  Peculiar Risk of Harm; Retained Control  8.89
    • B.  Intentional Torts  8.90
    • C.  State Claims  8.91
    • D.  Federal Claims  8.92

9

Dispute Resolution Procedures

Charles Lawrence Swezey

  • I.  INTRODUCTION  9.1
  • II.  DISPUTE RESOLUTION PROCEDURES
    • A.  Disputes Regarding Compensability of Injury (Lab C §4060)  9.2
      • 1.  When Medical Evaluation Is Needed to Determine Compensability  9.3
      • 2.  Liability for Evaluations Not Obtained Under Lab C §4060  9.4
      • 3.  Self-Procured Compensability Evaluations Are Inadmissible  9.5
    • B.  Disputes Regarding Permanent Disability or Need for Future Medical Care (Lab C §4061)
      • 1.  Represented Employees  9.6
      • 2.  Unrepresented Employees  9.7
        • a.  Request for Correction of Factual Errors  9.8
        • b.  Summary Rating  9.9
      • 3.  Rebuttal Evaluation From Privately Retained Expert Is Inadmissible  9.10
    • C.  Disputes Regarding Medical Treatment
      • 1.  For Injuries Occurring On or After 1/1/2013 or When UR Decision Is Communicated After 7/1/2013
        • a.  Mandatory Independent Medical Review (IMR) Process  9.11
          • (1)  Disputes Not Subject to IMR  9.12
          • (2)  Who May Request IMR  9.13
          • (3)  Deadline to Request IMR  9.14
          • (4)  Fees  9.15
          • (5)  Initial Eligibility Review  9.16
          • (6)  Notice of Assignment to IMR Organization  9.17
          • (7)  Document Production  9.18
          • (8)  Standards of Review; Deadline for Decision  9.19
          • (9)  Format of Decision; Implementation  9.20
          • (10)  Appeal of IMR Decision  9.21
          • (11)  Penalties  9.22
        • b.  Spinal Surgery Disputes Now Handled Through IMR  9.23
        • c.  When UR Decision Is Untimely or Otherwise Procedurally Deficient  9.24
      • 2.  Labor Code §4062 Governs All Other Medical Disputes  9.25
    • D.  Carve-Outs  9.26
  • III.  OBTAINING AME/QME EVALUATIONS
    • A.  When Used  9.27
    • B.  Definitions  9.28
    • C.  Selecting an AME  9.29
    • D.  Selecting a QME
      • 1.  Represented Employee Injured On or After January 1, 2005 (Lab C §4062.2)  9.30
        • a.  When QME Panel May Be Requested  9.31
        • b.  Procedure for Requesting QME Panel  9.32
        • c.  Panel Assigned Automatically; Time for Service of Assignment  9.33
        • d.  Resolution of QME Panel Selection Disputes  9.34
        • e.  Deadline to Strike Names  9.35
      • 2.  Represented Employee Injured Before January 1, 2005  9.36
      • 3.  Unrepresented Employee (Lab C §4062.1)
        • a.  Procedure for Requesting QME Panel
          • (1)  Mandatory Use of QME Form 105  9.37
          • (2)  Additional Documents  9.38
          • (3)  Incomplete Form  9.39
        • b.  Deadlines for Assignment of Panel and Selection of Evaluator  9.40
        • c.  Referral When Employee Selects Acupuncturist as QME  9.41
      • 4.  QME Replacement Requests  9.42
    • E.  Information Provided to QME or AME
      • 1.  Required Information  9.43
      • 2.  Information That Must Not Be Provided  9.44
      • 3.  Service on Opposing Party  9.45
      • 4.  Objecting to Proposed Information  9.46
      • 5.  Remedy for Violation of Lab C §4062.3(b)  9.46A
    • F.  Communications with QME or AME  9.47
    • G.  Making the Appointment; Location of Examination  9.48
    • H.  Appointment Notification and Cancellation
      • 1.  QME Must Send Appointment Notification Form  9.49
      • 2.  Time Limits for Cancellations and Rescheduled Appointments  9.50
    • I.  Before the Appointment  9.51
    • J.  At the Appointment
      • 1.  Required Disclosures and Opportunity to Ask Questions  9.52
      • 2.  Minimum Examination Times  9.53
      • 3.  Physician Must Examine Worker  9.54
    • K.  QME/AME Reporting Requirements
      • 1.  Time Limits for Preparing and Submitting Report  9.55
      • 2.  Required Contents and Form  9.56
      • 3.  Consultation With Treating Physician  9.57
      • 4.  When There Are Issues Outside Evaluator’s Area of Expertise  9.58
      • 5.  When Evaluator Determines That Employee Is Permanently Disabled  9.59
      • 6.  Service of Report
        • a.  General Rules  9.60
        • b.  Service of Report Involving Claimed or Disputed Injury to Psyche  9.61
    • L.  Correction of Factual Errors in Unrepresented Cases  9.62
    • M.  Supplemental Reports in Unrepresented Cases
      • 1.  When Report Finds That Injury Has Not Become Permanent and Stationary  9.63
      • 2.  When Report Finds Permanent Disability  9.64
    • N.  Use of Same Evaluator When New Medical Issue Arises  9.65
    • O.  Panel QME in Second Medical Specialty  9.66
    • P.  Cross-Examination of Evaluator by Deposition  9.67
    • Q.  Effect of Evaluation  9.68
  • IV.  DISPUTE RESOLUTION IN MEDICAL PROVIDER NETWORKS
    • A.  When Employee Disputes Treating Physician’s Diagnosis or Treatment Recommendation
      • 1.  Requesting Second and Third Opinions  9.69
        • a.  Procedures for Obtaining Second Opinion  9.70
        • b.  Procedure for Obtaining Third Opinion  9.71
        • c.  If Second or Third Opinion Physician Determines That Injury Is Outside Scope of Practice  9.72
        • d.  Contents of Second and Third Opinion  9.73
        • e.  If Employee Accepts Second or Third Opinion  9.74
      • 2.  Requesting MPN Independent Medical Review  9.75
    • B.  When Employee or Employer Disputes UR Decision  9.75A
  • V.  MEDICAL-LEGAL EXPENSES  9.76
    • A.  Costs Must Be Reasonable and Necessary  9.77
    • B.  Showing of Employment Prerequisite  9.78
    • C.  Expenses Must Be for Contested Claim  9.79
    • D.  Reports Must Meet Legal Requirements  9.80
      • 1.  Complete History  9.81
      • 2.  Review of Medical Records  9.82
      • 3.  Appropriate Conclusions  9.83
    • E.  Reports From Multiple Specialists  9.84
    • F.  Interpreter Fees  9.85
    • G.  Copying and Related Services  9.86
      • 1.  Allowable Services (When Fee Schedule Applies)  9.87
      • 2.  Fees for Copying and Related Services  9.88
    • H.  Nonmedical Expert Witnesses  9.89
    • I.  Recovery of Medical-Legal Expenses  9.90
      • 1.  60 Days to Pay or Contest the Bill  9.91
      • 2.  Second Review; Independent Bill Review  9.92
      • 3.  When Bill Is Denied for Reasons Other Than Amount Billed  9.93
      • 4.  Waiver of Medical-Legal Expense Issue  9.94
      • 5.  Penalty on Unpaid Portion of Bill  9.95
      • 6.  Bad Faith Actions or Tactics  9.96
    • J.  WCAB Hearing for Reimbursement  9.97
    • K.  Expenses for Copying Medical Records  9.98
    • L.  Reimbursement for Medical Testimony  9.99

10

Representing Injured Workers

Frank D. Russo

  • I.  OVERVIEW
    • A.  Challenges of Workers’ Compensation Practice  10.1
    • B.  Is Worker’s Injury Compensable?  10.2
    • C.  What Benefits Should Worker Pursue?  10.3
    • D.  Duty to Advise  10.4
    • E.  Resources  10.5
  • II.  INTAKE
    • A.  Interacting With Potential Clients  10.6
      • 1.  Form: Potential New Client Questionnaire  10.7
      • 2.  Form: Letter Confirming Appointment  10.8
      • 3.  Form: Nonengagement Letter  10.9
    • B.  Initial Office Interview
      • 1.  Objectives  10.10
      • 2.  Documents Client Should Bring  10.11
      • 3.  Scope of Interview  10.12
    • C.  Necessary Forms and Releases  10.13
      • 1.  Fee Disclosure
        • a.  Preparation of Fee Disclosure Statement  10.14
        • b.  Form: Fee Disclosure Statement (DWC Form 3)  10.15
        • c.  Supplementary Disclosure Statement  10.16
        • d.  Form: Supplementary Fee Disclosure Statement  10.17
      • 2.  Declaration of Nonviolation of Lab C §139.3 (Declaration Under Lab C §4906(g))  10.18
      • 3.  Venue Authorization
        • a.  When Venue Authorization Is Required  10.19
        • b.  Form: Venue Authorization  10.20
      • 4.  Form: Authorization for Release of Medical Information  10.21
      • 5.  Form: Authorization for Release of Psychiatric, Drug, and Alcohol Treatment Records  10.22
      • 6.  Form: Authorization for Release of Employment and School Records  10.23
      • 7.  Form: Letter to Workers’ Compensation Insurance Rating Bureau Requesting Compensation Coverage Information [Deleted]  10.24
    • D.  Checklist: Information Necessary to Pursue State Workers’ Compensation Claim  10.25
      • 1.  Checklist: Injured Employee and Dependents  10.26
      • 2.  Checklist: Employment Status  10.27
      • 3.  Checklist: Earnings  10.28
      • 4.  Checklist: Employer’s Insurance  10.29
      • 5.  Checklist: Injury  10.30
        • a.  Checklist: Injuries Resulting in Death  10.31
        • b.  Checklist: Prior Injuries or Disabilities  10.32
      • 6.  Checklist: Medical Treatment and Expenses  10.33
      • 7.  Checklist: Compensation to Date  10.34
      • 8.  Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After 1/1/2004 and Before 1/1/2013)  10.35
      • 9.  Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After January 1, 2013)  10.35A
      • 10.  Checklist: Claim Form; Procedural Information  10.36
  • III.  REPRESENTING THE CLIENT  10.37
    • A.  Form: Letter of Representation to New Client  10.38
    • B.  Filing Application With Workers’ Compensation Appeals Board; Venue  10.39
    • C.  Serving Claim Form on Employer; Notice of Representation  10.40
    • D.  Form: Notice of Representation to Employer  10.41
    • E.  Notice of Representation to Insurer or Adjusting Agency
      • 1.  Informing Insurer or Adjusting Agency of Representation  10.42
      • 2.  Form: Letter to Insurer or Adjusting Agency  10.43
    • F.  Serving Lien Claimants and Others  10.44
    • G.  Send Other Letters at Outset or When Necessary  10.45
      • 1.  Form: Letter Requesting Vocational Rehabilitation [Deleted]  10.46
      • 2.  Form: Letter Designating Primary Treating Physician  10.47
      • 3.  Form: Letter Regarding Medical Bills Received by Applicant  10.48
    • H.  Documenting the Client’s File  10.49
    • I.  Discovery
      • 1.  Expenses  10.50
      • 2.  Sources of Discovery  10.51
      • 3.  Limits on Discovery  10.51A
      • 4.  Deposition of Injured Worker
        • a.  Generally  10.52
        • b.  Preparing Worker  10.53
        • c.  Attorney Fees and Other Expenses  10.54
        • d.  After Deposition Is Scheduled
          • (1)  Send Letter to Worker  10.55
          • (2)  Form: Letter to Worker Regarding Deposition  10.56
        • e.  Form: Letter Requesting Payment for Fees and Costs Associated With Injured Worker’s Deposition  10.57
        • f.  Form: Petition for Attorney Fees and Expenses for Injured Worker’s Deposition  10.58
        • g.  Form: Letter Requesting Worker to Review Deposition Transcript  10.59
    • J.  Medical Evaluations
      • 1.  Generally  10.60
      • 2.  Form: Letter to Worker Regarding Medical Evaluation  10.61
    • K.  Delays in Obtaining Medical and Disability Benefits
      • 1.  Generally  10.62
      • 2.  Form: Letter to Doctor to File Lien  10.63
    • L.  Hearing; Mandatory Settlement Conference
      • 1.  Form: Letter Notifying Worker of Hearing Request  10.64
      • 2.  Form: Letter Notifying Worker of Settlement Conference Date  10.65
    • M.  Settlement  10.66
      • 1.  Effect on Other Benefits  10.67
      • 2.  Stipulations With Request for Award or Compromise and Release  10.68
    • N.  Closing the File
      • 1.  Generally  10.69
      • 2.  Form: Letter Notifying Worker of Closed Case File  10.70

11

Representing Defendants

Glen J. Grossman

  • I.  BASIC ETHICAL CONSIDERATIONS  11.1
    • A.  Conflicts of Interest and Duty of Loyalty
      • 1.  California Rules of Professional Conduct; Bus & P C §6068(e)  11.2
      • 2.  State Bar Formal Opinion 1995–139  11.3
      • 3.  Other State Bar Formal Opinions Impacting the Defense Attorney  11.3A
      • 4.  Applicability to Workers’ Compensation  11.4
    • B.  Protecting Employer’s Interests (Tricor)  11.5
      • 1.  Understanding Tricor’s Importance [Deleted]  11.6
      • 2.  Determining Whether Employer Has a Tricor Interest in the Claim  11.7
        • a.  Experience Rating  11.8
        • b.  Experience Modification  11.9
          • (1)  Experience Period  11.10
          • (2)  Statistical Reporting and Claim Valuation  11.11
        • c.  Example of Tricor-Recognized Interest  11.12
  • II.  GATHERING INFORMATION
    • A.  Getting the Big Picture  11.13
      • 1.  First 90 Days  11.14
      • 2.  Employer’s Report of Occupational Injury or Illness (Form 5020)  11.15
        • a.  When Employer Must File  11.16
        • b.  Using Form 5020  11.17
      • 3.  Doctor’s First Report of Occupational Injury or Illness (Form 5021)  11.18
        • a.  Admissibility  11.19
        • b.  Pesticide Poisoning  11.20
        • c.  Using Form 5021  11.21
      • 4.  Form: Statement of Employee’s Gross Earnings  11.22
      • 5.  Benefit Notices  11.23
        • a.  Temporary Disability Notices  11.24
        • b.  Permanent Disability Notices  11.25
          • (1)  Condition Not Permanent and Stationary but Injury May Cause Permanent Disability  11.25A
          • (2)  Injury Has Caused Permanent Disability  11.26
            • (a)  Additional Requirements for Notices to Unrepresented Employees  11.26A
            • (b)  Additional Requirements for Notice to Represented Employees  11.27
        • c.  Offer of Supplemental Job Displacement Benefit  11.28
        • d.  Return to Work Notices  11.28A
      • 6.  Form: Compensation Litigation Transmittal Note  11.29
    • B.  Contacting the Employer  11.30
    • C.  Notice of Representation  11.31
    • D.  Obtaining Information From Employment Development Department  11.32
      • 1.  Examine Any Employment Development Department Lien or Notice  11.33
      • 2.  Form: Letter to Employment Development Department  11.34
    • E.  Social Security Earnings Information  11.35
      • 1.  If Injured Worker Will Not Sign Release  11.36
      • 2.  Form: Letter Requesting Signed Social Security Earnings Release  11.37
    • F.  Applicant’s Deposition
      • 1.  Deposition Goals
        • a.  Gather Information  11.38
        • b.  Assess How Claim Will Proceed  11.39
        • c.  Influence Medical Treatment [Deleted]  11.40
        • d.  Understand Worker’s Goal  11.41
      • 2.  Form: Applicant’s Deposition Worksheet  11.42
      • 3.  Form: Petition to Compel Answers to Questions and Production of Documents at Deposition  11.43
    • G.  Applicant’s Deposition—Psychiatric Injury  11.44
      • 1.  Areas to Explore  11.45
      • 2.  Form: Petition for Order Compelling Production of Psychiatric Records; Order  11.46
    • H.  Primary Treating Physician’s Deposition  11.47
      • 1.  Form: Deposition Letter to Primary Treating Physician  11.48
      • 2.  Form: Petition to Compel Attendance at Medical Evaluation  11.49
  • III.  ANALYZING THE INFORMATION
    • A.  Denying or Shifting Liability  11.50
    • B.  Specific Injury Claims  11.51
    • C.  Cumulative Injury Claims  11.52
      • 1.  Compromise and Release (Lab C §5005)  11.53
      • 2.  Joinder; Election  11.54
      • 3.  Form: Petition for Joinder  11.55
    • D.  Coverage  11.56
      • 1.  Form: Letter to Employer Re: Lack of Coverage  11.57
      • 2.  Form: Letter to Applicant or Codefendant Re: Lack of Coverage  11.58
      • 3.  Form: Petition to Dismiss for Lack of Coverage; Order  11.59
  • IV.  TAKING THE OFFENSIVE
    • A.  Attacking the Pleadings  11.60
      • 1.  Form: Petition to Strike Application (Lab C §4906(g), Declaration Missing); Order  11.61
      • 2.  Form: Petition to Dismiss—No Employment Within Last Year of Injurious Exposure  11.62
      • 3.  Form: Petition to Dismiss—No Coverage Within Last Year of Injurious Exposure  11.63
      • 4.  Form: Petition to Dismiss—Statute of Limitations  11.64
      • 5.  Form: Petition to Dismiss—Failure to Prosecute  11.65
    • B.  Lien Claims  11.66
      • 1.  Employment Development Department  11.67
      • 2.  Medical-Legal Expense  11.68
        • a.  Penalties (Lab C §4622(a))  11.69
        • b.  Other Demands for Payment  11.70
          • (1)  Lab C §4060  11.71
          • (2)  Lab C §4061  11.72
          • (3)  Lab C §4062  11.73
          • (4)  Lab C §4062.5  11.74
          • (5)  Lab C §4064  11.75
          • (6)  Lab C §4620  11.76
          • (7)  Lab C §4621  11.77
          • (8)  Lab C §4622  11.78
          • (9)  Lab C §4628  11.79
          • (10)  8 Cal Code Regs §§9794–9795  11.80
        • c.  Form: Objection to Medical-Legal Expense  11.81
      • 3.  Reimbursement From Medical-Legal Providers  11.82
      • 4.  Medical Treatment Liens  11.83
      • 5.  Penalties and Interest  11.84
      • 6.  Form: Objection to Medical Treatment Expense  11.85
      • 7.  Other Lien Claimants  11.86
  • V.  COMPENSATION RECOVERY  11.87
    • A.  Form: Petition for Credit for Third Party Recovery  11.88
    • B.  Form: Petition for Restitution From Injured Worker  11.89
    • C.  Form: Petition for Reimbursement From Codefendant  11.90
    • D.  Petition for Contribution (Lab C §5500.5)  11.91
    • E.  Form: Petition for Reimbursement of Paid Medical-Legal Expense  11.92
  • VI.  COLLATERAL ISSUES
    • A.  Penalty Petitions  11.93
    • B.  Serious and Willful Misconduct Petitions  11.94
    • C.  Form: Letter From Insurer’s Attorney Advising Employer of Serious and Willful Misconduct Petition  11.95
    • D.  Discrimination Petitions  11.96
    • E.  Form: Letter Advising Insured Employer of Petition Alleging Discrimination  11.97
    • F.  Employer’s Bill of Rights (Lab C §3761 Proceedings)  11.98
  • VII.  ALTERNATIVE DISPUTE RESOLUTION  11.99

