ADJ10448534 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied

Petition for Reconsideration filed by Applicant after denial of Petition to Set Aside Stipulations with Request for Award

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What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

Reconsideration / removalDefendant prevailedright eye · left shoulder

The court found no mutual mistake because the right eye was not pled or listed in the Stipulations, no medical evidence showed industrial relation, and the petition was filed beyond the 5-year limit for reopening under Labor Code § 5804.

From the decision · page 3I. INTRODUCTION Applicant filed an Application for Adjudication of Claim alleging injury to the back, arm, legs, and knee, while working on 7/19/2014. Applicant settled the claim by way of Stipulation with Request for Award on 9/5/2017. On 9/6/2022, Applicant filed a Petition to Set Aside the Stipulations with Request for Award with a Declaration of Readiness. The matter proceeded to trial on the Petition to Set Aside. Applicant filed a timely and verified Petition for Reconsideration under Labor Code § 5903 following the court's Findings and Order dated 2/10/2023 finding there was no good cause or mutual mistake to set aside the Stipulations with Request for Award. Applicant contends because defendant admitted compensability by paying for treatment to the eye, there was a mutual mistake and the Stipulation with Request for Award should be set aside. At the time of this report, Defendant had not filed an answer to the Petition for Reconsideration.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

The Petition to Set Aside was filed more than 5 years after the injury, beyond the statutory limit for reopening.

Favours Defendant prevailed

The court lacked jurisdiction to reopen the Award.

The right eye was not pled as an industrial injury in the Application or Stipulation with Request for Award.

Favours Defendant prevailed

This showed no mutual mistake existed to set aside the Stipulation.

From the decision · page 4III. DISCUSSION As to Applicant's assertion that defendant admitted compensability of right eye on 1/20/2022, the court offers the following: Applicant referenced a letter from defendant to Dr. Lawrence Miller regarding a UR denial to the left shoulder dated 1/20/2022. Applicant's Exhibit 3. The letter states the left shoulder is denied. The letter does state the right eye has been accepted, however, the letter is four and half years after the Award was issued and almost 8 years after the date of injury. The letter is not evidence of a mutual mistake from 5 years ago. The right eye was not a pled body part on the Application for Adjudication of Claim, an Amended Application was never filed, and the right eye was not listed on the Stipulation with Request for Award nor was medical evidence provided to show that the right eye was industrially related.

No medical evidence was provided to establish the right eye condition was work related.

Favours Defendant prevailed

Lack of medical evidence supported denial of setting aside the Stipulation.

From the decision · page 5Applicant did not provide any medical evidence regarding the left shoulder. Medical records were produced regarding the right eye. The Applicant was evaluated on 11/20/2015 at John F. Kennedy Memorial Hospital. Dr. Schultz noted Applicant had extreme loss of vision in the right eye that had developed during the past years. The Applicant reported his work injury of 7/17/2014 to Dr. Schultz, however, Dr. Schultz noted he was originally seen on 12/19/2014 and the lens was clear. When the Applicant returned 9 months later, the vision in the right eye had significantly reduced. Retinal detachment was not confirmed, but Dr. Schultz opined it was a cataract and Applicant underwent cataract surgery on or around 11/23/2015. Applicant's Exhibit 2. No

What the panel did with the medical opinions

The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.

AMERelied upon

Provided the AME report dated 10/20/2016 that was the basis for the original Stipulation with Request for Award.

From the decision · page 3II. STATEMENT OF FACTS Applicant filed an Application for Adjudication of Claim alleging injury to the back, arm, legs, and knee, while working on 7/19/2014. Applicant settled the claim by way of Stipulation with Request for Award on 9/5/2017. The Stipulations stated Applicant had sustained injury arising out of and in the course of employment to "the left knee, left elbow, and lower back." Defendant's Exhibit A. The settlement was based upon the AME report of Dr. Soheil Aval dated 10/20/2016. On 9/6/2022, Applicant filed a Petition to Set Aside the Stipulations with Request for Award alleging there was a mutual mistake when parties entered into the Stipulations with Request for Award because the eye had not been included. Applicant filed his Petition to Set Aside 5 years from the date the Award was issued and over 8 years after the date of injury. At trial, parties submitted on documentary evidence. The undersigned judge found there was no mutual mistake and denied the Petition to Set Aside the Stipulations with Request for Award. It is from this Finding and Order that Applicant Petitions for Reconsideration under Labor Code § 5903.

otherGiven great weight

Referenced in a letter from defendant regarding UR denial to left shoulder, stating the right eye was accepted but this was not evidence of mutual mistake.

