What the panel ordered
Petition for Reconsideration denied.
Petition for Reconsideration filed by defendant XL Specialty Insurance Company was reviewed and denied by the Appeals Board panel, adopting and incorporating the WCJ report dated May 29, 2025.
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.
Defendant failed to prove actual prejudice from late notice, so the claim was not barred under Labor Code 5400.
From the decision · page 7In workers' compensation matters, the burden of proof rests on the party "holding the affirmative of the issue." (Lab, Code, § 5705) Defendant bears the burden of proving prejudice.
The WCJ found the applicant's testimony credible and the QME deferred industrial causation to the trier of fact, supporting the finding of injury arising out of and in the course of employment.
From the decision · page 6Petitioner contends that the WCALJ erred in finding that the Applicant's injury arose out of and occurred in the course of her employment. The undersigned maintains that the facts, medical evidence and law supports a finding of AOE/COE on the following grounds:
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant credibly testified to experiencing left knee pain during a folkloric dance at work, supporting injury causation.
Favours Applicant prevailed
This testimony was relied upon by the WCJ and Appeals Board to find injury arose out of and in the course of employment.
From the decision · page 3Here, the WCJ notes in the Report that panel qualified medical evaluator (PQME) Dr. Mark Mikhael deferred the issue of industrial causation of the left knee to the trier of fact. (Report, at p. 3.) The WCJ determined the applicant "testified credibly that she experienced pain in the left knee when she turned around while participating in the folkloric dance in support of her subjective narrative." (Id.) We conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determination(s). (Garza, supra, at pp. 318-319.)
QME Dr. Mark Mikhael deferred the issue of industrial causation to the trier of fact, emphasizing reliance on applicant's subjective narrative.
Favours Applicant prevailed
The Board relied on this deferral and the applicant's credible testimony to uphold injury causation.
From the decision · page 3Here, the WCJ notes in the Report that panel qualified medical evaluator (PQME) Dr. Mark Mikhael deferred the issue of industrial causation of the left knee to the trier of fact. (Report, at p. 3.) The WCJ determined the applicant "testified credibly that she experienced pain in the left knee when she turned around while participating in the folkloric dance in support of her subjective narrative." (Id.) We conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determination(s). (Garza, supra, at pp. 318-319.)
Defendant failed to prove actual prejudice from late injury notice, so claim was not barred under Labor Code 5400.
Favours Applicant prevailed
Lack of evidence of prejudice led to denial of claim bar defense.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Deferred the issue of industrial causation of the left knee to the trier of fact, noting the issue primarily rests upon the applicant's subjective narrative.
The QME report indicated further information was needed on the nature and extent of the injury, but deferred causation to the trier of fact.
From the decision · page 3Here, the WCJ notes in the Report that panel qualified medical evaluator (PQME) Dr. Mark Mikhael deferred the issue of industrial causation of the left knee to the trier of fact. (Report, at p. 3.) The WCJ determined the applicant "testified credibly that she experienced pain in the left knee when she turned around while participating in the folkloric dance in support of her subjective narrative." (Id.) We conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determination(s). (Garza, supra, at pp. 318-319.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code Section 5909
A petition for reconsideration must be acted upon within 60 days of transmission to the Appeals Board, with notice to parties.
The Board acted timely on the petition filed by defendant.
From the decision · page 1I. Former Labor Code section 59091 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, section 5909 was amended to state in relevant part that: (a) A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board.
Labor Code Section 5813
Sanctions under Labor Code section 5813 require bad-faith actions or tactics that are frivolous or solely intended to cause unnecessary delay.
The Board declined to impose sanctions despite some specious arguments by defendant.
From the decision · page 3III. We now address applicant counsel's request for sanctions under section 5813 and attorney's fees and costs under section 5814. The Appeals Board is authorized to impose sanctions, costs and attorney's fees under section 5813, against a person who engages in "bad-faith actions or tactics that are frivolous or solely intended to cause unnecessary delay." (Lab. Code, § 5813.) WCAB Rule 10421, subdivision (b) (Cal. Code Regs., tit. 8, § 10421(b)) provides a comprehensive but non-exclusive list of actions that could be subject to sanctions. Sanctions under section 5813 are designed to punish litigation abuses and to provide the court with a tool for curbing improper legal tactics and controlling their calendars. (Duncan v. Workers' Comp. Appeals Bd. (2008) 166 Cal.App.4th 294, 302.) Accordingly, sanctions are similar to penalties under section 5814, in that they are designed to have both remedial and penal aspects. (See Ramirez v.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's credible testimony of pain in left knee during folkloric dance supports injury causation.
From the decision · page 3Here, the WCJ notes in the Report that panel qualified medical evaluator (PQME) Dr. Mark Mikhael deferred the issue of industrial causation of the left knee to the trier of fact. (Report, at p. 3.) The WCJ determined the applicant "testified credibly that she experienced pain in the left knee when she turned around while participating in the folkloric dance in support of her subjective narrative." (Id.) We conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determination(s). (Garza, supra, at pp. 318-319.)
Employer witness testimony about late injury report was insufficient to prove actual prejudice to defendant.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
- If you are named in this decision and want this page removed, write to privacy@similarcase.com.