12

Time Limitations

Paul Peyrat

  • I.  INTRODUCTION
    • A.  Need for Timely Notices, Claims, and Applications  12.1
    • B.  Determining Date of Injury
      • 1.  Specific Injury  12.2
      • 2.  Cumulative Injury  12.3
        • a.  Compensable Disability  12.4
        • b.  Employee’s Knowledge of Industrial Cause  12.5
        • c.  Occupational Disease  12.6
      • 3.  Latent Injury  12.7
  • II.  ASSERTING AND RESPONDING TO INDUSTRIAL INJURY CLAIMS
    • A.  Employee: Give Employer Notice of Injury
      • 1.  Ascertaining and Ensuring Employer’s Knowledge  12.8
      • 2.  Serving Written Notice; Alternatives
        • a.  30-Day Notice and Its Equivalents  12.9
        • b.  Form: Notice of Injury  12.10
      • 3.  Showing Employer’s Knowledge of Injury  12.11
      • 4.  Meeting Absent or Defective Notice Defense
        • a.  Employer’s Need to Show Prejudice  12.12
        • b.  Effect of Notice to Employer’s Insurer  12.13
      • 5.  Prenotice Medical Treatment  12.14
    • B.  Employer: Provide Claim Form, Notice of Eligibility, and Advice
      • 1.  Claim Form and Notice of Eligibility
        • a.  Use DWC-Approved Claim and Notice Form  12.15
        • b.  Provide Claim and Notice Form as Soon as Possible  12.16
        • c.  Form: Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility  12.17
      • 2.  Printed Advice to Employee  12.18
        • a.  Notice to Employees Poster  12.18A
        • b.  Form: Notice to Employees—Injuries Caused By Work (DWC 7)  12.18B
    • C.  Employee: Complete Claim Form and File With Employer
      • 1.  Reasons to File Claim Form  12.19
      • 2.  Filling in Blanks  12.20
      • 3.  Filing Form With Employer  12.21
    • D.  Employer: Respond to Filed Claim Form
      • 1.  Completing and Distributing Claim Form  12.22
      • 2.  Accepting the Claim  12.23
      • 3.  Denying (Rejecting) the Claim
        • a.  Restarting Limitations Periods  12.24
        • b.  Avoiding Presumption of Compensability  12.25
    • E.  Employee: File Application With Workers’ Compensation Appeals Board
      • 1.  If Employer Has Rejected Claim  12.26
      • 2.  If Employer Has Paid Compensation  12.27
  • III.  ASCERTAINING APPLICABLE LIMITATIONS
    • A.  Preliminary Considerations
      • 1.  Liberal Construction  12.28
      • 2.  One Cause of Action  12.29
      • 3.  Table of Limitations  12.30
    • B.  Disability Indemnity and Medical Treatment
      • 1.  1-Year Limit  12.31
      • 2.  5-Year Limit for New and Further Disability  12.32
        • a.  Meaning of “New and Further Disability”  12.33
        • b.  When Workers’ Compensation Appeals Board Loses Jurisdiction Over “New and Further Disability”  12.34
      • 3.  Medical Treatment as “Furnishing of Benefits”  12.35
        • a.  When Medical Treatment Is Furnished  12.36
        • b.  When Medical Treatment Is Not Furnished  12.37
        • c.  Lien Claims
          • (1)  Labor Code §4903.5  12.37A
          • (2)  Labor Code §4903.6  12.37B
    • C.  Death; Burial Expense
      • 1.  1-Year Limit  12.38
      • 2.  240-Week Limit  12.39
    • D.  Serious and Willful Misconduct
      • 1.  Employee’s Claim  12.40
      • 2.  Employer’s Claim  12.41
    • E.  Unreasonable Delay or Refusal to Pay Compensation  12.41A
    • F.  Employer Discrimination  12.42
    • G.  Subsequent Injuries Benefits Trust Fund  12.43
    • H.  Vocational Rehabilitation for Injuries Occurring Before January 1, 2004
      • 1.  1-Year Limit [Deleted]  12.44
      • 2.  5-Year Limit [Deleted]  12.45
    • I.  Claims by Asbestos Workers’ Account  12.46
    • J.  Contribution  12.47
    • K.  Reopening Orders and Awards  12.48
  • IV.  SUSPENSION OF LIMITATIONS PERIODS
    • A.  Minority  12.49
    • B.  Incompetence
      • 1.  Tolling for Incompetence  12.50
      • 2.  Allegations of Incompetence, Competence Regained  12.51
    • C.  Imprisonment  12.52
    • D.  Servicemembers’ Civil Relief Act  12.53
    • E.  Request for Administrative Assistance  12.54
    • F.  Filing Civil Action  12.55
  • V.  ASSERTING THE DEFENSE
    • A.  Burden of Proof  12.56
    • B.  Waiver
      • 1.  Failure to Assert Before Submission  12.57
      • 2.  Agreement  12.58
    • C.  Estoppel
      • 1.  Active Conduct  12.59
      • 2.  Failure to Notify Employee  12.60
      • 3.  Pleading and Procedure  12.61

13

Filing With the Workers’ Compensation Appeals Board

Colleen S. Casey

  • I.  WORKERS’ COMPENSATION APPEALS BOARD FILING PROCEDURES  13.1
    • A.  Required Pleadings and Papers  13.2
      • 1.  Liberal Construction of Pleadings  13.3
      • 2.  Filing Methods in EAMS  13.3A
      • 3.  Form and Size Requirements for Filed Documents
        • a.  General Requirements  13.4
        • b.  Requirements for OCR Forms  13.4A
        • c.  Document Cover and Separator Sheets  13.4B
        • d.  Requirements for Electronically Filed Documents  13.4C
    • B.  Procedural Tracks  13.5
      • 1.  Post-1993 Injuries  13.6
      • 2.  1990–1993 Injuries (Window Period)  13.7
      • 3.  Pre-1990 Injuries  13.8
    • C.  Exhaust Other Required Remedies  13.9
  • II.  PARTIES TO BOARD PROCEEDINGS  13.10
    • A.  Injured Workers and Dependents of Deceased Workers  13.11
    • B.  Employers and Insurance Carriers  13.12
      • 1.  Insured Employers  13.13
      • 2.  Self-Insured Private Employers  13.14
      • 3.  Unlawfully Uninsured Employers  13.15
      • 4.  Lawfully Uninsured and Self-Insured Government Agencies  13.16
    • C.  Lien Claimants  13.17
    • D.  Department of Industrial Relations  13.18
    • E.  Asbestos Workers’ Account  13.19
    • F.  Joinder of Injured Employee and Others  13.20
    • G.  Parties Checklist  13.21
  • III.  APPLICATIONS FOR ADJUDICATION OF CLAIMS
    • A.  General Rules and Effect  13.22
    • B.  Separate Applications and Consolidating Claims  13.23
    • C.  Preparing DWC/WCAB Form 1A  13.24
      • 1.  Form: Application for Adjudication of Claim (DWC/WCAB Form 1A)  13.25
      • 2.  Caption
        • a.  Case Number  13.26
        • b.  Employee’s Social Security Number  13.27
        • c.  Venue  13.27A
        • d.  Names and Addresses  13.27B
          • (1)  Minors and Incompetents  13.28
          • (2)  Corporations  13.29
          • (3)  Partnerships and Unincorporated Associations  13.30
          • (4)  Fictitious Names  13.31
          • (5)  Governmental Entities  13.32
        • e.  Employer’s Insurance Status
          • (1)  Self-Insured  13.33
          • (2)  Lawfully Uninsured  13.34
          • (3)  Unlawfully Uninsured  13.35
          • (4)  Insured  13.36
        • f.  Insurance Carriers and Adjusting Agents  13.37
      • 3.  Item 1: Jurisdictional Facts
        • a.  Date of Birth  13.38
        • b.  Employee’s Occupation; Date of Injury  13.39
        • c.  Place of Injury  13.40
        • d.  Parts of Body Injured  13.41
      • 4.  Item 2: How Injury Occurred  13.42
      • 5.  Item 3: Earnings  13.43
      • 6.  Item 4: Period of Disability  13.44
      • 7.  Item 5: Payment of Compensation  13.45
      • 8.  Item 6: Unemployment or Disability Benefits Received  13.46
      • 9.  Item 7: Medical Treatment  13.47
      • 10.  Item 8: Other Applications  13.48
      • 11.  Item 9: Issues and Requested Relief  13.49
        • a.  Temporary Disability Indemnity  13.50
        • b.  Permanent Disability Indemnity  13.51
        • c.  Reimbursement for Medical Expense  13.52
        • d.  Medical Treatment  13.53
        • e.  Compensation at Proper Rate  13.54
        • f.  Supplemental Job Displacement Benefit  13.55
        • g.  Other  13.56
      • 12.  Date and Signature  13.57
    • D.  WCAB Form 1 [Window Period]  13.58
      • 1.  Form: Application for Adjudication of Claim [1990–1993 Injuries] (WCAB Form 1 [Window Period]) [Deleted]  13.59
      • 2.  Caption
        • a.  Same Information as in DIA WCAB Form 1 [Deleted]  13.60
        • b.  Information in Addition to That on DIA WCAB Form 1 [Deleted]  13.61
      • 3.  Venue Selection [Deleted]  13.62
      • 4.  Bona Fide Dispute on Issues; Effort to Resolve Dispute [Deleted]  13.63
      • 5.  Mandatory Arbitration [Deleted]  13.64
      • 6.  Claims; Reports and Documents [Deleted]  13.65
      • 7.  Declaration of Readiness [Deleted]  13.66
      • 8.  Date and Signature [Deleted]  13.67
    • E.  Preparing DIA WCAB Form 2  13.68
      • 1.  Form: Application for Adjudication of Claim (Death Case) (DIA WCAB Form 2)  13.69
      • 2.  Caption  13.70
        • a.  Case Number  13.71
        • b.  Applicant and Other Parties; Deceased Employee  13.72
      • 3.  Claims
        • a.  Items 1–6  13.73
        • b.  Item 7: Burial Expenses  13.74
        • c.  Item 8: Dependents  13.75
      • 4.  Request for Hearing and Award; Date and Signature  13.76
    • F.  WCAB Form 1A [Window Period]  13.77
      • 1.  Form: Application for Adjudication of Claim (Death Case) [1990–1993 Injuries] (WCAB Form 1A [Window Period]) [Deleted]  13.78
      • 2.  Refer to Information on DIA WCAB Forms 1 and 2 [Deleted]  13.79
    • G.  Preparing Applications That Allege Occupational Disease and Cumulative Injury
      • 1.  Definitions  13.80
      • 2.  Form of Application  13.81
      • 3.  Which Employers Are Liable  13.82
      • 4.  Naming Employers and Carriers  13.83
      • 5.  Alleging Injury and Exposure  13.84
      • 6.  Form: Sample Allegations of Injury and Exposure  13.85
      • 7.  Separate Injuries; Antimerger Doctrine  13.86
      • 8.  Electing Defendants  13.87
    • H.  Applications Naming the Uninsured Employers Benefits Trust Fund  13.88
      • 1.  Joining the Uninsured Employers Benefits Trust Fund  13.89
      • 2.  Serving the Uninsured Employer and the Uninsured Employers Benefits Trust Fund  13.90
      • 3.  Form: Special Notice of Lawsuit (WCAB Form)  13.91
  • IV.  PETITIONS
    • A.  Preparing Petition for Serious and Willful Misconduct
      • 1.  Basis of Serious and Willful Misconduct Petition Against Employer or Insurer  13.92
      • 2.  How to Claim Increased Benefits for Employer’s Serious and Willful Misconduct  13.93
      • 3.  Pleading Employee’s Serious and Willful Misconduct  13.94
      • 4.  Form: Petition for Award for Employer’s Serious and Willful Misconduct  13.95
      • 5.  Form: Petition for Award for Employer’s Serious and Willful Misconduct—Violation of Safety Order (Lab C §4553.1)  13.95A
        • a.  Caption  13.96
        • b.  First Cause of Action  13.97
        • c.  Verification  13.98
        • d.  Service  13.99
      • 6.  Sample Allegation: Violation of Safety Order  13.100
        • a.  Cite or Refer Correctly to Safety Order or Statute  13.101
        • b.  State How Safety Order or Statute Was Violated  13.102
      • 7.  Sample Allegation: General Misconduct  13.103
    • B.  Preparing Petition for Increased Benefits Based on Discriminatory Conduct by Employer or Insurer  13.104
      • 1.  Form: Petition for Award Under Lab C §132a  13.105
      • 2.  Prepare and File Within 1 Year  13.106
    • C.  Petition for Guardian Ad Litem and Trustee
      • 1.  Need for Guardian and Trustee; Powers  13.107
      • 2.  Procedure  13.108
      • 3.  Bonds  13.109
      • 4.  Form: Petition for Appointment of Guardian Ad Litem and Trustee (DIA WCAB Form 8)  13.110
  • V.  APPLICATION ATTACHMENTS AND ACCOMPANYING PAPERS
    • A.  In General  13.111
    • B.  Lab C §4906(g) Declaration
      • 1.  Lab C §4906(g) Requirement  13.112
      • 2.  Form: Declaration Under Lab C §4906(g)  13.113
    • C.  Claim Form  13.114
    • D.  Declaration of Readiness to Proceed (DWC-CA Form 10250.1)  13.115
    • E.  Proof of Service  13.116
    • F.  Consent to Venue  13.117
    • G.  Election of Defendants  13.118
    • H.  Request for Benefits From Subsequent Injuries Benefits Trust Fund
      • 1.  Availability of Benefits for Previous Disability  13.119
      • 2.  Making Application Against the Subsequent Injuries Benefits Trust Fund  13.120
      • 3.  Form: Application for Subsequent Injuries Benefits Trust Fund Benefits [Deleted]  13.121
      • 4.  Form: Application for Subsequent Injuries Fund Benefits (Application for SIF Benefits)  13.122
      • 5.  Filing and Serving Separate Subsequent Injuries Benefits Trust Fund Application  13.123
    • I.  Arbitration Submittal Form  13.124
  • VI.  FILE AND SERVE APPLICATIONS AND PETITIONS
    • A.  Filing Mechanics  13.125
      • 1.  All Applications, Regardless of Date of Injury  13.126
      • 2.  Applications Filed for Injuries Occurring During the Window Period  13.127
    • B.  Place of Filing—Venue  13.128
      • 1.  Venue Options  13.129
      • 2.  Incorrect Venue  13.130
      • 3.  Objection to Venue (Lab C §5501.5)  13.131
      • 4.  Change of Venue (Lab C §5501.6)  13.132
    • C.  Serve Application
      • 1.  Ordinary Service  13.133
      • 2.  Service on Uninsured Employer and Uninsured Employers Benefits Trust Fund  13.134
  • VII.  ANSWERS
    • A.  Effect of Failure to Answer  13.135
    • B.  Preparing Answer to Application  13.136
    • C.  Form: Answer to Application for Adjudication of Claim (DWC/WCAB Form 10)  13.137
      • 1.  Caption  13.138
      • 2.  Denials  13.139
      • 3.  Affirmative Defenses  13.140
      • 4.  Verification  13.141
      • 5.  Attachments and Accompanying Documents  13.142
    • D.  Form: Answer to Application for Adjudication of Claim: Injuries Occurring on or After January 1, 1990, and Before January 1, 1994 (WCAB Form 2 [Window Period]) [Deleted]  13.143
    • E.  Answer to Petitions  13.144
    • F.  Requesting Dismissal of Application
      • 1.  Applications Subject to Dismissal  13.145
        • a.  Insufficient Detail  13.146
        • b.  More Than One Injury Alleged  13.147
        • c.  Dismissal or Joinder of Parties Required  13.148
        • d.  Improper Venue or Jurisdiction  13.149
      • 2.  Form: Answer to Petition and Request for Dismissal or Continuance  13.150
    • G.  File and Serve Answer  13.151
    • H.  Amending Answer  13.152
  • VIII.  STIPULATIONS WITH REQUEST FOR AWARD
    • A.  Uses of Stipulations With Request for Award  13.153
    • B.  Procedure  13.154
  • IX.  ATTORNEYS’ APPEARANCE AND SUBSTITUTION
    • A.  Initial Appearance  13.155
    • B.  Substitution and Dismissal  13.156
      • 1.  Mutual Consent  13.157
      • 2.  Attorney Withdraws  13.158
      • 3.  Notice of Dismissal  13.159
      • 4.  Disqualification of Attorney  13.160
      • 5.  Form: Substitution of Attorneys (DWC WCAB Form 36)  13.161
      • 6.  Form: Notice of Dismissal of Attorney (DWC/WCAB Form 37)  13.162