From the decision · page 4III. DISCUSSION As to Applicant's assertion that defendant admitted compensability of right eye on 1/20/2022, the court offers the following: Applicant referenced a letter from defendant to Dr. Lawrence Miller regarding a UR denial to the left shoulder dated 1/20/2022. Applicant's Exhibit 3. The letter states the left shoulder is denied. The letter does state the right eye has been accepted, however, the letter is four and half years after the Award was issued and almost 8 years after the date of injury. The letter is not evidence of a mutual mistake from 5 years ago. The right eye was not a pled body part on the Application for Adjudication of Claim, an Amended Application was never filed, and the right eye was not listed on the Stipulation with Request for Award nor was medical evidence provided to show that the right eye was industrially related.

otherGiven great weight

Evaluated applicant's right eye condition, noting vision loss developed after injury but no confirmation of retinal detachment; opined cataract was present and surgery was performed in 2015; no evidence of work-related cause.

From the decision · page 5Applicant did not provide any medical evidence regarding the left shoulder. Medical records were produced regarding the right eye. The Applicant was evaluated on 11/20/2015 at John F. Kennedy Memorial Hospital. Dr. Schultz noted Applicant had extreme loss of vision in the right eye that had developed during the past years. The Applicant reported his work injury of 7/17/2014 to Dr. Schultz, however, Dr. Schultz noted he was originally seen on 12/19/2014 and the lens was clear. When the Applicant returned 9 months later, the vision in the right eye had significantly reduced. Retinal detachment was not confirmed, but Dr. Schultz opined it was a cataract and Applicant underwent cataract surgery on or around 11/23/2015. Applicant's Exhibit 2. No

What proof carried it

The evidence the panel weighed, by kind.

Documentary evidencefavours Defendant prevailed

The letter from defendant to Dr. Lawrence Miller stating the right eye was accepted but left shoulder was denied.

From the decision · page 4III. DISCUSSION As to Applicant's assertion that defendant admitted compensability of right eye on 1/20/2022, the court offers the following: Applicant referenced a letter from defendant to Dr. Lawrence Miller regarding a UR denial to the left shoulder dated 1/20/2022. Applicant's Exhibit 3. The letter states the left shoulder is denied. The letter does state the right eye has been accepted, however, the letter is four and half years after the Award was issued and almost 8 years after the date of injury. The letter is not evidence of a mutual mistake from 5 years ago. The right eye was not a pled body part on the Application for Adjudication of Claim, an Amended Application was never filed, and the right eye was not listed on the Stipulation with Request for Award nor was medical evidence provided to show that the right eye was industrially related.

Medical recordsfavours Defendant prevailed

Medical records from Dr. Schultz showing vision loss in right eye developed after injury but no industrial relation established.

From the decision · page 5Applicant did not provide any medical evidence regarding the left shoulder. Medical records were produced regarding the right eye. The Applicant was evaluated on 11/20/2015 at John F. Kennedy Memorial Hospital. Dr. Schultz noted Applicant had extreme loss of vision in the right eye that had developed during the past years. The Applicant reported his work injury of 7/17/2014 to Dr. Schultz, however, Dr. Schultz noted he was originally seen on 12/19/2014 and the lens was clear. When the Applicant returned 9 months later, the vision in the right eye had significantly reduced. Retinal detachment was not confirmed, but Dr. Schultz opined it was a cataract and Applicant underwent cataract surgery on or around 11/23/2015. Applicant's Exhibit 2. No

ADJ10448534 · April 25, 2023

What the panel ordered

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The facts that decided it

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