ADJ10964062 · May 30, 2024

Applicant timely invoked WCAB jurisdiction under Labor Code section 5410 for new and further disability within five years of injury; defendant did not meet burden to prove statute of limitations defense based on notice adequacy.

From the decision · page 1Defendant seeks reconsideration of the Findings of Fact issued by the workers' compensation administrative law judge (WCJ) on November 19, 2020, wherein the WCJ found in pertinent part that defendant did not meet its burden of proof with respect to the statute of limitations defense.

Applicant filed his first Application for Adjudication of Claim in August 2017, less than five years from the date of injury.

Favours Applicant prevailed

This timely filing invoked WCAB jurisdiction under Labor Code section 5410 for new and further disability benefits.

From the decision · page 4Pursuant to WCAB Rule 10536, the jurisdiction of the WCAB under section 5410 shall be invoked by a petition for new and further disability or, if no prior Application for Adjudication of Claim has been filed, jurisdiction shall be invoked by the filing of an original Application for Adjudication of Claim. (Cal. Code Regs., tit. 8, § 10536.) Here, applicant's date of injury was November 12, 2013, applicant received workers' compensation benefits in 2013-2014, and applicant's first Application for Adjudication of Claim was filed in August 2017, less than five years from the date of injury. Thus, applicant timely invoked WCAB jurisdiction.

Applicant did not understand the defendant's notice to mean he had only one year to file a claim or lose benefits.

Favours Applicant prevailed

This lack of understanding supports the finding that defendant did not meet its burden to prove the statute of limitations defense.

From the decision · page 32. Following receipt of this letter, applicant did not understand the letter to mean that he had one year from the last provision of benefits to file an Application at the WCAB, or his future benefits would be barred. If he had known that, he would have filed an Application within one year of the last provision of benefits.

Provided medical report dated November 12, 2013, related to applicant's injury and benefits.

From the decision · page 2BACKGROUND We will briefly review the relevant facts. Applicant, while employed as a firefighter and paramedic on November 12, 2013, sustained injury to his back. The parties stipulated that applicant's injury arose out of and in the course of employment (AOE/COE). (Pre-trial conference statement, p. 2; Minutes of Hearing and Summary of Evidence, August 19, 2020 trial (MOH/SOE), p. 2.) Defendant provided benefits in the form of medical treatment and payment for loss of salary, in lieu of temporary disability payments pursuant to Labor Code section 4850. 2 (Medical report by Thomas Marsella, M.D., Applicant's Ex. 2, dated November 12, 2013, pp. 1-2; medical report by Dr. Lisa Zacharewicz, dated January 27, 2014, applicant's Ex. 1, p. 1; printout of benefits, dated April 21, 2020, Joint Ex. 2, p. 2.) On November 21, 2013, defendant issued a letter titled "notice regarding permanent disability benefits" "monitor for disability status." (Benefit notices, Applicant's Ex. 3, pp. 3-4.) On January 28, 2014, defendant issued a further letter titled "notice regarding permanent disability" "denial," which states in pertinent part as follows:

Provided medical report dated January 27, 2014, related to applicant's injury and benefits.

From the decision · page 2BACKGROUND We will briefly review the relevant facts. Applicant, while employed as a firefighter and paramedic on November 12, 2013, sustained injury to his back. The parties stipulated that applicant's injury arose out of and in the course of employment (AOE/COE). (Pre-trial conference statement, p. 2; Minutes of Hearing and Summary of Evidence, August 19, 2020 trial (MOH/SOE), p. 2.) Defendant provided benefits in the form of medical treatment and payment for loss of salary, in lieu of temporary disability payments pursuant to Labor Code section 4850. 2 (Medical report by Thomas Marsella, M.D., Applicant's Ex. 2, dated November 12, 2013, pp. 1-2; medical report by Dr. Lisa Zacharewicz, dated January 27, 2014, applicant's Ex. 1, p. 1; printout of benefits, dated April 21, 2020, Joint Ex. 2, p. 2.) On November 21, 2013, defendant issued a letter titled "notice regarding permanent disability benefits" "monitor for disability status." (Benefit notices, Applicant's Ex. 3, pp. 3-4.) On January 28, 2014, defendant issued a further letter titled "notice regarding permanent disability" "denial," which states in pertinent part as follows:

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

Employers must provide adequate notice to injured workers of their rights to preserve claims under the statute of limitations.

Defendant's notice was insufficient to bar applicant's claim; purpose of notice is to protect injured workers who may be ignorant of their rights.

From the decision · page 4Although Reynolds is distinguishable, the analysis regarding the purpose of the notice requirement is instructive. In Reynolds, the court held the employer was precluded from raising a statute of limitations defense where the worker suffered a heart attack at work and the employer did not provide notice of workers' compensation benefits. The court explained that:

Labor Code sections 5405, 5410

Labor Code section 5405 and 5410 set time limits for filing claims for workers' compensation benefits.

Applicant timely filed claim within five years of injury under section 5410; defendant's notice was insufficient to bar claim under section 5405.

From the decision · page 2*** Labor Code Section 5405 states that an injured worker has one (1) year from the date of either last payment of temporary disability benefits or last furnishing of medical benefits to commence proceeding with the Workers' Compensation Appeals Board for the collection of benefits. Labor Code Section 5410 states that an injured worker shall have five (5) years from the date of injury to commence proceedings to collect benefits for new and further disability for temporary disability, permanent disability, vocational rehabilitation services or medical treatment.

Applicant did not understand the notice of permanent disability benefits denial to mean he had one year to file an application or lose benefits.

From the decision · page 32. Following receipt of this letter, applicant did not understand the letter to mean that he had one year from the last provision of benefits to file an Application at the WCAB, or his future benefits would be barred. If he had known that, he would have filed an Application within one year of the last provision of benefits.