14

Gathering Evidence

Barry M. Lesch

James P. Pettibone

  • I.  INFORMATION GATHERING DURING FIRST 90 DAYS (LAB C §5402)
    • A.  Initial Investigation by Claims Administrator  14.1
      • 1.  Information Gathered During Initial Investigation  14.2
      • 2.  Conducting the Investigation  14.3
    • B.  Evidence From Employee  14.4
    • C.  Evidence From Employer  14.5
      • 1.  Form 5020 Information  14.6
      • 2.  Form: Employer’s Report of Occupational Injury or Illness (Form 5020)  14.7
    • D.  Evidence From Medical Providers
      • 1.  Primary Treating Physicians; Form 5021  14.8
      • 2.  Obtaining Medical Reports  14.9
      • 3.  Obtaining Additional Records by Use of a Medical Release  14.10
      • 4.  Form: Authorization for Medical Information  14.11
      • 5.  Limits on Medical Discovery  14.12
    • E.  Additional Information
      • 1.  Form: Request for Social Security Earnings Information (SSA-7050-F4)  14.13
      • 2.  Miscellaneous Information  14.14
  • II.  ATTORNEY ROLES AT EARLY STAGES
    • A.  Defense Attorney  14.15
    • B.  Employee’s Attorney
      • 1.  Instructing the Employee Concerning Medical Examinations  14.16
      • 2.  Finding Lay Witnesses  14.17
      • 3.  Establishing Serious and Willful Misconduct  14.18
        • a.  Safety Orders; Safety Standards  14.19
        • b.  Proving Knowledge  14.20
  • III.  REBUTTABLE PRESUMPTION OF COMPENSABILITY IF CLAIM NOT DENIED WITHIN FIRST 90 DAYS  14.21
    • A.  Rebutting the Presumption  14.22
    • B.  Discovery Allowed on Other Issues  14.23
  • IV.  OBTAINING MEDICAL EVIDENCE IN GENERAL  14.24
    • A.  Medical-Legal Expenses  14.25
    • B.  Types of Physicians  14.26
    • C.  Selecting Examining Physicians  14.27
      • 1.  Is Physician Qualified to Report?  14.28
      • 2.  Arranging the Examination  14.29
      • 3.  Communicating With Physicians  14.30
      • 4.  Requesting Medical-Legal Report  14.31
    • D.  Contents of Medical-Legal Report  14.32
      • 1.  Lab C §4628 Requirements  14.33
      • 2.  Form: Declaration by Signing Physician  14.34
      • 3.  If Report Violates Lab C §4628  14.35
      • 4.  If Report Violates 8 Cal Code Regs §10606  14.36
      • 5.  On Receiving Report  14.37
  • V.  OBTAINING MEDICAL EVIDENCE ON SPECIFIC MEDICAL ISSUES AFTER THE FIRST 90 DAYS
    • A.  Compensability Evaluations (Lab C §4060)  14.38
      • 1.  If Employee Is Not Represented by an Attorney  14.39
      • 2.  If Employee Is Represented by an Attorney  14.40
    • B.  Primary Treating Physician Reports  14.41
      • 1.  Ongoing Reports From Primary Treating Physician  14.42
      • 2.  Primary Treating Physician’s Report Concerning Permanent Disability  14.43
      • 3.  Presumption of Correctness of Treating Physician’s Findings Repealed  14.44
        • a.  Rebutting the Presumption  14.45
        • b.  Defeating the Presumption  14.46
      • 4.  Rebuttable Presumption of Percentage of Permanent Disability Attributed to Each Injury Covered by 2005 Permanent Disability Rating Schedule  14.46A
      • 5.  Rebuttable Presumption of Correctness of Medical Treatment Utilization Schedule  14.46B
    • C.  Medical-Legal Evaluations Under Lab C §§4060–4068  14.47
      • 1.  Disputes Under Lab C §4062  14.48
        • a.  Procedure for Objecting  14.49
        • b.  Contents of Evaluation  14.50
      • 2.  Disputes Under Lab C §4061  14.51
        • a.  Procedure Under Lab C §4061  14.52
        • b.  Contents and Service of Evaluation  14.53
      • 3.  After the Comprehensive Medical Examination: Payment or Hearing  14.54
    • D.  Medical Provider Networks  14.54A
    • E.  Production of Medical Reports  14.55
  • VI.  OBTAINING EVIDENCE IN DEATH CASES  14.56
    • A.  Autopsy  14.57
    • B.  Nonmedical Evidence  14.58
  • VII.  DEFENDANT’S SURVEILLANCE AND FILMING OF EMPLOYEE  14.59
    • A.  When Surveillance May Be Beneficial  14.60
    • B.  Limits on Filming
      • 1.  No Entrapment, Fraud, or Deceit  14.61
      • 2.  Liability Under CC §1708.8 for Invasion of Privacy  14.62
    • C.  Use of Film  14.63
      • 1.  Determine Value  14.64
      • 2.  Discrediting Film  14.65
      • 3.  Presenting Film to Physicians  14.66
        • a.  Panel Qualified Medical Evaluator  14.67
        • b.  Medical Evaluators  14.68
        • c.  Agreed Medical Evaluators  14.69
      • 4.  Use for Impeachment of Employee  14.70
    • D.  Disclosing Film During Discovery  14.71
      • 1.  Until Employee’s Deposition  14.72
      • 2.  Until Mandatory Settlement Conference or Trial  14.73
  • VIII.  DEPOSITIONS AND WITNESS STATEMENTS
    • A.  Generally  14.74
    • B.  Employee’s Deposition  14.75
      • 1.  Information From and Attendance of Employer  14.76
      • 2.  Employee’s Deposition Rights  14.77
      • 3.  Limitation on Questions Concerning Medical History  14.78
      • 4.  Checklist: Deposition Information From Employee  14.79
    • C.  Depositions Taken by Employee
      • 1.  Purpose of Depositions  14.80
      • 2.  Obtaining Deposition of Employer or Defense Witness  14.81
    • D.  Depositions of Physicians
      • 1.  To Obtain Evidence, Not Only Discovery  14.82
        • a.  Balance Risks and Benefits of Cross-Examination  14.83
        • b.  Whether to Cross-Examine Treating Physician, Agreed Medical Examiner, or Panel Qualified Medical Examiner  14.84
      • 2.  Costs of Medical Depositions  14.85
    • E.  Third Party Witnesses
      • 1.  Witness Statements  14.86
        • a.  Written or Recorded Statements  14.87
        • b.  Statements Are Discoverable  14.88
      • 2.  Deposition of Witnesses  14.89
    • F.  Subpoenas  14.90
    • G.  Failure to Appear or Answer  14.91
  • IX.  NONMEDICAL EXPERT EVIDENCE  14.91A
    • A.  Continued Use of Vocational Experts  14.91B
    • B.  Functional Capacity Evaluation  14.91C
  • X.  OBTAINING RECORDS
    • A.  Medical Records  14.92
    • B.  Production of Documents by Opposing Party  14.93
    • C.  By Subpoena  14.94
    • D.  Enforcing Subpoena  14.95
  • XI.  OTHER DISCOVERY METHODS  14.96
  • XII.  DISCOVERY CUTOFF  14.97
  • XIII.  LIMITATIONS ON GATHERING AND USING EVIDENCE
    • A.  Injury Arising From Sexual Conduct (Injuries On or After January 1, 1994)  14.98
    • B.  HIV/AIDS Cases  14.99
    • C.  Privilege Statutes Apply in Workers’ Compensation Proceedings  14.99A

15

Lien Claims

Pamela W. Foust

  • I.  OVERVIEW
    • A.  Restrictions on Disbursement of Benefits to Claimant  15.1
    • B.  Nature of Lien  15.2
    • C.  Statutory Classes
      • 1.  Permissive Liens  15.3
      • 2.  Mandatory Liens  15.4
    • D.  Compensation Subject to Liens  15.5
    • E.  Assignment of Liens  15.5A
    • F.  WCAB’s Jurisdiction to Allow Liens Is Exclusive  15.6
      • 1.  Support for Deserted or Neglected Dependents  15.7
      • 2.  Attorney Fees  15.8
      • 3.  Medical Treatment Liens  15.8A
  • II.  ALLOWABLE LIENS
    • A.  Chart: Liens Allowable and Not Allowable  15.9
    • B.  Attorney Fees and Disbursements  15.10
      • 1.  Determining Attorney Fee Amount
        • a.  Factors Board Considers  15.11
        • b.  Life Pension Cases  15.12
        • c.  Complexity of Case  15.13
        • d.  Lack of Care and Skill  15.14
        • e.  Vocational Rehabilitation Claims (Injuries Before January 1, 2004)  15.15
      • 2.  Deposition Attorney Fees  15.16
      • 3.  Attorney Fees Payable by Defendant  15.17
        • a.  Permissive Fee Awards  15.18
        • b.  Attorney Fees Payable as Sanction  15.18A
        • c.  Mandatory Fee Awards  15.19
      • 4.  Allocation of Fees Between Successive Attorneys  15.20
      • 5.  Disbursements  15.21
    • C.  Medical Treatment
      • 1.  Items Subject to Lien  15.22
      • 2.  Time Limit for Filing Lien Claim
        • a.  Labor Code §4903.5  15.22A
        • b.  Other Limitations on Filing  15.22B
        • c.  Labor Code §4903.6  15.22C
      • 3.  Dismissal of Applicant’s Case  15.22D
      • 4.  Substantive Matters
        • a.  Disputes About Threshold Issues  15.22E
        • b.  Medical Control  15.22F
      • 5.  Limited to Cure or Relief of Industrial Injury [Deleted]  15.23
      • 6.  Qualifications of Medical Providers  15.24
      • 7.  Reasonable Medical Necessity  15.24A
      • 8.  Timing of Treatment and Lien Filing [Deleted]  15.25
      • 9.  When Lien Claimant Disputes Settlement Allocation [Deleted]  15.26
      • 10.  Dismissal of Applicant’s Case [Deleted]  15.27
      • 11.  Reasonable Value  15.28
      • 12.  Insurers’ Medical Treatment Liens  15.29
    • D.  Medical-Legal Expenses
      • 1.  Recoverable as Lien  15.30
      • 2.  When Costs Not Allowable: Examples  15.31
      • 3.  Worker’s Claim Must Be Contested; Timing and Notice Issues  15.32
      • 4.  Defendant’s Obligation to Pay or Object  15.33
      • 5.  No Cost Claim for Unnecessary Reports  15.34
      • 6.  Who May Write Medical-Legal Reports  15.35
      • 7.  Antifraud Provisions  15.36
        • a.  Duties of Physician  15.37
        • b.  Contents of Medical Report  15.38
      • 8.  Medical Report Must Be Capable of Proving or Disproving Essential Disputed Medical Facts  15.39
      • 9.  Fee Schedule; Interpreter Rates  15.40
    • E.  Employee and Dependent Living Expenses  15.41
      • 1.  Included, Excluded Expenses  15.42
      • 2.  Unrelated Medical Expenses  15.43
      • 3.  Compensation Paid by Mistake  15.44
      • 4.  Loss of Income Benefits  15.45
    • F.  Burial Expense  15.46
    • G.  Living Expenses of Deserted or Neglected Spouse or Minor Children  15.47
    • H.  Employment Development Department Benefits  15.48
      • 1.  Disability  15.49
      • 2.  Unemployment Insurance  15.50
    • I.  Victim of Violent Crime Indemnification  15.51
    • J.  Family Temporary Disability Insurance Benefits (Paid Family Leave)  15.51A
    • K.  Asbestos Workers’ Benefits [Deleted]  15.52
    • L.  Nonmedical Litigation Costs  15.53
      • 1.  Interpreter Services  15.54
      • 2.  Costs Under Lab C §5811
        • a.  Post-SB 863 Costs  15.55
        • b.  Pre-SB 863 Costs  15.55A
    • M.  Uninsured Employers Benefits Trust Fund Payments  15.56
    • N.  Tax Liens  15.57
  • III.  ELECTRONIC ADJUDICATION MANAGEMENT SYSTEM (EAMS)  15.57A
  • IV.  LIEN PROCEDURE
    • A.  Preliminary Steps  15.58
    • B.  Notices of Representation, Change of Representation, and Non-Representation  15.58A
      • 1.  Required Contents of Notice; Verification  15.58B
      • 2.  Time for Filing and Service  15.58C
      • 3.  Additional Requirements for Non-Attorney Representatives  15.58D
      • 4.  Notice of Non-Representation  15.58E
    • C.  Fees
      • 1.  Filing Fee for Medical Treatment Lien and Cost Claim (Filed After 1/1/2013)  15.58F
      • 2.  Activation Fee for Medical Treatment Lien (Filed Before 1/1/2013)  15.58G
      • 3.  Reimbursement  15.58H
    • D.  Time to File
      • 1.  Lab C §§4903.5 and 4903.6  15.59
      • 2.  Laches  15.60
    • E.  Who May File  15.61
    • F.  Completing, Filing, and Serving Lien Claims
      • 1.  When Lien Claim Must Be Filed Electronically  15.62
      • 2.  When OCR Form Permitted  15.62A
      • 3.  When Lien Claim May Be Filed on Non-OCR Form  15.63
      • 4.  Requirements for Filing Lien Claims
        • a.  Case Number; Party Names and Addresses  15.64
        • b.  Claims  15.65
        • c.  Signature  15.66
      • 5.  Supporting Documents  15.67
      • 6.  Filing  15.68
      • 7.  Proof of Service  15.68A
      • 8.  Verification to Filing of Lien Claim or Application by Lien Claimant  15.68B
      • 9.  Verification to Filing of Declaration of Readiness by or on Behalf of Lien Claimant  15.68C
      • 10.  Service  15.69
      • 11.  Amendments  15.70
      • 12.  Duty to Notify Parties of Changes in Contact Information  15.70A
      • 13.  Notification of Hearing  15.70B
      • 14.  Notice After Resolution or Withdrawal  15.70C
    • G.  Defendants’ Obligations  15.71
      • 1.  Withhold Funds in Anticipation of Lien  15.72
      • 2.  Notify Employment Development Department  15.73
      • 3.  Disclose All Liens [Deleted]  15.74
    • H.  Service of Medical Reports
      • 1.  On Party or Physician Lien Claimant  15.75
      • 2.  On Non-Physician Lien Claimant  15.75A
      • 3.  Manner of Service  15.75B
    • I.  Hearings and Dismissal of Liens
      • 1.  When Case in Chief Is Resolved by Compromise and Release or Stipulated Award  15.76
      • 2.  Lien Conferences  15.76A
      • 3.  Lien Trials  15.76B
      • 4.  Dismissal of Lien for Lack of Prosecution
        • a.  When Petition for Dismissal May Be Filed  15.77
        • b.  Required Documents  15.77A
        • c.  Service  15.77B
        • d.  Notice of Intention to Dismiss  15.77C
      • 5.  Dismissal for Failure to Appear  15.77D
      • 6.  Summary Lien Claim Procedure [Deleted]  15.78
      • 7.  Arbitration  15.79
    • J.  Lien Claimant’s Rights and Obligations
      • 1.  “Right to Relief” or “Party in Interest”  15.80
      • 2.  Due Process  15.81
    • K.  Burden of Proof  15.82
    • L.  Sanctions  15.82A
    • M.  Attorney Fees and Costs  15.83
      • 1.  Procedure  15.84
      • 2.  Request for Fee Increase  15.85
    • N.  Medical-Legal Costs  15.86
    • O.  Settled Claims  15.87
  • V.  WORKERS’ COMPENSATION APPEALS BOARD’S DISCRETION
    • A.  Limits  15.88
    • B.  Determining Reasonableness  15.89
    • C.  Payment Priorities  15.90
    • D.  Payment Method  15.91
    • E.  Allowance on Workers’ Compensation Appeals Board’s Own Motion  15.92
    • F.  Need for Opportunity to Be Heard  15.93
    • G.  Settled Claims  15.94
  • VI.  LIEN CLAIMANT’S LIABILITY FOR ATTORNEY FEES
    • A.  Statutory Provisions  15.95
    • B.  Common Fund Principle [Deleted]  15.96
    • C.  Procedure  15.97

