What the panel treated as outcome-determinative, and which side it favoured.
The December 15, 2009 report of Dr. Nelson did not use the term 'cumulative trauma' and deferred apportionment discussion pending further review.
Favours Defendant prevailed
This report was found insufficient to establish knowledge of a cumulative trauma injury for purposes of Labor Code §5412 date of injury.
From the decision · page 4""As for apportionment, it is clear that she had a specific injury. There
have been clear periods of trauma after this. This includes a period where her
symptoms were significantly absent after her first operation. In the joint letter, a
deposition has been alluded to and I realize that it has not yet been forwarded to
our office. I believe, at this time, I will defer her apportionment discussion until I
receive her deposition and am able to compare her thoughts on her injuries and
trauma to the current records. At that time, I will issue a supplemental on the
apportionment status between continuous traumas and specific injury." (emphasis
added).
The November 17, 2010 report of Dr. Nelson clearly defined a continuous trauma period after the applicant's return to work from her first operation.
Favours Applicant prevailed
This report was the first to satisfy the knowledge prong of Labor Code §5412, fixing the date of injury for the cumulative trauma claim.
From the decision · page 5In the instant case, the first medical report which clearly and unequivocally set forth the
existence of a separate cumulative trauma injury was the later Nelson reportof November 17,
2010. This is the first and only report that describes a defined period of industrial cumulative
trauma after applicant returns to work from her operation. Thus, the parties cannot be charged with
knowledge of cumulative trauma until the issuance of Dr. Nelson's November 17, 2010 report.
CIGA filed the cumulative trauma application on April 27, 2011, within one year of the November 17, 2010 date of injury.
Favours Applicant prevailed
This filing was timely under the statute of limitations set by Labor Code §5405, making the application valid and not barred by limitations.
From the decision · page 3During the pendency of that claim, the parties agreed to utilize the services of Dr. Russell
Nelson, M.D. as Agreed Medical Examiner. Based on the reporting of Dr. Nelson, on April 27, 2011,
CIGA filed an application for adjudication of claim in case ADJ7763838, claiming a May 14, 1999,
to August 1, 2006 cumulative trauma injury to the same body parts and naming subsequent insurers
SCIF1