ADJ2862836 · November 4, 2024

The Appeals Board agreed with the WCJ that the penalty period should match the period of denial of medical treatment from 4/4/2017 to 3/9/2020, and amended the Findings of Fact accordingly.

From the decision · page 71. Applicant's second major point out is well taken. The WCJ determined in her Findings of Fact that Defendant denied the Applicant medical treatment from 4/28/2017 to 3/9/2020. Applicant contends that the penalties awarded pursuant to Labor Code Section 5814 should reflect the same period as the finding of denial of medical treatment. After additional consideration the WCJ agrees. Therefore it is recommended that Applicant's Petition for Reconsideration be granted in part and the Findings of Fact be amended as follows:

The Appeals Board found the stipulation for 36 chiropractic treatments per year with Dr. Jalili binding and not limited to that specific doctor, rejecting defendant's argument that the stipulation was void due to Dr. Jalili's unavailability.

From the decision · page 9Here the parties stipulated in 2013 and the WCJ previously found that: "Applicant is entitled to future medical treatment including but not limited to 36 chiropractic treatments per year with Dr. Jalili." Sometime after this stipulation, Dr. Jalili became unavailable. Defendant argues that it is no longer required to provide 36 chiropractic treatments per year because the stipulation was to a specific doctor. Defendant's argument on this point borders on skeletal and is not persuasive.

Defendant denied medical treatment from 4/4/2017 to 3/9/2020.

Favours Applicant prevailed

This fact established the period for which penalties under Labor Code Section 5814 were awarded, supporting applicant's claim.

From the decision · page 71. Applicant's second major point out is well taken. The WCJ determined in her Findings of Fact that Defendant denied the Applicant medical treatment from 4/28/2017 to 3/9/2020. Applicant contends that the penalties awarded pursuant to Labor Code Section 5814 should reflect the same period as the finding of denial of medical treatment. After additional consideration the WCJ agrees. Therefore it is recommended that Applicant's Petition for Reconsideration be granted in part and the Findings of Fact be amended as follows:

The parties stipulated in 2013 that applicant was entitled to 36 chiropractic treatments per year with Dr. Jalili, and defendant did not abide by this stipulation after Dr. Jalili became unavailable.

Favours Applicant prevailed

This fact supported the finding that defendant unreasonably delayed treatment by denying further chiropractic visits, favoring applicant.

From the decision · page 9Defendant stipulated to provide 36 chiropractic treatments per year and has not abided by that stipulation. Accordingly, we agree with the WCJ that defendant unreasonably delayed treatment by denying applicant further chiropractic visits.

Labor Code Sections 112, 115, 5301, 5901, 5908.5, 5950; Cal. Code Regs., tit. 8, §§ 10320, 10330

Only the Appeals Board is statutorily authorized to issue a decision on a petition for reconsideration and must conduct de novo review of the merits.

The Appeals Board reviewed the petitions for reconsideration de novo and issued a decision after reconsideration.

From the decision · page 4Only the Appeals Board is statutorily authorized to issue a decision on a petition for reconsideration. (Lab. Code, § 112, 115, 5301, 5901, 5908.5, 5950; see Cal. Code Regs., tit. 8, § 10320, 10330.)2 The Appeals Board must conduct de novo review as to the merits of the petition and review the entire proceedings in the case. (Lab. Code, § 5906, 5908; see Lab. Code, § 5301, 5315, 5701, 5911.) Once a final decision by the Appeals Board on the merits of the petition issues, the parties may seek review under Labor Code section 5950, but appellate review is limited to review of the record certified by the Appeals Board. (Lab. Code, § 5901, 5951.)

Kaiser Foundation Hospitals v. Workers' Compensation Appeals Board (1978) 83 Cal.App.3d 413; Truck Ins. Exchange v. Workers' Comp. Appeals Bd. (Kwok) (2016) 2 Cal.App.5th 394; State Farm General Ins. Co. v. Workers' Comp. Appeals Bd. (Lutz) (2013) 218 Cal.App.4th 258; Dyer v. Workers' Comp. Appeals Bd. (1994) 22 Cal.App.4th 1376; Elkins v. Derby (1974) 12 Cal.3d 410; Shipley v. Workers' Comp. Appeals Bd. (1992) 7 Cal.App.4th 1104

The Appeals Board has broad equitable powers and may apply equitable tolling when administrative errors prevent timely action on petitions.

The Appeals Board applied equitable tolling due to administrative errors delaying action on the petition, ensuring due process rights were protected.

From the decision · page 5It is well-settled that the Appeals Board has broad equitable powers. (Kaiser Foundation Hospitals v. Workers' Compensation Appeals Board (1978) 83 Cal.App.3d 413, 418 [43 Cal.Comp.Cases 785] citing Bankers Indem. Ins. Co. v. Indus. Acc. Com. (1935) 4 Cal.2d 89, 94- 98 [47 P.2d 719]; see Truck Ins. Exchange v. Workers' Comp. Appeals Bd. (Kwok) (2016) 2 Cal.App.5th 394, 401 [81 Cal.Comp.Cases 685]; State Farm General Ins. Co. v. Workers' Comp. Appeals Bd. (Lutz) (2013) 218 Cal.App.4th 258, 268 [78 Cal.Comp.Cases 758]; Dyer v. Workers' Comp. Appeals Bd. (1994) 22 Cal.App.4th 1376, 1382 [59 Cal.Comp.Cases 96].) It is an issue of fact whether an equitable doctrine such as laches applies. (Kwok, supra 2 Cal.App.5th at p. 402.) The doctrine of equitable tolling applies to workers' compensation cases, and the analysis turns on the factual determination of whether an opposing party received notice and will suffer prejudice if equitable tolling is permitted. (Elkins v. Derby (1974) 12 Cal.3d 410, 412 [39 Cal.Comp.Cases 624].) As explained above, only the Appeals Board is empowered to make this factual determination.4

Labor Code Section 5702

Parties may stipulate facts in writing and the Appeals Board may base findings and awards on such stipulations.

The Appeals Board relied on the 2013 stipulation for chiropractic treatment as binding and enforceable.

California Civil Code Section 1636

A contract must be interpreted to give effect to the mutual intention of the parties at the time of contracting.

The Appeals Board interpreted the stipulation to require 36 chiropractic treatments per year, not limited to a specific doctor.

From the decision · page 9"A contract must be so interpreted as to give effect to the mutual intention of the parties as it existed at the time of contracting, so far as the same is ascertainable and lawful." (Cal. Civ. Code, § 1636.) Here the parties stipulated that applicant was to receive 36 chiropractic treatments per year and that defendant would authorize Dr. Jalili to provide them. Defendant makes no legal arguments in its Petition, and thus, it is impossible to determine under what legal theory defendant argues that it has been relieved of the stipulation. The stipulation itself does not limit treatment to Dr. Jalili. Had defendant sought such a limitation, it could have used appropriate restrictive language (e.g., "only Dr. Jalili"). Such language does not exist in the present stipulation.