16

Settlement

Raymond E. Frost

  • I.  ADVANTAGES AND TYPES OF SETTLEMENT  16.1
  • II.  COMPROMISE AND RELEASE AGREEMENT  16.2
    • A.  Advantages  16.3
    • B.  Primary Issues to Resolve
      • 1.  Permanent Disability  16.4
      • 2.  Temporary Disability  16.5
      • 3.  Future Medical Care  16.6
      • 4.  Other Issues  16.7
    • C.  Types of Compromise and Releases
      • 1.  Full or Partial Release  16.8
      • 2.  Claims Against Subsequent Injuries Benefits Trust Fund  16.9
      • 3.  Claims for Vocational Rehabilitation (Injuries Occurring Before January 1, 2004) [Deleted]  16.10
        • a.  Thomas Finding [Deleted]  16.10A
        • b.  One-Time Payment [Deleted]  16.10B
        • c.  Form: RU-122 [Deleted]  16.10C
      • 4.  Serious and Willful Misconduct of Employer or Employee  16.11
      • 5.  Third Party Settlement  16.12
    • D.  Circumstances Justifying Settlement
      • 1.  General Policy  16.13
      • 2.  Worker’s Considerations  16.14
      • 3.  Defense Considerations  16.15
    • E.  Negotiation
      • 1.  Evaluating Case Value  16.16
      • 2.  Negotiating Techniques  16.17
        • a.  On Behalf of Worker  16.18
        • b.  On Behalf of Defense  16.19
      • 3.  Specific Types of Cases  16.20
      • 4.  Lien Claims  16.21
    • F.  Drafting, Service, and Filing
      • 1.  Requirements; Using WCAB C&R Forms  16.22
      • 2.  Separate Forms for Separate Injuries Not Required  16.23
      • 3.  Form: Compromise and Release Agreement (DWC-CA Form 10214(c))  16.24
      • 4.  Completing DWC-CA Form 10214(c)
        • a.  Case Number(s); Venue; Parties  16.25
        • b.  Description of Injury and Claim  16.26
        • c.  Scope of Release  16.27
        • d.  Compensation Paid and Claimed  16.28
        • e.  Amount of Compromise and Deductions  16.29
        • f.  Liens to Be Disallowed or Reduced  16.30
        • g.  Attorney Fees  16.31
        • h.  Reason for Compromise  16.32
          • (1)  Special Provisions  16.33
          • (2)  Form: Addendum to Compromise and Release  16.34
        • i.  Provision for Hearing  16.35
        • j.  Execution  16.36
      • 5.  Accompanying Papers  16.37
      • 6.  Reducing Lien Claims
        • a.  Statutory Authority
          • (1)  Unemployment Compensation Liens  16.38
          • (2)  Certain Medical and Group Disability Liens  16.39
        • b.  Allocation by Formula
          • (1)  Unemployment Compensation Liens (Baird Formula)  16.40
          • (2)  Medical and Group Disability Liens  16.41
        • c.  Procedure  16.42
        • d.  Form: Sample Computation of Fair Allocation to Unemployment Compensation Disability Lien Claim (Baird Formula)  16.43
        • e.  Form: Sample Computation of Lien Reduction Under Lab C §4903.1(a)(4)  16.44
      • 7.  Service and Filing  16.45
      • 8.  “Walk-Through” Filing  16.46
      • 9.  Form: Compromise and Release Agreement—Dependency Claim (DWC-CA Form 10214(d))  16.47
      • 10.  Form: Compromise and Release Agreement—Third Party (DWC-CA Form 10214(e))  16.48
    • G.  Status of Executed Compromise and Release Before Approval  16.49
      • 1.  Effect of Worker’s Death  16.50
      • 2.  Effect of Party’s Repudiation  16.51
      • 3.  Effect of Disapproval [Deleted]  16.52
    • H.  Approval of Agreement
      • 1.  WCAB’s Responsibility  16.53
      • 2.  Informal Discussion With Workers’ Compensation Judge  16.54
      • 3.  Employers’ Objections  16.55
      • 4.  Hearing  16.56
      • 5.  Workers’ Compensation Appeals Board’s Authority  16.57
      • 6.  Effect of Approval
        • a.  On Parties  16.58
        • b.  On Dependents  16.59
        • c.  On Right to Vocational Rehabilitation Services (Injuries Occurring Before January 1, 2004) [Deleted]  16.60
    • I.  Effect of Disapproval  16.60A
    • J.  Procedures to Reconsider, Review, or Set Aside Approval
      • 1.  Petitions for Reconsideration and Review  16.61
      • 2.  Setting Aside
        • a.  Petition to Reopen  16.62
        • b.  Restitution Ordinarily Not Condition Precedent  16.63
        • c.  Grounds for Reopening  16.64
          • (1)  Fraud, Duress, or Undue Influence  16.65
          • (2)  Mutual Mistake of Fact  16.66
          • (3)  Mistake of Law  16.67
          • (4)  Invalidity of Execution  16.68
          • (5)  Incompetency or Minority at Time of Execution  16.69
  • III.  STIPULATIONS WITH REQUEST FOR AWARD
    • A.  Legal Effect  16.70
    • B.  Strategic Considerations  16.71
    • C.  Components
      • 1.  Permanent Disability  16.72
      • 2.  Temporary Disability  16.73
      • 3.  Lien Claims  16.74
    • D.  Negotiation  16.75
    • E.  Deciding Whether to Execute Stipulations  16.76
    • F.  Stipulations Form
      • 1.  Preparation  16.77
      • 2.  Form: Stipulations With Request for Award (DWC-CA Form 10214(a))  16.78
      • 3.  Filing, Service, and Attachments  16.79
      • 4.  Lien Claims  16.80
      • 5.  Death Case
        • a.  Preparation  16.81
        • b.  Form: Stipulations With Request for Award (Death Case) (DWC-CA Form 10214(b))  16.82
        • c.  Filing, Service, and Attachments  16.83
        • d.  Form: Sample Letter Requesting Fee (To Accompany WCAB Form 4)  16.84
    • G.  Ruling on Stipulations  16.85

17

Preparing for Trial

Yale I. Jones

Robert E. Buch

  • I.  WORKERS’ COMPENSATION APPEALS BOARD HEARINGS IN GENERAL
    • A.  Continuing Implementation of EAMS  17.1
    • B.  Need for Hearing  17.1A
    • C.  Setting Case for Hearing  17.2
  • II.  TYPES OF HEARINGS  17.3
    • A.  Regular Hearing (Trial Calendar)  17.4
    • B.  Mandatory Settlement Conference  17.5
      • 1.  Conduct of Conference  17.6
        • a.  Continuance  17.7
        • b.  Failure to Appear  17.8
        • c.  Consolidation  17.8A
      • 2.  Effect of Mandatory Settlement Conference  17.9
        • a.  Listing Witnesses and Disclosing Evidence  17.10
        • b.  Raising Issues  17.11
      • 3.  Form: Pretrial Conference Statement §5502(d)(3) (WCAB Form 24)  17.12
    • C.  Consultative Disability Evaluations at Mandatory Settlement Conference  17.13
    • D.  Hearing by Pro Tempore Judge  17.14
    • E.  Emergency Hearings  17.15
    • F.  Expedited Hearings
      • 1.  When Appropriate  17.16
      • 2.  How to Request an Expedited Hearing  17.17
      • 3.  Form: Declaration of Readiness to Proceed to Expedited Hearing (Trial) (DWC-CA Form 10208.3)  17.18
    • G.  Rating Mandatory Settlement Conference  17.18A
    • H.  Status Conference  17.18B
    • I.  Priority Conference  17.18C
    • J.  Walk-Through Procedure  17.18D
  • III.  SETTING FOR HEARING
    • A.  Declaration of Readiness to Proceed
      • 1.  Need to File  17.19
      • 2.  Content  17.20
      • 3.  Requesting Specific Date  17.21
      • 4.  Form: Declaration of Readiness to Proceed (DWC-CA Form 10250.1)  17.22
    • B.  Objection to Declaration  17.23
    • C.  Screening by Presiding Judge  17.24
      • 1.  Ordinary and Death Benefits  17.25
      • 2.  Serious and Willful Misconduct  17.26
      • 3.  Subsequent Injuries Benefits Trust Fund Benefits  17.27
      • 4.  Petition to Reopen Prior Decision  17.28
      • 5.  Arbitration  17.29
    • D.  Judge’s Calendaring Discretion  17.30
    • E.  Priorities in Setting  17.31
    • F.  Medical and Vocational Rehabilitation Testimony Disfavored  17.32
    • G.  Notice of Hearing  17.33
      • 1.  Notice to Lien Claimants  17.34
      • 2.  Notice to Uninsured Employers  17.35
      • 3.  Waiver of Notice  17.36
    • H.  Obtaining Continuance  17.37
    • I.  Changing the Judge  17.38
      • 1.  Petition for Automatic Reassignment of Trial or Expedited Hearing and Automatic Reassignment After Reversal
        • a.  When to File  17.39
        • b.  Form: Petition for Automatic Reassignment to Another Workers’ Compensation Judge  17.40
      • 2.  Petition for Disqualification
        • a.  When to File  17.41
        • b.  Form: Petition to Disqualify Assigned Workers’ Compensation Judge  17.42
    • J.  Removal of Case From Calendar  17.43
    • K.  Dismissal of Off-Calendar Cases  17.44
  • IV.  APPLICANT’S PREPARATION
    • A.  Differences From Civil Practice  17.45
    • B.  Raising Issues  17.46
    • C.  Checklist: Refining Issues  17.47
    • D.  Compelling Attendance of Witnesses
      • 1.  Interviewing Witnesses; Securing Attendance  17.48
        • a.  Subpoenas  17.49
        • b.  Form: Subpoena (WCAB Form 30)  17.50
        • c.  Form: Subpoena Duces Tecum (WCAB Form 32)  17.51
      • 2.  Safety Officers and State Employees  17.52
      • 3.  Failure of Witnesses to Appear  17.53
    • E.  Proving Earnings and Other Sums  17.54
    • F.  Preparing Medical Evidence  17.55
      • 1.  Need for Narrative Medical Reports  17.56
      • 2.  Need for Expert Testimony  17.57
    • G.  Medical Testimony  17.58
      • 1.  Direct Examination of Physician  17.59
      • 2.  Cross-Examination of Physician  17.60
      • 3.  Cross-Examination Tactics
        • a.  General Strategy  17.61
        • b.  Flaws in Medical History  17.62
        • c.  Flaws in Reasoning  17.63
        • d.  Ambiguous Conclusions  17.64
    • H.  Petitions and Motions Before Trial  17.65
    • I.  Preparing the Applicant to Testify  17.66
      • 1.  Discuss Case Issues; Go Over Questions  17.67
      • 2.  When Extent of Permanent Disability Is at Issue  17.68
      • 3.  Activities and Surveillance Videotapes or Films to Impeach Applicant  17.69
    • J.  Dealing With the Apportionment Issue  17.70
    • K.  Preparing Proposed Permanent Disability Rating—“Baseball Arbitration” [Deleted]  17.71
  • V.  DEFENDANT’S PREPARATION
    • A.  Differences From Civil Practice  17.72
    • B.  Ascertaining Issues  17.73
      • 1.  Prerequisites to Formal Litigation (Injuries Occurring After 1990)  17.74
      • 2.  Application  17.75
      • 3.  Employer or Insurer  17.76
        • a.  Compensation Litigation Transmittal Note  17.77
        • b.  Employer’s Report of Occupational Injury or Illness  17.78
        • c.  Form: Additions to Employer’s Report of Occupational Injury or Illness  17.79
        • d.  Doctor’s First Report of Occupational Injury or Illness  17.80
      • 4.  Statement of Employee’s Gross Earnings  17.81
    • C.  Identifying Affirmative Defenses  17.82
      • 1.  Injured Worker’s Status as Independent Contractor  17.83
      • 2.  Intoxication  17.84
        • a.  Proof of Intoxication  17.85
        • b.  Proximate Cause of Injury  17.86
        • c.  Estoppel From Asserting Defense  17.87
      • 3.  Employee’s Serious and Willful Misconduct  17.88
      • 4.  Aggravation of Disability by Employee’s Unreasonable Conduct  17.89
      • 5.  Prejudice From Lack of Notice  17.90
      • 6.  Apportionment of Permanent Disability  17.91
      • 7.  Reasonableness of Delay or Refusal to Pay Benefits Under Lab C §5814  17.91A
      • 8.  Statutes of Limitations  17.92
      • 9.  Fraud  17.93
    • D.  Employer’s Insurance Coverage  17.94
    • E.  Marshaling Evidence
      • 1.  Time Available  17.95
      • 2.  Reviewing Discovery; Medical Testimony  17.96
      • 3.  Witness Preparation  17.97
      • 4.  Earnings Records  17.98
      • 5.  Form: Letter to Applicant’s Attorney Requesting Earnings Information  17.99
      • 6.  Surveillance Videotapes and Films
        • a.  Admissibility  17.100
        • b.  Authentication  17.101
        • c.  Relevance  17.102
        • d.  Impeachment Value  17.103
        • e.  Meeting Applicant’s Rebuttal  17.104
    • F.  Medical Preparation  17.105
    • G.  Petitions and Motions Before Trial  17.106
      • 1.  Form: Petition to Dismiss Application  17.107
      • 2.  Petition to Dismiss for Lack of Prosecution (Injuries Occurring Before January 1, 1990, or On or After January 1, 1994)  17.108
      • 3.  Dismissal for Want of Prosecution (Injuries Occurring On or After January 1, 1990, and Before January 1, 1994)  17.109
      • 4.  Form: Petition to Dismiss Improperly Joined Insurer  17.110
      • 5.  Form: Petition to Join Additional Employers and Insurers  17.111
      • 6.  Form: Petition for Order Directing Exhumation and Autopsy  17.112
      • 7.  Form: Petition to Suspend Proceedings and to Compel Medical Examination  17.113
      • 8.  Form: Petition to Bar Applicant’s Right to Disability Payments  17.114
    • H.  Preparing Proposed Permanent Disability Rating  17.115

