What the panel ordered
Petition for Reconsideration denied; October 22, 2021 Amended Findings of Fact and Order affirmed.
Petition for Reconsideration filed by applicant was considered and denied, affirming the October 22, 2021 Amended Findings of Fact and Order.
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.
Applicant's SIBTF claim was filed more than five years after the subsequent injury date, exceeding the statutory limitation period under Talcott and Adams, making the claim untimely.
From the decision · page 3We should, in the absence of statutory direction and to avoid an injustice, prevent the barring of an applicant's claim against the Fund before it arises. Therefore, we hold that where, prior to the expiration of five years from the date of injury, an applicant does not know and could not reasonably be deemed to know that there will be substantial likelihood he will become entitled to subsequent injuries benefits, his application against the Fund will not be barred -- even if he has applied for normal benefits against his employer - - if he files a proceeding against the Fund within a reasonable time after he learns from the board's findings on the issue of permanent disability that the Fund has probable liability. (Talcott, supra, 2 Cal.3d at p. 65.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's SIBTF claim was filed on August 2, 2019, which was ten years after the subsequent injury date of September 14, 2009.
Favours Defendant prevailed
This filing date exceeded the five-year limitation period for SIBTF claims under Talcott and Adams, leading to the claim being untimely.
From the decision · page 2On August 2, 2019, applicant filed an application in the present matter for SIBTF benefits. Thereafter, applicant underwent medical evaluations in 2019 and 2020 by Dr. Ramin Shiva (Applicant's Exhibits 1 and 4), Dr. Allan Kipperman (Applicant's Exhibit 2), and Dr. Christopher Chen (Applicant's Exhibit 3) for orthopedic, psychiatric, and internal medicine issues. The doctors generally opined that as a result of applicant's combined injuries and preexisting medical conditions, applicant's ability to recover from his injuries was hindered, and he was precluded [] from most jobs and the ability to compete in the labor market. (Opinion on Decision dated October 22, 2021, pp. 2-4.)
Applicant was represented by counsel at the time of the 2012 Stipulations and Award, which imputed knowledge of SIBTF eligibility to him.
Favours Defendant prevailed
The WCJ found applicant had constructive knowledge of his eligibility due to legal representation, supporting the untimeliness finding.
From the decision · page 4of his likelihood entitlement to SIBTF benefits and did not find applicant credible when he testified at trial that he did not know about the existence of the SIBTF at the time. The WCJ found applicant had imputed knowledge because he was represented by counsel in the 2012 Stipulations and Award. (Report, pp. 4-5.)
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.
Opined that applicant's combined injuries and preexisting conditions hindered recovery and precluded most jobs and labor market competition.
From the decision · page 2On August 2, 2019, applicant filed an application in the present matter for SIBTF benefits. Thereafter, applicant underwent medical evaluations in 2019 and 2020 by Dr. Ramin Shiva (Applicant's Exhibits 1 and 4), Dr. Allan Kipperman (Applicant's Exhibit 2), and Dr. Christopher Chen (Applicant's Exhibit 3) for orthopedic, psychiatric, and internal medicine issues. The doctors generally opined that as a result of applicant's combined injuries and preexisting medical conditions, applicant's ability to recover from his injuries was hindered, and he was precluded [] from most jobs and the ability to compete in the labor market. (Opinion on Decision dated October 22, 2021, pp. 2-4.)
Opined that applicant's combined injuries and preexisting conditions hindered recovery and precluded most jobs and labor market competition.
From the decision · page 2On August 2, 2019, applicant filed an application in the present matter for SIBTF benefits. Thereafter, applicant underwent medical evaluations in 2019 and 2020 by Dr. Ramin Shiva (Applicant's Exhibits 1 and 4), Dr. Allan Kipperman (Applicant's Exhibit 2), and Dr. Christopher Chen (Applicant's Exhibit 3) for orthopedic, psychiatric, and internal medicine issues. The doctors generally opined that as a result of applicant's combined injuries and preexisting medical conditions, applicant's ability to recover from his injuries was hindered, and he was precluded [] from most jobs and the ability to compete in the labor market. (Opinion on Decision dated October 22, 2021, pp. 2-4.)
Opined that applicant's combined injuries and preexisting conditions hindered recovery and precluded most jobs and labor market competition.
From the decision · page 2On August 2, 2019, applicant filed an application in the present matter for SIBTF benefits. Thereafter, applicant underwent medical evaluations in 2019 and 2020 by Dr. Ramin Shiva (Applicant's Exhibits 1 and 4), Dr. Allan Kipperman (Applicant's Exhibit 2), and Dr. Christopher Chen (Applicant's Exhibit 3) for orthopedic, psychiatric, and internal medicine issues. The doctors generally opined that as a result of applicant's combined injuries and preexisting medical conditions, applicant's ability to recover from his injuries was hindered, and he was precluded [] from most jobs and the ability to compete in the labor market. (Opinion on Decision dated October 22, 2021, pp. 2-4.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Talcott, supra, 2 Cal.3d 56
The limitation period to file a SIBTF claim is five years from the date of injury if the applicant knew or reasonably should have known of substantial likelihood of entitlement before expiration of five years; otherwise, a reasonable time after learning of probable liability from the WCAB's findings.
Applied to determine timeliness of applicant's SIBTF claim.
From the decision · page 3We should, in the absence of statutory direction and to avoid an injustice, prevent the barring of an applicant's claim against the Fund before it arises. Therefore, we hold that where, prior to the expiration of five years from the date of injury, an applicant does not know and could not reasonably be deemed to know that there will be substantial likelihood he will become entitled to subsequent injuries benefits, his application against the Fund will not be barred -- even if he has applied for normal benefits against his employer - - if he files a proceeding against the Fund within a reasonable time after he learns from the board's findings on the issue of permanent disability that the Fund has probable liability. (Talcott, supra, 2 Cal.3d at p. 65.)
What proof carried it
The evidence the panel weighed, by kind.
Applicant was represented by counsel at the time of the 2012 Stipulations and Award, which imputed knowledge of SIBTF eligibility to him.
From the decision · page 4of his likelihood entitlement to SIBTF benefits and did not find applicant credible when he testified at trial that he did not know about the existence of the SIBTF at the time. The WCJ found applicant had imputed knowledge because he was represented by counsel in the 2012 Stipulations and Award. (Report, pp. 4-5.)
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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.
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