California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board

163 Cal. App. 4th 853, 77 Cal. Rptr. 3d 868, 2008 Cal. App. LEXIS 834, 2 Cal. WCC 613
CourtCalifornia Court of Appeal
DecidedJune 4, 2008
DocketB199404
StatusPublished
Cited by4 cases

This text of 163 Cal. App. 4th 853 (California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board, 163 Cal. App. 4th 853, 77 Cal. Rptr. 3d 868, 2008 Cal. App. LEXIS 834, 2 Cal. WCC 613 (Cal. Ct. App. 2008).

Opinions

Opinion

MANELLA, J.—

INTRODUCTION

We granted the petition of the California Insurance Guarantee Association (CIGA) for a writ of review, filed after the Workers’ Compensation Appeals Board (WCAB or Board) denied CIGA’s petition for reconsideration of an award of benefits to injured worker David Carls.1 CIGA contends the Board erred in rejecting its statute of limitations defense.2 CIGA admits that the statutory period was tolled by the employer’s failure to advise Carls of his rights under the workers’ compensation law; however, it contends that Carls had actual knowledge of his rights more than one year before Carls filed a claim for benefits, causing the statutory period to run. CIGA also challenges the Board’s finding that CIGA was estopped to assert the statute of limitations due to its delay in determining that the 1997 injury was a covered claim. Because CIGA has failed to show that it carried its burden to prove [857]*857actual knowledge sufficient to end the tolling of the statute of limitations, we reject its first contention. We also reject CIGA’s substantial evidence challenge to the estoppel finding. We conclude that on the record presented, the Board did not err in rejecting CIGA’s statute of limitations defense, and we affirm the order denying reconsideration.

BACKGROUND

The material facts are undisputed. After we issued the writ of review, injured worker David Carls filed an answer admitting all material allegations of the petition, and adopting the petition’s statement of facts as his own. Our summary is taken from the admitted allegations and the administrative record provided by the WCAB.

Carls was employed by Claremont Colleges as a sign painter. In 1996, he sustained a work injury to his left shoulder and neck, filed a workers’ compensation claim and received temporary disability payments. In 1997, Carls injured his back after arriving at work two hours early. Although he notified his employer, the employer did not advise him of his potential eligibility for workers’ compensation, and did not furnish him with a claim form, as required by law.3 In 1999, Carls retained an attorney, Larry D. Rosenstein, who filed an application to adjudicate Carls’s right to additional benefits relating to the 1996 injury. Carls did not file a claim for workers’ compensation benefits for the 1997 injury until 2004.

In August 2002, when the claim for additional benefits for the 1996 injury was called for trial, the workers’ compensation judge (WCJ) placed the matter off calendar to allow Carls to file a new or amended claim for the 1997 injury, but no new claim was presented until March 8, 2004, when Carls filed an application for adjudication of his claim for the 1997 injury. As a defense to the claim, CIGA raised the one-year statute of limitations set forth in section 5405, subdivision (a).

The 1996 and 1997 claims were consolidated for trial, which went forward in October 2004. Carls testified that when he injured his back in 1997, he reported the injury to Steve (his supervisor), who did not provide him with a claim form. Carls also spoke to Belinda Ochoa (apparently the employer’s workers’ compensation manager), who questioned why he had come to work so early. Because Ochoa “gave him a ‘hard time,’ ” Carls went to his own doctor for treatment. He never received a letter from his employer advising him of his right to file a workers’ compensation claim.

[858]*858The reports and deposition of Dr. Jon Greenfield, the physician who conducted the agreed medical examination (AME), were admitted into evidence. In his July 23, 2001 AME report, Dr. Greenfield noted that in 1997, Carls had injured his back and reported the injury to his employer. A notation on the signature page of the AME indicated that a copy of the AME report was sent to Rosenstein. Dr. Greenfield also reviewed and summarized Carls’s medical records relating to treatment for the 1996 injury by Dr. Edward D. Amorosi and Dr. Ronald B. Perelman.4

Also in evidence were several of Dr. Perelman’s reports. As early as 1999 Dr. Perelman sent a report to Rosenstein, in which he wrote: “In the latter part of 1997, while at work, [Carls] states that he stepped in a hole and twisted his body, which caused severe pain in his low back and right lower extremity. He states that this occurred about two hours before the start of his shift. He went to the office, laid [sic] on the floor and propped his legs up in a chair .... Thereafter, he reported the injury to his [foreman] and an injury report was completed. Apparently, he was told this injury took place prior to his shift and this was not considered work related.”

In May 2005, the WCJ issued his findings and award, ruling that the claim was not barred by the statute of limitations. CIGA filed its first petition for reconsideration of that decision. Before it was heard, the WCJ rescinded the order, conducted further proceedings, and in April 2006, issued his amended findings and award. CIGA filed a second petition for reconsideration, which was granted. Finding the record inadequate to allow meaningful review, the Board rescinded the award and findings, and returned the matter for further proceedings.

After considering additional evidence, the WCJ again rejected CIGA’s statute of limitations defense and entered an award. CIGA again petitioned the Board for reconsideration. In his report and recommendation regarding the petition for reconsideration, the WCJ found that, although Carls had filed his claim for benefits more than one year after his workplace injury, the statute was tolled by the failure of the employer, insurer, or CIGA to notify Carls of his right to claim benefits. Citing testimony by Carls that he was not sure that he had seen Dr. Greenfield’s reports attributing his back pain to the 1997 injury, the WCJ found that CIGA had not met its burden to prove that Carls had actual knowledge of his right to claim workers’ compensation [859]*859benefits for the 1997 injury. In addition, the WCJ concluded that CIGA was estopped from raising the statute of limitations because its conduct in failing to admit coverage for the 1997 injury until May 2003 “ultimately delayed applicant’s filing of the Application for Adjudication . . . .”

The WCAB adopted the WCJ’s report and recommendation, and incorporated them into its order denying reconsideration. On January 25, 2007, the WCJ entered a compensation award for the 1997 injury, and after the WCAB denied CIGA’s petition for reconsideration of that order, CIGA timely filed its petition for review by this court. We granted the petition and issued the writ January 31, 2008.

DISCUSSION

1. CIGA’s Contentions

CIGA contends that the one-year statute of limitations barred Carls’s claim for benefits for his 1997 back injury. As CIGA acknowledges, the statute is tolled by an employer’s failure to notify its injured employee of a potential right to benefits, as required by section 5401, subdivision (a). (See Kaiser Foundation Hospitals v. Workers’ Comp. Appeals Bd. (1985) 39 Cal.3d 57, 60 [216 Cal.Rptr. 115, 702 P.2d 197] (Kaiser).)

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Bluebook (online)
163 Cal. App. 4th 853, 77 Cal. Rptr. 3d 868, 2008 Cal. App. LEXIS 834, 2 Cal. WCC 613, Counsel Stack Legal Research, https://law.counselstack.com/opinion/california-insurance-guarantee-assn-v-workers-compensation-appeals-board-calctapp-2008.