18

Trial

Yale I. Jones

  • I.  REGULAR HEARING PROCEDURE (TRIAL)  18.1
    • A.  Trial Briefs and Oral Statements  18.2
    • B.  Persuasion  18.3
    • C.  Time Limitations and Narrowing Issues
      • 1.  Time Limitations  18.4
      • 2.  Narrowing Issues  18.5
      • 3.  Collateral Issues  18.6
      • 4.  Economy of Proof; Frivolous Delay  18.7
    • D.  Review of Issues and Stipulations
      • 1.  Confirm Issues and Stipulations  18.8
      • 2.  Raise Issue or Risk Waiver
        • a.  Rule  18.9
        • b.  Exceptions  18.10
    • E.  Admitting Documents Into Evidence  18.11
    • F.  Order of Proof  18.12
    • G.  How Workers’ Compensation Judge Weighs Evidence  18.13
    • H.  Continuances  18.14
    • I.  Failure to Appear  18.15
      • 1.  Dismissal  18.16
      • 2.  Order Off Calendar  18.17
      • 3.  Submit and Decide  18.18
      • 4.  Continuance  18.19
      • 5.  Sanctions  18.19A
  • II.  BURDENS OF PROOF AND PRESUMPTIONS  18.20
    • A.  Applicant’s Burden of Proof  18.21
      • 1.  Proving Cause of Physical Injury  18.22
      • 2.  Proving Cause of Psychiatric Injury  18.23
    • B.  Defense Burden of Proof
      • 1.  Affirmative Defenses  18.24
      • 2.  Assertion of Issue  18.25
      • 3.  Burden Shifts During Trial  18.26
    • C.  Presumptions in General  18.27
    • D.  Conclusive Presumptions
      • 1.  Dependency  18.28
      • 2.  Total Disability  18.29
      • 3.  Other Conclusive Presumptions  18.30
    • E.  Rebuttable Presumptions
      • 1.  Employee Status  18.31
        • a.  Independent Contractors Excluded  18.32
        • b.  Licensed/Unlicensed Contractors  18.33
      • 2.  Failure to Deny Liability Within 90 Days (Lab C §5402)  18.34
        • a.  Counting 90 Days  18.35
        • b.  Employer’s Duty to Provide Claim Form  18.36
        • c.  Rebutting Presumption  18.37
        • d.  Form and Notice of Denial  18.38
      • 3.  Findings of Treating Physician [Deleted]  18.39
        • a.  When Former Presumption Inapplicable [Deleted]  18.40
        • b.  Rebutting Former Presumption [Deleted]  18.41
      • 4.  Duration of Temporary Disability  18.42
      • 5.  Presumption of Correctness Regarding Extent and Scope of Medical Treatment  18.42A
      • 6.  Other Rebuttable Presumptions
        • a.  Public Safety Employees  18.43
        • b.  Unlawfully Uninsured Employers  18.43A
        • c.  Vocational Rehabilitation [Deleted]  18.43B
        • d.  Refusal to Permit Autopsy  18.43C
    • F.  “Quasi-Presumptions”  18.44
    • G.  Inferences  18.45
    • H.  Effect of Stipulations
      • 1.  Parties Bound  18.46
      • 2.  Workers’ Compensation Appeals Board Not Bound  18.47
  • III.  EVIDENCE
    • A.  General Evidentiary Policies and Rules  18.48
      • 1.  Hearsay  18.49
      • 2.  Full Disclosure Requirement  18.50
      • 3.  Objections to Evidence  18.51
    • B.  Documentary Evidence
      • 1.  Admitting Documents in Evidence  18.52
      • 2.  Objections to Admission of Document  18.53
    • C.  Evidentiary Privileges
      • 1.  Applicability of Privileges  18.54
      • 2.  Medical Information  18.55
      • 3.  Self-Incrimination  18.56
      • 4.  Attorney-Client Privilege; Work Product Doctrine  18.57
      • 5.  Inadvertent Receipt of Privileged Information  18.58
      • 6.  Sexual Conduct  18.59
      • 7.  Other Privileges  18.60
  • IV.  WITNESSES  18.61
    • A.  Witness Preparation and Direct Examination  18.62
    • B.  Cross-Examination  18.63
    • C.  Offers of Proof  18.64
  • V.  DEVELOPMENT AND PROTECTION OF THE RECORD
    • A.  Preserving the Record  18.65
    • B.  Form: Minutes of Hearing (DWC-CA Form 10245) [Deleted]  18.66
    • C.  Workers’ Compensation Judges’ Obligation to Develop Record  18.67
    • D.  Use of Record on Reconsideration  18.68
  • VI.  POSTHEARING PROCEDURES
    • A.  Closing the Record; Disposition Orders  18.69
    • B.  Petition to Vacate Submission  18.70
    • C.  Attorney Fees  18.71
      • 1.  Defendant's Liability for Applicant's Attorney Fees  18.71A
      • 2.  Only Licensed Attorneys May Receive Fee  18.71B
      • 3.  Declaration of Readiness to Proceed Filed by Defendant  18.71C
      • 4.  Calculating Attorney Fees  18.71D
      • 5.  Appropriate Withholding of Attorney Fees  18.71E
    • D.  Costs  18.71F
      • 1.  Deposition Fees and Costs  18.71G
      • 2.  Appellate Costs  18.71H
      • 3.  Bad Faith Actions  18.71I
      • 4.  Effect of Third Party Recovery  18.71J
      • 5.  When Costs May Be Denied  18.71K
    • E.  Service of Formal Rating  18.72
    • F.  Methods of Objecting to Rating  18.73
      • 1.  Obvious Errors  18.74
      • 2.  Motion to Strike  18.75
      • 3.  Cross-Examination of Disability Evaluation Unit Rater  18.76
      • 4.  Rebuttal Evidence  18.77

19

Arbitration

Dennis J. Hannigan

  • I.  GOVERNING PROVISIONS  19.1
  • II.  EMPLOYEE OR DEPENDENT MUST BE REPRESENTED BY COUNSEL  19.2
  • III.  WHEN MANDATORY  19.3
    • A.  Insurance Coverage  19.4
    • B.  Right of Contribution Under Lab C §5500.5  19.5
    • C.  Permanent Disability  19.6
    • D.  Vocational Rehabilitation Issues  19.7
  • IV.  WHEN VOLUNTARY  19.8
  • V.  FORMS
    • A.  Form: Arbitration Submittal Form (DWC-CA Form 10297)  19.9
    • B.  Form: Arbitration Submittal Orders (WCAB Form 33)  19.10
    • C.  Form: Arbitrator Application  19.10A
  • VI.  ARBITRATORS
    • A.  Eligibility  19.11
    • B.  Selection  19.12
    • C.  Powers  19.13
  • VII.  PROCEEDINGS
    • A.  Time and Place  19.14
    • B.  Filing and Service of Documents  19.15
    • C.  Ex Parte Communications and Disclosure of Settlement Offers Prohibited  19.16
    • D.  Other Ground Rules  19.17
    • E.  Decision  19.18
    • F.  Payment of Costs  19.19
    • G.  Reconsideration  19.20
  • VIII.  CARVE-OUTS  19.20A
    • A.  Construction Industry Carve-Outs  19.21
    • B.  General Industry Carve-Outs  19.21A
  • IX.  INSURANCE CONTROVERSIES  19.22

20

Decisions, Awards, and Judgments

  • I.  DECISIONS
    • A.  Terminology  20.1
    • B.  When Issued  20.2
    • C.  Components
      • 1.  Summary of Evidence  20.3
      • 2.  Opinion on Decision  20.4
      • 3.  Findings of Fact  20.5
        • a.  Specific Findings  20.6
        • b.  Amendment to Conform to Proof  20.7
      • 4.  Award  20.8
      • 5.  WCAB File  20.8A
      • 6.  Destruction of Case Files  20.8B
    • D.  Types of Awards
      • 1.  Provision for Adjustment by Parties  20.9
      • 2.  Continuing Awards  20.10
      • 3.  Separate, Joint, and Several Awards
        • a.  Cases Consolidated for Hearing  20.11
        • b.  Multiple Defendants  20.12
        • c.  Cumulative Injuries and Occupational Diseases  20.13
    • E.  Unresolved and Deferred Issues  20.14
    • F.  Penalties, Costs, Fees, and Interest
      • 1.  Penalties, Costs, and Fees  20.15
      • 2.  Interest  20.16
      • 3.  Prejudgment Interest on Lab C §132a Award  20.16A
      • 4.  Interest Rate  20.17
      • 5.  Interest on Medical-Legal and Medical Treatment Expenses  20.18
      • 6.  Interest Payable to Employment Development Department  20.19
    • G.  Service
      • 1.  Service by Board and Parties  20.20
      • 2.  Extension of Time for Responding  20.20A
      • 3.  Proof of Service  20.21
      • 4.  Defective Service  20.22
  • II.  COLLECTING AWARDS
    • A.  Alternative Methods  20.23
    • B.  Uninsured Employers Benefits Trust Fund
      • 1.  Nature of Fund  20.24
      • 2.  Demand on Fund  20.25
      • 3.  Fund Liability  20.26
      • 4.  Fund’s Recovery From Uninsured Employer
        • a.  In General  20.27
        • b.  Civil Penalty Assessments  20.28
        • c.  Lien Against Property  20.29
        • d.  Liquidated Damages, Judgment, and Civil Foreclosure  20.30
        • e.  Judgment Against Entities Regulated by Public Utilities Commission or Department of Motor Vehicles  20.31
      • 5.  Fund’s Recovery From Third Party  20.32
    • C.  Assignment to Labor Commissioner  20.33
    • D.  Judgment; Execution
      • 1.  Converting Award Into Judgment  20.34
        • a.  Obtain Certified Copy of Decision  20.35
        • b.  Superior Court Clerk Enters Judgment  20.36
      • 2.  Writ of Execution  20.37
      • 3.  Stay of Execution
        • a.  Authority  20.38
        • b.  Automatic 10-Day Stay  20.39
        • c.  Stay Before Entry of Judgment; Withholding Certified Copy of Award  20.40
        • d.  Stay After Entry of Judgment  20.41
        • e.  Procedure  20.42
      • 4.  Supplemental Proceedings on Execution  20.43
      • 5.  Satisfaction of Judgment  20.44
  • III.  PRIORITY; INSOLVENCY
    • A.  Priority of Compensation Claims  20.45
    • B.  Bankruptcy or Insolvency of Employer or Insurer
      • 1.  In General  20.46
      • 2.  California Insurance Guarantee Association  20.47
      • 3.  Self-Insurers’ Security Fund  20.48
      • 4.  Bankruptcy  20.49

21

Reconsideration

Dennis J. Hannigan

  • I.  INTRODUCTION
    • A.  Overview of Reconsideration Procedure  21.1
    • B.  Review of Arbitrator’s Decision  21.2
    • C.  Review of Contempt Finding  21.3
    • D.  Reopening and Removal Distinguished
      • 1.  Reopening  21.4
      • 2.  Removal  21.5
  • II.  BEFORE PETITIONING FOR RECONSIDERATION
    • A.  Understand Reasons to Petition for Reconsideration  21.6
    • B.  Assess Prospects for Success  21.7
  • III.  PREREQUISITES TO RECONSIDERATION
    • A.  Final Order, Decision, or Award  21.8
      • 1.  Orders That Are Not Final  21.9
      • 2.  Severed Threshold Issues  21.10
      • 3.  Finality for Some Parties, But Not Others  21.11
    • B.  Petitioner Is Person Aggrieved  21.12
    • C.  Statutory Grounds  21.13
      • 1.  Workers’ Compensation Appeals Board Exceeded Powers  21.14
      • 2.  Decision Procured by Fraud  21.15
      • 3.  Findings Not Justified by Evidence  21.16
      • 4.  Newly Discovered Evidence  21.17
      • 5.  Findings Do Not Support Order or Award  21.18
      • 6.  Change in the Law  21.18A
      • 7.  Preserving Grounds at Trial; Waiver  21.19
    • D.  Timely Filing  21.20
      • 1.  If Order, Decision, or Award Served by Mail  21.21
      • 2.  If Order, Decision, or Award Served by Fax, E-mail, or Any Other Method  21.21A
      • 3.  If Order, Decision, or Award Defectively Served  21.22
      • 4.  Filing Supplemental Reconsideration Petitions  21.23
      • 5.  Arbitrator’s Decisions Under Lab C §§3201.5, 3201.7  21.24
  • IV.  FILING PETITION FOR RECONSIDERATION
    • A.  Content; Specificity  21.25
    • B.  Waiver of Unstated Grounds  21.26
    • C.  Drafting the Petition
      • 1.  Format Requirements  21.27
      • 2.  Caption; Introduction  21.28
      • 3.  Preliminary Statement; Grounds  21.29
      • 4.  Statement of Contentions  21.30
      • 5.  Summary of Material Facts  21.31
      • 6.  Argument  21.32
      • 7.  Request for Transcript  21.33
      • 8.  Prayer  21.34
      • 9.  Signature; Verification  21.35
      • 10.  Form: Petition for Reconsideration (WCAB Form 45)  21.36
    • D.  Exhibits  21.37
    • E.  Service  21.38
    • F.  Proof of Service  21.39
      • 1.  Statement on Petition  21.40
      • 2.  Statement in Letter of Transmittal  21.41
      • 3.  Declaration of Service  21.42
      • 4.  Proof of Service by E-mail or Fax  21.42A
      • 5.  Failure of Service  21.42B
    • G.  Filing: How and Where  21.43
  • V.  ANSWERS AND REPLIES
    • A.  Answer to Petition for Reconsideration  21.44
    • B.  Reply to Answer  21.45
    • C.  Reply to Workers’ Compensation Judge’s Report  21.46
  • VI.  DISPOSITION OF PETITION
    • A.  Workers’ Compensation Judge’s or Arbitrator’s Actions and Reports  21.47
      • 1.  Workers’ Compensation Judge Actions  21.48
      • 2.  Workers’ Compensation Judge Report  21.49
      • 3.  Arbitrator Report  21.50
      • 4.  Settlement Conference Referee Report [Deleted]  21.51
    • B.  Board’s Authority  21.52
    • C.  Board’s Action on Petition
      • 1.  Procedure  21.53
      • 2.  Adequacy of Board Decision on Reconsideration (Lab C §5908.5)  21.54
      • 3.  Time to Grant or Deny  21.55
      • 4.  Permissible Actions
        • a.  Dismissal  21.56
        • b.  Denial  21.57
        • c.  Grant: Options  21.58
          • (1)  Immediate Decision on the Record  21.59
          • (2)  Grant for Study, Transcript, or Supplemental Report  21.60
          • (3)  Grant to Take Additional Evidence  21.61
          • (4)  Grant to Rescind and Return to Workers’ Compensation Judge for Further Proceedings  21.62
    • D.  Successive Petitions for Reconsideration  21.63
    • E.  Effects on Order, Decision, or Award (of Filing Petitions for Reconsideration)
      • 1.  Enforcement; Stay  21.64
      • 2.  Interest  21.65
      • 3.  Nonpetitioning Parties  21.66
  • VII.  RECONSIDERATION ON BOARD’S OWN MOTION  21.67

