ADJ1058134 · September 4, 2025

The issue of industrial injury was raised but not decided by the WCJ and is deferred for trial level determination.

From the decision · page 9Applicant raises another issue in the petition for reconsideration, which is that applicant sustained industrial injury. While the issue of injury was raised at trial, it was not decided by the WCJ, and thus it is not ripe for adjudication at this time. We will return that issue to the trial level for the WCJ to determine in the first instance.

Defendant failed to meet its burden of proving the statute of limitations because there was no evidence of notice of benefits to applicant, and the employer did not provide statutory notice, triggering the claims administrator's duty to notify.

From the decision · page 9Accordingly, we grant applicant's Petition for Reconsideration and as our Decision After Reconsideration, we rescind the June 10, 2025 F&O and substitute a new Finding of Fact that defendant failed to meet its burden of proving the statute of limitations and return this matter to the trial level for further proceedings.

Defendant failed to provide statutory notice of benefits to applicant.

Favours Applicant prevailed

Without notice, the statute of limitations defense cannot be established.

From the decision · page 9We are bound to follow the holdings of the Supreme Court, and the holding of Reynolds precludes application of the statute of limitations in cases where the employer has not provided statutory notice. There is no dispute in this case that the employer did not provide statutory notices of applicant's right to file a claim. Thus, per the Labor Code it was incumbent upon the claims administrator to provide statutory notices. Here, there is not any evidence at all establishing when a notice of benefits issued. Accordingly, defendant has not met its burden of proof as to the running of the statute of limitations.

Employer did not provide statutory notice of applicant's right to file a claim.

Favours Applicant prevailed

This triggered the claims administrator's duty to provide notice, which was not shown to have occurred.

From the decision · page 9We are bound to follow the holdings of the Supreme Court, and the holding of Reynolds precludes application of the statute of limitations in cases where the employer has not provided statutory notice. There is no dispute in this case that the employer did not provide statutory notices of applicant's right to file a claim. Thus, per the Labor Code it was incumbent upon the claims administrator to provide statutory notices. Here, there is not any evidence at all establishing when a notice of benefits issued. Accordingly, defendant has not met its burden of proof as to the running of the statute of limitations.

Date of injury pursuant to Labor Code section 5412 was not found by the WCJ.

Favours neutral

Without a date of injury, the running of the statute of limitations cannot be properly determined.

From the decision · page 81) The date of injury pursuant to section 5412. 2) The date that applicant was provided a notice of benefits. 3) The date upon which the application for adjudication was filed. Here, the date of injury pursuant to section 5412 was never found. This is a common error made on all sides of statute of limitations disputes. In order to determine when a statute of limitations runs, the date of injury must first be decided. Here the WCJ made no findings of fact as to the date of injury. Another common error is to mistake the date of injury under section 5412 as synonymous with the dates of liability under section 5500.5. Sometimes these dates will coincide. Oftentimes, these dates are disparate. The parties and the WCJ must be cognizant that a date of injury under section 5412 must be found in order to determine whether the statute of

Provided Agreed Medical Examiner reports supporting prior claims and permanent disability rating.

From the decision · page 2The specific injury claim of 12/28/1996 (ADJ3563078) and the CT claim from 12/28/1996 to 07/15/1998 (ADJ2923317) were resolved by a Joint Stipulated Award on November 27, 2002, at 34.25% permanent disability (PD) to his left upper extremity, left knee, neck and back. The settlement was based on the Agreed Medical Examiner (AME) reports of Dr. Angerman. Future medical care was needed and pursuant the AME reports of Dr. Angerman. CIGA for Reliance Insurance Company, in liquidation, is the carrier on these two prior claims. (Judicial Notice is taken of the Stipulated Award dated 11/27/2002 (EAMS ID #34831712).

Labor Code section 5705

The statute of limitations is an affirmative defense and the defendant has the burden of proof.

Applied to determine burden of proof for statute of limitations defense.

From the decision · page 6II. The statute of limitations is an affirmative defense and defendant, as the party asserting the defense, has the burden of proof. (§ 5705.) The limitations period for which a claim must be filed is the later of (1) one year from the date of injury, (2) one year from the last provision of disability payments per sections 4650 et seq., or (3) one year from the last provision of medical benefits. (Ibid.) "Limitations provisions in the [workers'] compensation law must be liberally construed in favor of the employee unless otherwise compelled by the language of the statute, and such enactments should not be interpreted in a manner which will result in a loss of compensation." (Blanchard v. Workers' Comp. Appeals Bd. (1975) 53 Cal.App.3d 590, 595 [40 Cal.Comp.Cases 784] (internal citations omitted).) Establishing a date of injury is imperative to establishing the running of the statute of limitations.

Labor Code section 5412

Date of injury for cumulative injury claims is the date the employee first suffered disability and knew or should have known it was caused by employment.

Applied to establish date of injury for statute of limitations calculation.

From the decision · page 6Date of injury for cumulative injury claims is established under section 5412, which states: "The date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment." (§ 5412.) As used in section 5412, "disability" means either compensable temporary disability or permanent disability. (Chavira v. Workers' Comp. Appeals Bd.

Labor Code section 138.4

Claims administrator must provide notice of benefits if employer fails to do so, estopping the administrator from asserting statute of limitations defense until notice is given.

Applied to require claims administrator to notify applicant, preventing statute of limitations defense without notice.

From the decision · page 8Furthermore, it is also well established that where an employer is insured for workers' compensation liability, the insurer stands in the shoes of the employer. (§ 3755.) The Labor Code expressly requires that a claims administrator give notice when the employer fails to do so:

Reynolds v. Workmen's Comp. Appeals Bd. (1974) 12 Cal.3d 726

Employer's failure to provide statutory notice precludes raising statute of limitations defense.

Applied to bar statute of limitations defense where employer failed to notify employee of claim rights.

From the decision · page 1Applicant contends, in pertinent part, that the WCJ misapplied the burden of proof as the statute of limitations is defendant's burden and that the statute of limitations was tolled in this case pursuant to the holding in Reynolds because defendant failed to adequately notify applicant of his right to file a workers' compensation claim. (Reynolds v. Workmen's Comp. Appeals Bd. (1974) 12 Cal.3d 726 [39 Cal.Comp.Cases 768].)

Applicant's deposition testimony in 2010 was found more credible than his 2023 trial testimony regarding work restrictions.

From the decision · page 4(MOH and SOE, 3/6/2023, p. 8). However, at his deposition taken on August 1_1,2010, he testified that when he returned back to work in 1997, until his last day worked in 2002, he continued working with the work restrictions the entire time after reinstatement until his last day of work. (Defendant's Exhibit J, p. 36). This Court finds his deposition testimony is more credible since his memory was fresher to the actual events since the deposition took place in 2010. Additionally, at trial, Applicant testified that he worked for Consolidated Freight for 26 years, if he wanted to contact someone at Consolidated Freight after they went bankrupt, he could have, but he didn't try to contact anyone after they went bankrupt. (MOH and SOE, 3/6/2023, p. 7, lines 7-9).

Lack of evidence that defendant provided statutory notice of benefits to applicant.

From the decision · page 9We are bound to follow the holdings of the Supreme Court, and the holding of Reynolds precludes application of the statute of limitations in cases where the employer has not provided statutory notice. There is no dispute in this case that the employer did not provide statutory notices of applicant's right to file a claim. Thus, per the Labor Code it was incumbent upon the claims administrator to provide statutory notices. Here, there is not any evidence at all establishing when a notice of benefits issued. Accordingly, defendant has not met its burden of proof as to the running of the statute of limitations.