ADJ14840331 — California WCAB decision

What the panel ordered

The WCAB denied the defendant's Petition for Reconsideration, affirming that the claim was filed within the statute of limitations or that the defendant was estopped from asserting otherwise.

Defendant sought reconsideration of the WCJ's Findings and Order of March 25, 2024, which found the applicant's claim was not barred by the statute of limitations.

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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.

Statute of limitationsApplicant prevailedhead · neck · back · brain · right ankle · ribs · feet · stomach · hernia · incontinence

The WCAB found that the five-year statute of limitations applied because the defendant accepted liability and authorized medical treatment, tolling the one-year limitation period. The defendant never provided formal notice disclaiming liability as required by Rule 9812(i), so the statute did not revert to one year. Even if it did, the claim was filed within one year of informal denials. The defendant was also estopped from asserting the statute of limitations defense due to misrepresentations.

From the decision · page 1Defendant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings and Order of March 25, 2024, wherein it was found that applicant's claim is not barred by the statute of limitations. In this matter, applicant claims that while employed on April 16, 2019 as a substitute teacher, she sustained industrial injury to the head, neck, back, brain, right ankle, ribs, feet, stomach and in the forms of hernia and incontinence.

The facts that decided it

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

Defendant accepted liability and authorized medical treatment, tolling the statute of limitations to five years.

Favours Applicant prevailed

This conduct reasonably indicated acceptance of responsibility, extending the filing period under Labor Code section 5410.

Defendant never provided formal denial notice as required by Rule 9812(i), so the statute did not revert to one year.

Favours Applicant prevailed

Without formal denial, the extended five-year period remained applicable.

From the decision · page 4Here, applicant was never sent formal notice in compliance with Rule 9812(i) (Cal. Code Regs., tit. 8, § 9812, subd. (i)) that defendant was completely disclaiming liability for the industrial injury, and thus the statute of limitations never reverted to one year. Although defense counsel did ultimately tell applicant in emails that her claim was "denied," these informal denials did not contain the language required by Rule 9812(i). In any case, it appears that applicant's Application was filed within one year of these so-called denials.

Defendant's misrepresentations in notices induced applicant to delay filing, estopping defendant from asserting statute of limitations defense.

Favours Applicant prevailed

Estoppel prevents defendant from denying claim based on statute of limitations due to their own misleading conduct.

From the decision · page 4In any case, even if the five-year statute was not applicable in this case, defendant would be estopped to claim otherwise as a result of the September 19, 2019 and the June 23, 2020 notices telling the applicant that she had "five (5) years from the date of the injury or one (1) year from the date of last benefit" to file with the WCAB. An employer and its insurer are estopped to plead the statute of limitations when the actions or misrepresentations of either induce the employee to refrain from filing a claim until after the statute of limitations has run." (McGee Street Productions v. Workers' Comp. Appeals Bd. (Peterson) (2003) 108 Cal.App.4th 717, 726 [68 Cal.Comp.Cases 708].) As the Supreme Court explained in Benner v. Industrial Acc. Comm. (1945) 26 Cal.2d 346, 349-350 [10 Cal.Comp.Cases 110], "An estoppel may arise although there was no designed fraud on the part of the person sought to be estopped."

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code section 5410

Five-year statute of limitations under Labor Code section 5410 applies when employer accepts liability and provides benefits or authorizes treatment.

Applied to toll the one-year limitation period and extend filing deadline.

From the decision · page 3In McDaniel v. Workers' Comp. Appeals Bd. (1990) 218 Cal.App.3d 1011 [55 Cal.Comp.Cases 72], the Court of Appeal held that when a defendant provides medical treatment benefits knowing of a potential claim for workers' compensation benefits, the provision of treatment tolls the one-year limitation period of Labor Code section 5405(c) and triggers the five year period of Labor Code section 5410, running from the date of injury. Although McDaniel dealt with the normal situation that medical treatment was actually provided, and payment was advanced by the employer or insurer to the medical provider, the McDaniel court explained the purpose of the rule as follows:

Labor Code section 5405(c)

One-year limitation period under Labor Code section 5405(c) applies unless tolling occurs.

Considered in relation to tolling and denial notices.

From the decision · page 3In McDaniel v. Workers' Comp. Appeals Bd. (1990) 218 Cal.App.3d 1011 [55 Cal.Comp.Cases 72], the Court of Appeal held that when a defendant provides medical treatment benefits knowing of a potential claim for workers' compensation benefits, the provision of treatment tolls the one-year limitation period of Labor Code section 5405(c) and triggers the five year period of Labor Code section 5410, running from the date of injury. Although McDaniel dealt with the normal situation that medical treatment was actually provided, and payment was advanced by the employer or insurer to the medical provider, the McDaniel court explained the purpose of the rule as follows:

Administrative Rule 9812(i)

Formal denial notice required by Administrative Rule 9812(i) to trigger one-year limitation period after denial.

Defendant failed to provide such notice, so statute did not revert to one year.

From the decision · page 4Here, applicant was never sent formal notice in compliance with Rule 9812(i) (Cal. Code Regs., tit. 8, § 9812, subd. (i)) that defendant was completely disclaiming liability for the industrial injury, and thus the statute of limitations never reverted to one year. Although defense counsel did ultimately tell applicant in emails that her claim was "denied," these informal denials did not contain the language required by Rule 9812(i). In any case, it appears that applicant's Application was filed within one year of these so-called denials.

What proof carried it

The evidence the panel weighed, by kind.

Documentary evidencefavours Applicant prevailed

Defendant accepted liability and authorized medical treatment, suggesting to applicant that filing a claim was unnecessary, tolling the statute of limitations.

Documentary evidencefavours Applicant prevailed

Defendant's failure to provide formal denial notice as required by Rule 9812(i) prevented the statute from reverting to one year.

From the decision · page 4Here, applicant was never sent formal notice in compliance with Rule 9812(i) (Cal. Code Regs., tit. 8, § 9812, subd. (i)) that defendant was completely disclaiming liability for the industrial injury, and thus the statute of limitations never reverted to one year. Although defense counsel did ultimately tell applicant in emails that her claim was "denied," these informal denials did not contain the language required by Rule 9812(i). In any case, it appears that applicant's Application was filed within one year of these so-called denials.

Documentary evidencefavours Applicant prevailed

Defendant's misrepresentations in notices induced applicant to delay filing claim, estopping defendant from asserting statute of limitations defense.

From the decision · page 4In any case, even if the five-year statute was not applicable in this case, defendant would be estopped to claim otherwise as a result of the September 19, 2019 and the June 23, 2020 notices telling the applicant that she had "five (5) years from the date of the injury or one (1) year from the date of last benefit" to file with the WCAB. An employer and its insurer are estopped to plead the statute of limitations when the actions or misrepresentations of either induce the employee to refrain from filing a claim until after the statute of limitations has run." (McGee Street Productions v. Workers' Comp. Appeals Bd. (Peterson) (2003) 108 Cal.App.4th 717, 726 [68 Cal.Comp.Cases 708].) As the Supreme Court explained in Benner v. Industrial Acc. Comm. (1945) 26 Cal.2d 346, 349-350 [10 Cal.Comp.Cases 110], "An estoppel may arise although there was no designed fraud on the part of the person sought to be estopped."

ADJ14840331 · June 14, 2024

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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