22

Judicial Review

Peter Ray

Patricia S. Stephens

  • I.  MECHANISMS FOR JUDICIAL REVIEW
    • A.  Statutory Review
      • 1.  Writ of Review  22.1
      • 2.  Writ of Mandate  22.2
      • 3.  Writ of Prohibition  22.3
    • B.  Common Law Review: Habeas Corpus and Restraint of Execution  22.4
  • II.  TABLE: TIME LIMITS FOR JUDICIAL REVIEW  22.5
  • III.  CONSIDERATIONS BEFORE SEEKING REVIEW
    • A.  Difficulty of Overturning Board’s Decision  22.6
    • B.  Grounds for Review
      • 1.  Action Without or in Excess of Powers  22.7
      • 2.  Decision Procured by Fraud  22.8
      • 3.  Unreasonable Decision  22.9
      • 4.  Decision Not Supported by Substantial Evidence
        • a.  What Is “Substantial Evidence”?  22.10
        • b.  Board’s Fact-Finding Powers  22.11
        • c.  Power to Base Award on Hearsay Evidence  22.12
      • 5.  Failure of Findings to Support Decision
        • a.  Attacking Board Findings  22.13
        • b.  Typical Jurisdictional Facts on Which Findings Must Be Made  22.14
    • C.  Potential for Attorney Fees for Answering Petition Lacking Reasonable Basis  22.15
  • IV.  PLEADINGS AND PROCEDURES
    • A.  Petition for Writ of Review
      • 1.  Prerequisites
        • a.  Prior Petition for Reconsideration  22.16
        • b.  Final Decision  22.17
      • 2.  Procedural Requirements
        • a.  Time to File  22.18
        • b.  Where to File  22.19
        • c.  Method of Reproduction; Length  22.20
        • d.  Number of Copies  22.21
        • e.  Other Essential Requirements  22.22
      • 3.  Content and Format
        • a.  Components  22.23
        • b.  Cover  22.24
        • c.  Topical Index  22.25
        • d.  Table of Authorities Cited  22.26
        • e.  Title of Court and Cause  22.27
        • f.  Formal Address  22.28
        • g.  Opening Paragraph  22.29
        • h.  Allegations Identifying Parties and History of Claim
          • (1)  When Petitioner Is Employee  22.30
          • (2)  When Petitioner Is Dependent  22.31
          • (3)  When Petitioners Are Defendants  22.32
        • i.  Proceedings Before Board  22.33
        • j.  Grounds for Review Raised in Reconsideration Petition  22.34
        • k.  Questions Presented  22.35
        • l.  Incorporation of Points and Authorities  22.36
        • m.  Allegations Supporting Right to Petition
          • (1)  Petition Timely and Proper  22.37
          • (2)  No Right to Appeal  22.38
          • (3)  Residence and Beneficial Interest  22.39
        • n.  Prayer; Signature  22.40
        • o.  Verification
          • (1)  By Affidavit  22.41
          • (2)  By Declaration  22.42
          • (3)  Importance of Verification  22.43
        • p.  Exhibits  22.44
        • q.  Points and Authorities  22.45
          • (1)  Questions Presented  22.46
          • (2)  Statement of Material Facts  22.47
          • (3)  Argument and Authorities  22.48
          • (4)  Conclusion  22.49
      • 4.  Filing and Service
        • a.  Filing  22.50
        • b.  Service  22.51
      • 5.  Stay of Decision Pending Appellate Review  22.52
    • B.  Answer
      • 1.  Not Required But Always Filed  22.53
      • 2.  Who May File  22.54
      • 3.  Procedural Requirements
        • a.  Time to File; Copies  22.55
        • b.  Extension of Time
          • (1)  Stipulation Extending Time to File Answer  22.56
          • (2)  Application for Extension of Time to Answer  22.57
          • (3)  Order Extending Time to File Answer  22.58
      • 4.  Content and Format
        • a.  Same General Format as Petition  22.59
        • b.  Title When Attorney Fee Requested Under Lab C §5801  22.60
        • c.  Opening Paragraph  22.61
        • d.  Identification of Respondent; Denial of Allegations in Petition  22.62
        • e.  Allegation of Lack of Reasonable Basis for Petition  22.63
        • f.  Questions Presented  22.64
        • g.  Statement of Material Facts  22.65
        • h.  Argument and Authorities  22.66
        • i.  Conclusion  22.67
        • j.  Verification and Exhibits  22.68
      • 5.  Filing and Service  22.69
    • C.  Reply to Answer
      • 1.  Should Reply Be Made?  22.70
      • 2.  Time to File; Copies  22.71
      • 3.  Content and Format
        • a.  Same General Format as Petition; Exceptions  22.72
        • b.  Argument and Authorities  22.73
        • c.  Conclusion  22.74
      • 4.  Filing and Service  22.75
    • D.  Citation to New Authorities  22.75A
  • V.  DISPOSITION OF PETITION FOR WRIT OF REVIEW
    • A.  When Denied Without Hearing  22.76
    • B.  When Hearing Granted
      • 1.  Issuance of Writ of Review  22.77
      • 2.  Oral Argument
        • a.  Date  22.78
        • b.  Time Estimates  22.79
        • c.  Waiver  22.80
        • d.  Sequence of Presentations  22.81
      • 3.  Submission  22.82
      • 4.  Decision  22.83
    • C.  Appellate Costs  22.84
  • VI.  SUBSEQUENT PROCEEDINGS
    • A.  Petition for Rehearing in Court of Appeal
      • 1.  Not Available When Review Denied Without Opinion  22.85
      • 2.  When Review Granted  22.86
        • a.  Time to File; Copies  22.87
        • b.  Content and Format
          • (1)  Same General Format as Original Petition  22.88
          • (2)  Opening Paragraph  22.89
          • (3)  Questions Presented; Argument and Authorities  22.90
          • (4)  Prayer  22.91
      • 3.  Answer  22.92
      • 4.  Disposition  22.93
    • B.  Petition for Review by Supreme Court
      • 1.  Grounds  22.94
      • 2.  Time to File; Copies  22.95
      • 3.  Content and Format
        • a.  General Format; Page Limitation  22.96
        • b.  Caption, Formal Address, and Opening Paragraph  22.97
        • c.  Exhibits  22.98
      • 4.  Filing and Service  22.99
      • 5.  Answer  22.100
      • 6.  Reply to Answer  22.101
      • 7.  Petition May Be Denied Without Hearing  22.102
      • 8.  If Petition Is Granted  22.103
      • 9.  Oral Argument  22.104
      • 10.  Decision  22.105
    • C.  Petition for Rehearing in Supreme Court; Answer  22.106
  • VII.  REMITTITUR
    • A.  Nature  22.107
    • B.  Action of Board on Remittitur  22.108

23

Supplemental Proceedings

  • I.  BASES FOR CONTINUING JURISDICTION
    • A.  Statutory Authority  23.1
    • B.  Continuing Awards  23.2
    • C.  Issues Undecided in Original Proceedings  23.3
    • D.  Clerical Errors  23.4
    • E.  Enforcement of Award  23.5
  • II.  PETITIONS TO REOPEN
    • A.  Based on Good Cause (Lab C §5803)
      • 1.  Generally  23.6
      • 2.  Defendant’s Petition to Reopen  23.7
      • 3.  Time Limits
        • a.  Jurisdiction  23.8
        • b.  After Dismissal of Application  23.9
      • 4.  Condition Precedent  23.10
      • 5.  Good Cause
        • a.  Required Showing  23.11
        • b.  Examples  23.12
    • B.  Based on New and Further Disability (Lab C §5410)
      • 1.  Generally  23.13
      • 2.  Time Limits  23.14
      • 3.  Conditions Precedent  23.15
      • 4.  New and Further Disability Defined  23.16
    • C.  Procedure
      • 1.  Drafting the Petition  23.17
      • 2.  Response to Petition  23.18
      • 3.  Board Action on Petition to Reopen  23.19
      • 4.  Attorney Fees  23.20
    • D.  Table of Comparisons  23.21
    • E.  Form: Petition to Reopen (WCAB Form 42)  23.22
  • III.  TERMINATION OF LIABILITY
    • A.  Temporary Disability
      • 1.  Continuing Awards  23.23
      • 2.  Procedure for Terminating Liability  23.24
      • 3.  Effect of Vocational Rehabilitation on Petition to Terminate (Injuries Before January 1, 2004)  23.25
      • 4.  Form: Petition to Terminate Liability for Temporary Disability Indemnity (DWC/WCAB Form 46)  23.26
      • 5.  Objection to Petition to Terminate  23.27
    • B.  Further Medical Treatment  23.28
    • C.  Attorney Fees for Resisting Termination of Liability  23.29
    • D.  Automatic Termination of Liability  23.30
      • 1.  Statutory Limitation  23.31
      • 2.  Death  23.32
      • 3.  Credit for Third Party Recovery
        • a.  Right to Credit  23.33
        • b.  Amount of Credit  23.34
        • c.  Against Malpractice Recovery  23.35
        • d.  Against Attorney Fees; Against Other Recovery  23.36
  • IV.  PROCEEDINGS TO EVALUATE PERMANENT DISABILITY
    • A.  Permanent Disability  23.37
    • B.  Petition for Permanent Disability Rating  23.38
  • V.  CREDIT, RESTITUTION, AND LIENS
    • A.  Credit
      • 1.  Lab C §4909  23.39
      • 2.  Availability of Credit for Specific Types of Benefit Overpayments
        • a.  Temporary Disability  23.40
        • b.  Wage Payments  23.41
        • c.  Private Disability Plans  23.42
        • d.  Medical Expenses; Overpayment of Temporary Disability Indemnity and Permanent Disability Indemnity  23.43
        • e.  Labor Code §5814 Penalty  23.43A
        • f.  Social Security Disability Benefits  23.44
        • g.  Lab C §4850 Benefits  23.45
        • h.  Longshore and Harbor Workers’ Benefits  23.46
        • i.  Jurisdiction and Waiver  23.47
        • j.  Unilateral Credit  23.48
    • B.  Restitution
      • 1.  By Employee  23.49
      • 2.  By Lien Claimant  23.50
      • 3.  Examples of Restitution Orders  23.51
      • 4.  Restitution Under Ins C §§1871.4–1871.5  23.52
    • C.  Lien  23.53
  • VI.  CONTRIBUTION
    • A.  Nature of Proceeding  23.54
    • B.  Rights and Liabilities of Multiple Defendants  23.55
    • C.  Which Employers Are Liable  23.56
    • D.  Apportionment of Liability  23.57
    • E.  Time Limit for Filing Petitions for Contribution  23.58
    • F.  Form: Petition for Contribution Under Lab C §5500.5  23.59
    • G.  Contribution Proceedings  23.60
  • VII.  COMMUTATION OF WEEKLY PAYMENTS TO LUMP SUM
    • A.  Grounds; Timing  23.61
    • B.  Effect of Commutation  23.62
    • C.  Procedure
      • 1.  Form: Petition for Commutation of Future Payments (WCAB Form 49)  23.63
      • 2.  Request for Attorney Fees  23.64
      • 3.  Objection  23.65
      • 4.  Notice and Hearing  23.66
      • 5.  Determination
        • a.  Discretion of Workers’ Compensation Appeals Board  23.67
        • b.  Amount of Lump Sum  23.68
      • 6.  Order
        • a.  Full or Partial Commutation  23.69
        • b.  Commutation to Pay Lien Claims and Attorney Fees  23.70
        • c.  Prohibited Commutations  23.71
        • d.  Payment Restrictions  23.72
  • VIII.  OTHER SUPPLEMENTAL PROCEEDINGS
    • A.  Petition for Relief From Failure to Appear  23.73
    • B.  Correction of Clerical Errors  23.74

CALIFORNIA WORKERS' COMPENSATION PRACTICE

(4th Edition)

March 2019

TABLE OF CONTENTS

 

File Name

Book Section

Title

CH10

Chapter 10

Representing Injured Workers

10-007

§10.7

Potential New Client Questionnaire

10-008

§10.8

Letter Confirming Appointment

10-009

§10.9

Nonengagement Letter

10-017

§10.17

Supplementary Fee Disclosure Statement

10-020

§10.20

Venue Authorization

10-021

§10.21

Authorization for Release of Medical Information

10-022

§10.22

Authorization for Release of Psychiatric, Drug, and Alcohol Treatment Records

10-023

§10.23

Authorization for Release of Employment and School Records

10-026

§§10.26-10.30

Checklist: Injured Employee and Dependents

 

§10.27

Checklist: Employment Status

 

§10.28

Checklist: Earnings

 

§10.29

Checklist: Employer’s Insurance

 

§10.30

Checklist: Injury

10-031

§§10.31-10.34

Checklist: Injuries Resulting in Death

 

§10.32

Checklist: Prior Injuries or Disabilities

 

§10.33

Checklist: Medical Treatment and Expenses

 

§10.34

Checklist: Compensation to Date

10-035

§10.35

Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After 1/1/2004 and Before 1/1/2013)

10-035A

§10.35A

Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After January 1, 2013)

10-036

§10.36

Checklist: Claim Form; Procedural Information

10-038

§10.38

Letter of Representation to New Client

10-041

§10.41

Notice of Representation to Employer

10-043

§10.43

Letter to Insurer or Adjusting Agency

10-047

§10.47

Letter Designating Primary Treating Physician

10-048

§10.48

Letter Regarding Medical Bills Received by Applicant

10-056

§10.56

Letter to Worker Regarding Deposition

10-057

§10.57

Letter Requesting Payment for Fees and Costs Associated With Injured Worker’s Deposition

10-058

§10.58

Petition for Attorney Fees and Expenses for Injured Worker’s Deposition

10-059

§10.59

Letter Requesting Worker to Review Deposition Transcript

10-061

§10.61

Letter to Worker Regarding Medical Evaluation

10-063

§10.63

Letter to Doctor to File Lien

10-064

§10.64

Letter Notifying Worker of Hearing Request

10-065

§10.65

Letter Notifying Worker of Settlement Conference Date

10-070

§10.70

Letter Notifying Worker of Closed Case File

CH11

Chapter 11

Representing Defendants

11-022

§11.22

Statement of Employee’s Gross Earnings

11-029

§11.29

Compensation Litigation Transmittal Note

11-034

§11.34

Letter to Employment Development Department

11-037

§11.37

Letter Requesting Signed Social Security Earnings Release

11-042

§11.42

Applicant’s Deposition Worksheet

11-043

§11.43

Petition to Compel Answers to Questions and Production of Documents at Deposition

11-046

§11.46

Petition for Order Compelling Production of Psychiatric Records; Order

11-048

§11.48

Deposition Letter to Primary Treating Physician

11-049

§11.49

Petition to Compel Attendance at Medical Evaluation

11-055

§11.55

Petition for Joinder

11-057

§11.57

Letter to Employer Re: Lack of Coverage

11-058

§11.58

Letter to Applicant or Codefendant Re: Lack of Coverage

11-059

§11.59

Petition to Dismiss for Lack of Coverage; Order

11-061

§11.61

Petition to Strike Application (Lab C §4906(g), Declaration Missing); Order

11-062

§11.62

Petition to Dismiss—No Employment Within Last Year of Injurious Exposure

11-063

§11.63

Petition to Dismiss—No Coverage Within Last Year of Injurious Exposure

11-064

§11.64

Petition to Dismiss—Statute of Limitations

11-065

§11.65

Petition to Dismiss—Failure to Prosecute

11-081

§11.81

Objection to Medical-Legal Expense

11-085

§11.85

Objection to Medical Treatment Expense

11-088

§11.88

Petition for Credit for Third Party Recovery

11-089

§11.89

Petition for Restitution From Injured Worker

11-090

§11.90

Petition for Reimbursement From Codefendant

11-092

§11.92

Petition for Reimbursement of Paid Medical-Legal Expense

11-095

§11.95

Letter From Insurer’s Attorney Advising Employer of Serious and Willful Misconduct Petition

