Rodriguez v. Workers' Compensation Appeals Board

30 Cal. App. 4th 1425, 35 Cal. Rptr. 2d 713, 94 Cal. Daily Op. Serv. 9358, 94 Daily Journal DAR 17293, 59 Cal. Comp. Cases 857, 1994 Cal. App. LEXIS 1215, 1994 WL 627382
California Court of Appeal·Decided November 10, 1994·No. F020987·Published·Cited by 1 cases

Opinion

Opinion

ARDAIZ, P. J.

This case involves an interpretation of section 5402 of the Labor Code. Section 5401 of the Labor Code provides that an injured *1427 employee who seeks workers’ compensation benefits shall file with the employer a completed claim form advising the employer of the employee’s name and address, Social Security number, time of the injury and address where the injury occurred, the nature of the injury and the part of the body affected by the injury. Section 5402 states in relevant part: “If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division. The presumption is rebuttable only by evidence discovered subsequent to the 90-day period.” We are here concerned with what an employer must do in order for liability to be “rejected” within the meaning of section 5402. We conclude that rejecting liability is not the same thing as notifying the employee of the rejection, and that the statute requires only the former to occur within the 90-day period in order for the employer to avoid the presumption of compensability.

Facts and Procedural History

Petitioner Andrew Rodriguez was employed as a fabricator by respondent Flory Industries (Flory). His job required him to lift pieces of steel. The last day he actually worked at Flory was December 9, 1992, a Wednesday. On the morning of December 10, 1992, he called Flory at about 6:45 a.m. and told Norma Taylor, an accounts payable clerk, he was ill and would not be coming in. Four days later on Sunday, December 14, he visited Stanislaus Medical Center and complained of pain in his neck and left shoulder. Triage Nurse Patty Miligan wrote a report stating that petitioner “c/o pain in neck and L shoulder x 2 yrs. getting worse.” She also made the notation “LWOB.” She said this meant “left without being seen.”

Three days later on Wednesday, December 17, petitioner was seen at Flory by Rod Flory, a production manager and part owner of the business. Petitioner had his arm in a sling. According to Rod Flory, he asked petitioner about the sling and whether petitioner had incurred a workers’ compensation injury. Petitioner replied: “I don’t know. It might have happened at home, I have been pruning trees.”

Karlene Boyt was a bookkeeper and payroll clerk for Flory. On December 23, 1992, she received a telephone call from Stanislaus Medical Center. The caller wanted to know who Flory’s workers’ compensation carrier was. Boyt asked the caller what employee the inquiry pertained to and was told it pertained to petitioner. Boyt told the caller that petitioner had not notified Flory previously, and asked the caller to tell petitioner to come over and fill out a claim form, known as a “DWC 1.” That same afternoon petitioner came to Flory and filled out the claim form. Petitioner wrote on the claim *1428 form that he had suffered an injury to his left shoulder and neck on December 11, 1992.

On or about February 11, 1993, petitioner filed with respondent Workers’ Compensation Appeals Board (the WCAB or the board) an application for adjudication of claim. The application contained a verified claim that petitioner had sustained injury to his “neck, back, and shoulders” on December 9, 1992, while working as a fabricator at Flory and “lifting material (steel).”

On March 29, 1993, a Monday and the 96th day following petitioner’s December 23, 1992, submission of his completed “DWC 1” claim form to Flory, petitioner’s attorney received a written notification from Flory’s insurer (respondent Hartford Insurance Company, hereinafter Hartford) that his claim “is denied because based our [sic] initial investigation we have determined to deny your alleged injury.” This notice was dated March 22, 1993, and was mailed from Hartford’s office in Sacramento, California, to the office of petitioner’s attorney in Modesto, California. 1 Petitioner, Rory, and Hartford agree that March 22, 1993, was the 89th day following petitioner’s December 23, 1992, filing of his “DWC 1” claim form with Rory.

On April 7, 1993, petitioner gave a deposition.

On April 23, 1993, a conference was held preceding the hearing on petitioner’s application for adjudication. Petitioner’s attorney pointed out he would be contending that the Labor Code section 5402 presumption of compensability should apply to the board’s adjudication of petitioner’s claim for benefits.

The hearing on petitioner’s claim for benefits was held on September 27, 1993, a Monday. Petitioner did not appear personally but was represented by his attorney. According to petitioner’s attorney, petitioner had been in his attorney’s office on the previous Friday and had indicated he would be attending the hearing. Petitioner could not be located in the board building on Monday morning, and the hearing proceeded without him. The workers’ compensation judge rejected petitioner’s contention that the Labor Code section 5402 presumption should apply.

Five witnesses testified at the hearing. All were defense witnesses. Four of them were Patty Miligan, Norma Taylor, Rod Rory and Karlene Boyt, whose respective testimonies were described above. The fifth defense witness was Kent Rory. Kent Rory had been employed at Rory for 15 years. *1429 He was petitioner’s supervisor and a son of one of the owners of the business. He testified he worked the same shift as petitioner in December of 1992 and that petitioner made no mention to him on December 9, 1992, of having injured himself in any way.

The transcript of petitioner’s April 7 deposition testimony was also entered into evidence at the hearing. Petitioner’s deposition testimony differed in several respects from the testimony offered by the defense witnesses at the September 23 hearing. Petitioner stated he had told Kent Flory on December 9 that he (petitioner) had hurt himself that day. He said that when he called in on the morning of December 10, he told the woman who answered the phone he was not coming in “because of my neck.” He said he had not filled out the information on the “DWC 1” claim form on December 23, but had only signed the form on the signature line. First he said that Karlene had filled out the form. Later he said someone other than himself had filled out the form, that he did not know for sure who had actually filled out the form and he simply assumed it had been filled out by Karlene. He denied having any recollection of the December 17 conversation with Rod Flory that Rod Flory testified about, but did recall at some point he did visit Flory Industries while his arm was in a sling. There was no testimony by anyone at the September 23 hearing or by petitioner at his April 7 deposition about the purpose for this particular visit. Petitioner also testified he had worked at Rory on a prior occasion, that he quit going to work there after about five months, that he had then applied for unemployment benefits and he had falsely stated on his application for unemployment benefits he had been laid off. Petitioner also testified at his deposition that he did not remember ever having had an on-the-job injury when he was previously employed by the Stanislaus School District.

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Rodriguez v. Workers' Compensation Appeals Board, 30 Cal. App. 4th 1425, 35 Cal. Rptr. 2d 713, 94 Cal. Daily Op. Serv. 9358, 94 Daily Journal DAR 17293, 59 Cal. Comp. Cases 857, 1994 Cal. App. LEXIS 1215, 1994 WL 627382 (Cal. Ct. App. 1994).

30 Cal. App. 4th 1425 (Rodriguez v. Workers' Compensation Appeals Board) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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