11-097

§11.97

Letter Advising Insured Employer of Petition Alleging Discrimination

CH12

Chapter 12

Time Limitations

12-010

§12.10

Notice of Injury

12-051

§12.51

Allegations of Incompetence, Competence Regained

CH13

Chapter 13

Filing With the Workers’ Compensation Appeals Board

13-021

§13.21

Parties Checklist

13-085

§13.85

Sample Allegations of Injury and Exposure

13-095

§13.95

Petition for Award for Employer’s Serious and Willful Misconduct

13-095A

§13.95A

Petition for Award for Employer’s Serious and Willful Misconduct—Violation of Safety Order (Lab C §4553.1)

13-101

§13.101

Cite or Refer Correctly to Safety Order or Statute

13-102

§13.102

State How Safety Order or Statute Was Violated

13-103

§13.103

Sample Allegation: General Misconduct

13-105

§13.105

Petition for Award Under Lab C §132a

13-113

§13.113

Declaration Under Lab C §4906(g)

13-150

§13.150

Answer to Petition and Request for Dismissal or Continuance

13-155

§13.155

Initial Appearance

CH14

Chapter 14

Gathering Evidence

14-011

§14.11

Authorization for Medical Information

14-034

§14.34

Declaration by Signing Physician

14-079

§14.79

Checklist: Deposition Information From Employee

CH16

Chapter 16

Settlement

16-034

§16.34

Addendum to Compromise and Release

16-043

§16.43

Sample Computation of Fair Allocation to Unemployment Compensation Disability Lien Claim (Baird Formula)

16-044

§16.44

Sample Computation of Lien Reduction Under Lab C §4903.1(a)(4)

16-077

§16.77

Preparation

16-084

§16.84

Sample Letter Requesting Fee (To Accompany WCAB Form 4)

CH17

Chapter 17

Preparing for Trial

17-040

§17.40

Petition for Automatic Reassignment to Another Workers’ Compensation Judge

17-042

§17.42

Petition to Disqualify Assigned Workers’ Compensation Judge

17-047

§17.47

Checklist: Refining Issues

17-079

§17.79

Additions to Employer’s Report of Occupational Injury or Illness

17-099

§17.99

Letter to Applicant’s Attorney Requesting Earnings Information

17-107

§17.107

Petition to Dismiss Application

17-108

§17.108

Petition to Dismiss for Lack of Prosecution (Injuries Occurring Before January 1, 1990, or On or After January 1, 1994)

17-110

§17.110

Petition to Dismiss Improperly Joined Insurer

17-111

§17.111

Petition to Join Additional Employers and Insurers

17-112

§17.112

Petition for Order Directing Exhumation and Autopsy

17-113

§17.113

Petition to Suspend Proceedings and to Compel Medical Examination

17-114

§17.114

Petition to Bar Applicant’s Right to Disability Payments

CH21

Chapter 21

Reconsideration

21-028

§§21.28-21.35

Caption; Introduction

 

§21.29

Preliminary Statement; Grounds

 

§21.30

Statement of Contentions

 

§21.31

Summary of Material Facts

 

§21.32

Argument

 

§21.33

Request for Transcript

 

§21.34

Prayer

 

§21.35

Signature; Verification

21-040

§21.40

Statement on Petition

21-041

§21.41

Statement in Letter of Transmittal

21-042

§21.42

Declaration of Service

CH22

Chapter 22

Judicial Review

22-024

§§22.24-22.26

Cover

 

§22.25

Topical Index

 

§22.26

Table of Authorities Cited

22-028

§§22.28-22.42

Formal Address

 

§22.29

Opening Paragraph

 

§22.30

When Petitioner Is Employee

 

§22.31

When Petitioner Is Dependent

 

§22.32

When Petitioners Are Defendants

 

§22.33

Proceedings Before Board

 

§22.34

Grounds for Review Raised in Reconsideration Petition

 

§22.35

Questions Presented

 

§22.36

Incorporation of Points and Authorities

 

§22.37

Petition Timely and Proper

 

§22.38

No Right to Appeal

 

§22.39

Residence and Beneficial Interest

 

§22.40

Prayer; Signature

 

§22.41

By Affidavit

 

§22.42

By Declaration

22-047

§22.47

Statement of Material Facts

22-056

§22.56

Stipulation Extending Time to File Answer

22-057

§22.57

Application for Extension of Time to Answer

22-058

§22.58

Order Extending Time to File Answer

22-060

§22.60

Title When Attorney Fee Requested Under Lab C §5801

22-061

§22.61

Opening Paragraph

22-062

§22.62

Identification of Respondent; Denial of Allegations in Petition

22-063

§22.63

Allegation of Lack of Reasonable Basis for Petition

22-064

§22.64

Questions Presented

22-065

§22.65

Statement of Material Facts

22-067

§22.67

Conclusion

22-074

§22.74

Conclusion

22-089

§22.89

Opening Paragraph

22-091

§22.91

Prayer

22-097

§22.97

Caption, Formal Address, and Opening Paragraph

22-098

§22.98

Exhibits

CH23

Chapter 23

Supplemental Proceedings

23-059

§23.59

Petition for Contribution Under Lab C §5500.5

 

Selected Developments

March 2019 Update

Chapter 2 (Jurisdiction)

  • The California Supreme Court held that claims against utilization review management companies for injuries allegedly resulting from an erroneous utilization review process fall within the compensation bargain because utilization review is a normal part of the claims process. See King v CompPartners, Inc. (2018) 5 C5th 1039, 1053, in §2.15.

  • The personal comfort doctrine did not apply when an employee died in a car accident—while returning to work from lunch at home—because the employee was not paid for lunch breaks and he could have eaten lunch on the premises. See Raquedan v WCAB (2018) 83 CCC 1708 (writ denied) in §2.21.

  • The Board Panel in Raquedan (see above) also held that the dual purpose exception did not apply when an employee’s working from home was neither an express nor an implied condition of employment, and the employer derived no benefit from the employee’s work at home. In addition, a Board Panel held that the dual purpose rule was inapplicable because there was no evidence that the decedent’s activities at the time of his fatal injury benefitted his employer in any way. Although the decedent initially went to his employer’s business to set up the machines for the day, he then left to take his daughter to school and returned to his own business for an appointment with a customer for a dynamometer test, which was “exactly” what decedent was in business for, but was not something that was relevant to his employer’s head porting business. Salceda v WCAB (2018) 83 CCC 719 (writ denied). See §2.44A.

  • The Board Panel in Raquedan (see above) also held that the going and coming rule barred a surviving spouse’s claim for death benefits, when the decedent was killed in a car accident while returning to work from lunch at home. See §2.46.

  • Recent examples of the special mission or errand doctrine are Los Angeles County Metro. Transp. Auth. v WCAB (Estel) (2018) 83 CCC 715 (writ denied; attending week-long training at employer’s request that took place during opposite work shift from employee’s regular shift and that involved different duties and equipment than those that employee used in his regular work, even though commute to training was same as his regular commute) and Robles v Southern Cal. Gas Co. (Mar. 12, 2018, ADJ8075448) 2018 Cal Wrk Comp P.D. Lexis 98 (attending study day during ongoing contract negotiations, when employer expressly agreed that employee, who served as regional officer for union, should attend and be paid his full wages for day). See §2.48.

  • The applicant did not show that the decedent’s suicide was the result of a psychiatric injury when the Agreed Medical Evaluator (AME) stated in deposition that actual events of employment accounted for 20 percent of all causes of the decedent’s psychiatric injury. See Rockefeller v WCAB (2018) 83 CCC 1588 (writ denied) in §2.53.

  • A recent example of the “sudden and extraordinary” exception in Lab C §3208.3(d) is State Compensation Ins. Fund v WCAB (Guzman) (2018) 20 CA5th 796, 810, 83 CCC 185, in which a construction laborer was injured when the compactor he was using to pack down soil hit a rock while he was working on a hillside with a 45-degree angle, causing the compactor to rise in the air, the laborer to fall backwards, and the compactor to fall on top of him. The court determined that this did not constitute a “sudden and extraordinary employment condition” because there was no evidence that it was uncommon, unusual, and totally unexpected for there to be a rock in soil or for a compactor to be used on a slope (even if the laborer had never personally done so) and because the laborer had been using the compactor on the slope for approximately 30 minutes before the accident occurred. See §2.54A.

  • The defendant did not carry its burden under Lab C §3208.3(h) when it made no attempt to have the qualified medical evaluator (QME) parse out causation of personnel actions versus non-personnel actions. See Contra Costa Water Dist. v WCAB (Kirby) (2018) 83 CCC 366 (writ denied) in §2.56.

  • An athlete’s presence in California may be brief, but he or she must still actually be present in California during the relevant time period. Sutton v San Jose Sharks (May 16, 2018, ADJ9314776) 2018 Cal Wrk Comp P.D. Lexis 249 (applicant who spent no time in California during relevant time period could not claim exemption under Lab C §3600.5(c)). See §2.74B.

  • Even though professional football player’s employment contract with Indianapolis Colts was negotiated by his agent in California, it did not confer California jurisdiction when the contract was signed outside of the state. See Tripplett v WCAB (2018) 25 CA5th 556, 563, 83 CCC 1175, in §2.90.

Chapter 3 (Medical Treatment)

  • Because a prescription for home health care services need not contain a detailed description of the recommended services to be valid, the AME’s report simply stating that the applicant needed home health care services was sufficient. See United States Fire Ins. v WCAB (Kamakeeaina) (2018) 83 CCC 906 (writ denied) in §3.8.

  • The mileage reimbursement rate for medical and medical-legal travel expenses for 2019 has increased to 58 cents per mile. See §3.14.

  • That the request for authorization was signed not by the treating physician but by someone in his office did not excuse the defendant’s failure to act on it in a timely manner when the defect was curable and the treating physician signed the narrative report that formed the basis of the request. See San Francisco 49ers v WCAB (Visger) (2018) 83 CCC 1434 (writ denied) in §3.67.

  • The claims adjuster improperly modified a treatment request for eight sessions with a chiropractic neurologist when the adjuster authorized treatment with chiropractor. See Ives v DR Myers Distrib. Co. (Apr. 30, 2018, ADJ11025609) 2018 Cal Wrk Comp P.D. Lexis 184 in §3.70.

  • A defendant’s request for additional information following submission of a request for authorization was untimely because it was not made within 5-day deadline when the defendant mistakenly counted the Friday after Thanksgiving as a holiday. See California Dep’t of Corrections & Rehabilitation v WCAB (Gomez) (2018) 83 CCC 530 (writ denied) in §3.75.

Chapter 4 (Temporary Disability)

  • The Workers’ Compensation Appeals Board (WCAB) has no authority to award temporary disability benefits for any period of disability occurring more than 5 years from the date of injury. This is true even if the period of disability begins within 5 years of the date of injury and continues beyond the 5-year limit. See County of San Diego v WCAB (Pike) (2018) 21 CA5th 1, 83 CCC 465, in §4.9.

  • The removal of bone from the applicant’s thumb combined with the shortening of his thumb by 7 mm constituted an “amputation” as used in Lab C §4656(c)(3). See Parco, Inc. v WCAB (Martinez) (2018) 83 CCC 1288 (writ denied) in §4.11.

  • The statutory minimum and maximum average weekly earnings (AWE) for dates of injury in 2019 have increased to $281.57 and $1877.09. See §4.25.

  • Unemployment insurance benefits are not earnings for purposes of calculating the temporary disability rate of a seasonal worker. See Cerna v Eckert Cold Storage Co. (Apr. 18, 2018, ADJ10092023) 2018 Cal Wrk Comp P.D. Lexis 145 in §4.43.

  • It remains unclear whether an employee’s entitlement to maximum AWE under Lab C §4458.5 is dependent on whether the employee first qualifies for one of the listed statutory presumptions that the injury is work-related. A recent Board Panel held that the “language of [Lab C §4458.5] does not state that it applies only to the presumptions that existed at the time the section was enacted in 1978, but refers to those presumption sections for the ‘time prescribed’ therein for raising claims of injury that arise after the termination of public service employment.” See Sillers v City of Pleasant Hill (Feb. 23, 2018, ADJ10553459) 2018 Cal Wrk Comp P.D. Lexis 77 in §4.44.

Chapter 5 (Permanent Disability)

  • The presumption of total permanent disability in Lab C §4662(a) did not apply to a near paraplegic because “practically total paralysis” requires near quadriplegia. See Burr v The Best Demolition & Recycling Co. (Apr. 19, 2018, ADJ6860504) 2018 Cal Wrk Comp P.D. Lexis 143 in §5.6.

  • The court of appeal in Department of Corrections & Rehabilitation v WCAB (Fitzpatrick) (2018) 27 CA5th 607, 83 CCC 1680, harmonized Lab C §§4660 and 4662(b) by holding that Lab C §4662(b) simply provides that in nonconclusively presumed cases, permanent total disability is determined by the facts of the case, and that Lab C §4660 provides the manner in which that determination based on the facts is to be made, i.e., by using the 2005 Schedule for injuries occurring before January 1, 2013. See §5.7.

  • In cases involving state inmates whose injuries arise out of assigned work, the occupational group number associated with laborer (460) is used. See California Dep’t of Corrections & Rehabilitation v WCAB (Potter) (2018) 83 CCC 1060 (writ denied) in §5.37.

  • A vocational expert failed to rebut a scheduled rating under Ogilvie when she “opined that Applicant was not amenable to vocational rehabilitation due to ‘a combined, interactive, and synergistic’ effect of many factors, including being monolingual in Spanish and having limited education and poor test scores.” See Sandoval v WCAB (2018) 83 CCC 902 (writ denied) in §5.56.

  • To properly rebut a permanent disability rating, the physician must (1) provide a strict rating under the AMA Guides; (2) explain why that strict rating does not accurately reflect the employee’s impairment; (3) provide an alternative rating within the four corners of the AMA Guides; and (4) explain why that alternative rating most accurately reflects the employee’s level of impairment. See Golden Gate Bridge v WCAB (Case) (2018) 83 CCC 1704 (writ denied) in §5.58.

  • The statutory minimum and maximum average weekly earnings (AWE) for dates of injury in 2019 have increased to $281.57 and $1877.09. See §5.78.

  • If the employee dies, the employer’s liability for disability indemnity (temporary or permanent) terminates on the date of death. See Wilson v WCAB (2018) 83 CCC 1291 (writ denied) in §5.83.

  • An injured employee’s entitlement to permanent disability indemnity is not limited simply because he or she self-procured medical treatment. For a recent example, see Sutter Solano Med. Ctr. v WCAB (Go) (2018) 83 CCC 381 (writ denied) in §5.87.

  • To support apportionment, it is not necessary that the medical evidence shows that an asymptomatic preexisting condition, by itself, would eventually become symptomatic; “[r]ather, what is required is substantial medical evidence that the asymptomatic condition or pathology was a contributing cause of the disability.” City of Petaluma v WCAB (Lindh) (2018) 29 CA5th 1175, 1193, 83 CCC 1869. See §5.102.

  • Liability for permanent disability indemnity may be “apportioned” among employers or their insurance carriers when more than one period of exposure contributes to the applicant’s injury. See First Foursquare Church v WCAB (Austin) (2018) 83 CCC 1821 (writ denied; successive employers liable for respective portion of applicant’s multiple periods of cumulative injury) in §5.104.

  • An applicant must present contemporaneous evidence establishing that he or she had a labor-disabling disability before the subsequent industrial injury. Lopez v WCAB (2018) 83 CCC 543 (writ denied; applicant was not entitled to subsequent injuries benefits trust fund (SIBTF) benefits when determination of eligibility was based solely on AME’s speculative reporting and not on any contemporaneous medical records establishing nature and extent of applicant’s condition before subsequent industrial injury). See §5.110.

Chapter 6 (SJDB/RTW)

  • The defendant’s offer was not a bona fide offer because when the defendant made it, the applicant had been released from prison and could not return to work (RTW). See California Dep’t of Corrections & Rehabilitation v WCAB (Potter) (2018) 83 CCC 1060 (writ denied) in §6.13.

  • In Salcido v Option Care Enters., Inc. (Mar. 30, 2018, ADJ10542767) 2018 Cal Wrk Comp P.D. Lexis 135, the applicant was not entitled to conduct additional discovery to support his claimed entitlement to a supplemental job displacement benefit (SJDB) when the reporting indicated no permanent disability, the parties elected to settle without obtaining any additional reporting, and the terms of the compromise and release settled all issues relating to permanent disability. See §6.23A.

Chapter 8 (Penalties)

  • Return-to-work supplement payments are made by the Administrative Director and are not “compensation” subject to a penalty under Lab C §5814. See McFarland v WCAB (2018) 83 CCC 371 (writ denied) in §8.25.

  • The foreman at a construction site where the applicant was injured was an “executive or managing officer” under Lab C §4553 because he was the foreman, was the person to contact the general superintendent following the accident, and had authority to assign employees to dump material of the roof, which is what applicant was doing when he was injured. See B&B Roof Preparation, Inc. v WCAB (Leyva) (2018) 83 CCC 1055 (writ denied) in §8.43.

Chapter 9 (Dispute Resolution Procedures)

  • The Appeals Board has no authority to order the disclosure of the identity of independent medical review (IMR) reviewers. See Zuniga v WCAB (2018) 19 CA5th 981, 989, 83 CCC 1, in §9.20.

  • At least 20 days before providing information to the QME or AME, the party proposing to provide it must serve the information on the opposing party. See Suon v California Dairies (2018) 83 CCC 1803 (WCAB en banc) in §9.45.

  • The defendant violated Lab C §4062.3(b) by sending a job description purporting to reflect the applicant’s current position to the QME without first serving it on the applicant. See Pettit v Ventura Reg’l Sanitation Dist. (June 1, 2018, ADJ9869800) 2018 Cal Wrk Comp P.D. Lexis 271 in §9.45.

  • If the opposing party objects to any nonmedical information proposed to be sent to a QME or AME within 10 days, that information must not be provided to the evaluator unless a workers’ compensation judge (WCJ) orders the information to be provided. Wachiuri v Torrance Mem. Med. Ctr. (2018) 83 CCC 1494 (WCAB panel; striking language from defendant’s proposed advocacy letter disclosing reasons for claim’s denial that are irrelevant to determination of medical issues in dispute as well as inclusion of two denial notices). The opposing party must object to proposed medical information within a reasonable time to preserve the objection, and the failure to do so at the first opportunity may be construed as an implicit agreement to providing the information to the evaluator. Suon v California Dairies (2018) 83 CCC 1803 (WCAB en banc). See §9.46.

  • In fashioning a remedy for a violation of Lab C §4062.3(b), the WCJ has wide discretion and should consider the factors listed in Suon v California Dairies (2018) 83 CCC 1803 (WCAB en banc). See §9.46A.

  • A 6-minute phone call initiated by the QME to the applicant’s attorney’s office in which he discussed the applicant’s serious psychological condition, including his symptoms, as well as the QME’s diagnoses was an impermissible ex parte communication because it “essentially disclosed [QME’s] substantive findings as a psychiatric medical-legal evaluator.” See Amedee v Pacific Bell Tel. Co. (Feb. 22, 2018, ADJ8935903) 2018 Cal Wrk Comp P.D. Lexis 63 in §9.47.

  • If the aggrieved party wants to terminate a medical-legal evaluation, that party must exercise its right within a reasonable time following discovery of the prohibited communication, and conduct that is inconsistent with an intent to terminate the evaluation may be construed as waiving the right to that remedy. See Suon v California Dairies (2018) 83 CCC 1803 (WCAB en banc; “Inaction by the aggrieved party following discovery of the ex parte communication is in effect an election to proceed with the QME”) in §9.47.

  • The Medical Unit was required to issue a replacement panel as requested by the applicant, when the appointment with the original QME was not scheduled within the 60-day time limit, the applicant unilaterally scheduled the appointment for a date 90 days after the initial appointment request, and the parties did not agree to waive the 90-day time limit. See Oceanside Unified Sch. Dist. v WCAB (Orea) (Oct. 23, 2018, D074826) 2018 Cal Wrk Comp Lexis 105 in §9.48.

  • The Board Panel in Sosa v Advanced Knitting Mills (May 4, 2018, ADJ10614689) 2018 Cal Wrk Comp P.D. Lexis 193 rescinded the WCJ’s order for a QME in a second specialty when the initial QME’s report stating that the applicant needed a referral to an orthopedic specialist for “evaluation and treatment” was properly interpreted as a treatment recommendation rather than as a recommendation for an additional medical-legal evaluation. See §9.66.

Chapter 12 (Time Limitations)

  • The applicant’s “mere correlation” of psychiatric injury with work was insufficient to establish the requisite knowledge under Lab C §5412 when the applicant did not possess any special training, intelligence, or qualifications to obviate the need for medical advice regarding the cause of her disability. See County of San Bernardino v WCAB (Turner) (2018) 83 CCC 1282 (writ denied) in §12.5.

  • The running of a statute of limitations against an employee may be suspended (tolled) for the length of time, after 1 day, that the employer failed to provide the required claim form and notice, and failure to provide the claim form may estop the employer from later asserting that the employee’s claim is barred by the statute of limitations. See County of San Bernardino v WCAB (Griffin) (2018) 83 CCC 1278 (writ denied) in §§12.16, 12.60.

  • In Terry v WCAB (2018) 83 CCC 1064 (writ denied), the parties agreed that the decedent’s death from a car accident was caused in part by an industrial injury that occurred more than 240 weeks before the date of death. Although the claim for death benefits was filed within 1 year of decedent’s death, it was nonetheless barred because it was not filed within 240 weeks of the date of decedent’s industrial injury. The car accident did not create a new date of injury because decedent’s death was a compensable consequence of the industrial injury, in which case the subsequent injury (car accident) is deemed to relate back to the original industrial injury. See §12.39.

Chapter 14 (Gathering Evidence)

  • Labor Code §4061(i) does not require that medical reports all find the applicant to be permanent and stationary or that they address permanent disability. See Bustos v WCAB (2018) 83 CCC 378 (writ denied; although none of applicant’s primary treating physicians found him to be permanent and stationary, WCJ properly relied on panel QME’s report to determine permanent disability) in §14.46.

Chapter 18 (Trial)

  • Failure to raise an issue at the first hearing in which it may properly be raised can result in waiver of the issue. See First Foursquare Church v WCAB (Austin) (2018) 83 CCC 1821 (writ denied; issue of whether applicant sustained one or multiple cumulative trauma injuries could not be raised for first time after trial; prior litigation on issue of date of injury did not preserve question of whether applicant suffered separate injuries) in §18.9.

  • The applicant did not meet his burden of proving that his sarcoidosis and erythema nodosum was arising out of employment/course of employment (AOE/COE) when the agreed medical evaluator (AME) was unable to identify even a potential industrial agent or trigger that increased the likelihood of applicant’s developing these conditions. See Sayre v WCAB (2018) 83 CCC 374 (writ denied) in §18.21.

  • When two or more successive employers are subject to the presumption in Lab C §3212.1, the “no reasonable link” rebuttal standard does not apply in determining which of the employers are liable. See City of S. San Francisco v WCAB (2018) 20 CA5th 881, 893, 83 CCC 451 (first employer properly found liable, when cancer manifested within 5 years after service with that employer and latency period of particular cancer was at least 10 years) in §18.43.

  • The defendant failed to rebut application of presumption in Lab C §3212.1 when the panel QME could not rule out that the latency period for the applicant’s cancer was less than the generally accepted minimum 10 years based on specific factors he found present in applicant’s case. See City of Pittsburg v WCAB (Ligouri) (2018) 83 CCC 711 (writ denied) in §18.43.

  • Premature ventricular contractions (PVCs) qualified as “heart trouble” under Lab C §3212 even though PVCs had not restricted the applicant’s activities of daily living and do not rise to the level of a ratable disability because the condition creates a need for medical treatment sufficient to support a finding of cumulative trauma. See County of El Dorado v WCAB (Silvestri) (2018) 83 CCC 1420 (writ denied) in §18.43.

  • Herpes/Epstein-Barr virus exposure justified the application of the presumption in Lab C §3212.8. See Molar v Department of Corrections & Rehabilitation (Jan. 22, 2018, ADJ9431933) 2018 Cal Wrk Comp P.D. Lexis 35 in §18.43.

  • The defendant was not denied the right to due process and a fair hearing when the applicant refused to answer questions at trial based on the Fifth Amendment because the defendant did not make any offer of proof as to what questions it sought to ask, but was prevented from asking, that were directly relevant to the defense of applicant’s claim. See Federal Ins. Co. v WCAB (Shemet) (2018) 83 CCC 895 (writ denied) in §18.48.

Chapter 21 (Reconsideration)

  • Two recent cases found removal proper: Suon v California Dairies (2018) 83 CCC 1803 (WCAB en banc; removal proper to challenge decision regarding party’s improper provision of information to qualified medical evaluator (QME) or ex parte communication with QME) and Sosa v Advanced Knitting Mills (May 4, 2018, ADJ10614689) 2018 Cal Wrk Comp P.D. Lexis 193 (removal proper to review WCJ’s finding that good cause existed for appointment of additional QME panel). See §21.5.

Chapter 23 (Supplemental Proceedings)

  • An applicant’s petition to reopen based on new and further disability does not give the WCAB jurisdiction to consider the employer’s claim to decrease the award. See Star Ins. Co. v WCAB (Sanchez) (2018) 83 CCC 548 (writ denied; WCAB could not consider defendant’s claim that applicant’s disability actually decreased, when defendant failed to timely file either petition to reopen within 5 years of date of injury or counterpetition within 30 days of petition to reopen) in §23.7.

  • Although the petition to reopen was timely filed, the applicant failed to amend the petition to include psyche and internal injuries until after the 5-year period had elapsed and such injuries did not arise until more than 5 years after the date of the original injury. See Villa v WCAB (2018) 83 CCC 1438 (writ denied) in §23.14.

  • Petitions to reopen are liberally construed, and almost any document that reasonably indicates that the case should be reopened is effective to start proceedings. See Star Ins. Co. v WCAB (Sanchez) (2018) 83 CCC 548 (writ denied; even absent affirmative allegation of “new and further disability,” applicant’s statements that she “may” have additional disability and that her “condition has steadily worsened” were sufficient to give WCAB jurisdiction to consider petition). See §23.17.

About the Authors

BRETT A. BORAH received his B.A. in 1972 from the University of California, Berkeley, and his J.D. in 1979 from the University of California, Hastings College of the Law. He is a partner in the firm of Scher & Bassett, specializing in workers’ compensation law. Mr. Borah is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization. Mr. Borah has served as vice-chair of the State Bar Workers’ Compensation Law Advisory Commission and as chair of the Executive Committee of the Workers’ Compensation Section of the State Bar. He is presently on the Board of Governors of the California Applicants’ Attorneys Association.

ROBERT E. BUCH received his B.A. in 1969 and his M.S. in 1970 from the University of Southern California and his J.D. in 1973 from Loyola University School of Law. He is a partner in the firm of Seyfarth, Shaw, Fairweather & Geraldson, specializing in workers’ compensation law. Mr. Buch is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization. He is a former chairman of the Workers’ Compensation Law Advisory Commission and is presently on the State Bar Board of Legal Specialization.

COLLEEN S. CASEY received her B.A. from the University of California, Berkeley, and her J.D. from Golden Gate University School of Law. She is a commissioner for the Workers’ Compensation Appeals Board in San Francisco.

FREDERICK T. DIETRICH, JR., received his B.S. in 1970 from the University of San Francisco, his Master’s of Industrial and Labor Relations in 1972 from Cornell University, and his J.D. in 1978 from San Francisco Law School. He is an assistant secretary and deputy commissioner for the Workers’ Compensation Appeals Board. Mr. Dietrich is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

HON. PAMELA W. FOUST received her B.A. in 1966 from the University of California, Los Angeles, and her J.D. from the University of West Los Angeles, where she graduated cum laude in 1978. Judge Foust is with the Workers’ Compensation Appeals Board in Santa Monica.

RAYMOND E. FROST received his B.A. in 1972 from San Jose State University and his J.D. in 1977 from the University of La Verne College of Law. He is in private practice in Fremont, specializing in workers’ compensation law. In addition, he serves regularly as a judge pro tem and as an arbitrator for the Alameda County Superior Court. Mr. Frost is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

GLEN J. GROSSMAN received his B.A. in 1977 from State University College of New York at Geneseo and his J.D. in 1980 from the New England School of Law. He is a staff counsel for the State Compensation Insurance Fund in Salinas, specializing in workers’ compensation defense. Mr. Grossman is a past member of the Executive Committee of the Workers’ Compensation Section of the State Bar (1996–1999) and is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

DENNIS J. HANNIGAN received his B.A. in 1968 from the University of California, Davis, and his J.D. in 1971 from the University of California, Hastings College of the Law. He is a secretary and deputy commissioner for the Workers’ Compensation Appeals Board. Mr. Hannigan was co-author of the California Workers’ Compensation Practice Update from 1992 through 1999.

SALLY M. HARMS attended University of California, Berkeley, and received her J.D. in 1986 from New College of California, School of Law. Ms. Harms, a partner in the San Francisco firm of Lieberman & Harms, specializes in workers’ compensation, representing longshore and harbor workers. She is past chair of the Executive Committee of the Workers’ Compensation Section of the State Bar and is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

YALE I. JONES received his B.A. in 1963 from Stanford University and his J.D. in 1966 from the University of California, Los Angeles, School of Law. He is a partner in the San Francisco firm of Jones, Clifford, McDevitt & Johnson, specializing in workers’ compensation law. Mr. Jones is the past chair of the Board of Legal Specialization of the State Bar and past chair of the State Bar Committee on Workers’ Compensation (1985–1986). He is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization and is a frequent speaker at seminars on workers’ compensation law.

BARRY M. LESCH received his B.A. in 1965 from the University of Pennsylvania, his M.A. in 1971 from Indiana University, and his J.D. in 1975 from the University of California, Berkeley, School of Law. He is the managing partner with Laughlin, Falbo, Levy & Moresi in Sacramento, specializing in workers’ compensation law. He is also the legal editor of the California Workers’ Compensation Reporter. Mr. Lesch is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

DEBORAH LIEBERMAN attended the Hebrew University of Jerusalem and received her J.D. in 1986 from New College of California, School of Law. She is a partner in the San Francisco firm of Lieberman & Harms, specializing in workers’ compensation law. Ms. Lieberman is a current member of Executive Committee of the Workers’ Compensation Section of the State Bar and a past member of the Workers’ Compensation Advisory Commission to the California Board of Legal Specialization (1995–1998). She was a contributing editor for California Compensation Cases (1990–1994). Ms. Lieberman is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

JAMES P. PETTIBONE received his B.A. in 1981 and his J.D. in 1987 from the University of San Francisco. He is a partner in the firm of Laughlin, Falbo, Levy & Moresi in Sacramento, specializing in workers’ compensation law.

PAUL PEYRAT received his B.A. in 1955 and his J.D. in 1958 at the University of Minnesota. He was a legal editor for the third edition of California Workers’ Compensation Practice and is the author of California Workers’ Damages Practice and a contributing editor for the California Workers’ Compensation Reporter.

FRANK D. RUSSO received his B.A. in 1973 from Yale University and his J.D. in 1976 from the University of California, Berkeley, School of Law. He is a partner in the firm of Russo, Uriarte & Carr in Oakland, specializing in workers’ compensation law. Mr. Russo is a member and past president (1997–1998) of the California Applicants’ Attorneys Association. He is a frequent lecturer at seminars on workers’ compensation law and is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

ANDREW K. SHAFFER received his B.A. in 1989 from Brown University and his J.D. in 1995 from Santa Clara University. He is an associate with the firm of Scher & Bassett specializing in workers’ compensation and Social Security disability. He is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

PATRICIA S. STEPHENS received her B.A. in 1977 from California State University, Dominguez Hills, and her J.D. in 1987 from the University of California, Hastings College of the Law. She is a senior judicial attorney, workers’ compensation specialist, at the Court of Appeal, Second Appellate District, Los Angeles.

CHARLES LAWRENCE SWEZEY received his A.B. in 1943 from Cornell University and his LL.B. in 1948 from Stanford University. He was a member of the California Workers’ Compensation Appeals Board from 1974 to 1975 and from 1979 until his retirement in 1988. Currently, he is a legal consultant for the Commission on Health and Safety and Workers’ Compensation and a contributing editor for the California Workers’ Compensation Reporter.

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