Archive for the ‘3208.3’ Category

Court of Appeal Rules on Sudden and Extraordinary Case

March 29th, 2012 No comments

Your humble blogger was at his post yesterday, diligently fighting off claims and liens, when he suddenly received an alert of extraordinary nature.  The Court of Appeal, in an opinion posted only yesterday afternoon, has rendered its decision in the case of State Compensation Insurance Fund v. Workers’ Compensation Appeals Board, granting the relief sought by the defense.

In short, falling from a tree or ladder, while sudden for everyone and extraordinary for some professions, is not an extraordinary event for fruit pickers (avocados are fruit, right?)

Applicant Rigoberto Garcia had been working for his employer picking avocados from 35-foot-high avocado trees, using 24-foot ladders for roughly two months, when he suddenly fell from a ladder, sustaining various injuries, including an injury to the head. All aspects of his claim were admitted… except for the psyche claim.  The defendant raised the Labor Code section 3208.3(d) defense to psyche injuries claimed by employees with a less-than 6-month tenure.  This defense has been explored a time or two on this blog as well.

Applicant offered his own testimony at trial on the issue of the defense, claiming that he had never seen any other workers fall from a ladder with this employer, and was not warned at any time that this risk was common.  Defendant offered no evidence.

The workers’ compensation Judge found the injury was sudden and extraordinary, and the defendant filed for reconsideration.  The question that went before the WCAB was whether falling from a 24-foot ladder was a common risk to 35-foot avocado tree pickers, much like burning one’s hand while working as a drycleaner.

A split panel denied reconsideration, with the majority taking issue with defendant’s failure to present any evidence at trial as to the common occurrence of such falls.  In all fairness, the defense failed to carry its burden of proving the existence of gravity – the lawyers no doubt cursed themselves for failing to invest in apple orchards.

But, as all things that go up must come down (and there is nothing extraordinary about that), so, too, with applicant’s luck in the courts.  Defendant petitioned the Court of Appeal for a writ of review, arguing, again, that applicant failed to carry his burden in proving that the mechanism of injury was extraordinary.

The Court of Appeal, having watched the biography of Isaac Newton just the night before, granted defendant’s petition and reversed the WCAB.  The reasoning was, primarily, that common sense dictates that the injury-causing-event experienced by applicant was the exact type of injury one would expect would happen in applicant’s line of work.  Had applicant been attacked by a bear, the “extraordinary” element would have been much easier to prove.

So, the defense is now back to bearing the burden of proving common sense – what kind of injury can we expect from the following job duties…

Categories: 3208.3, Defenses Tags:

From Psyche to Migraine to Non-Compensable

March 5th, 2012 2 comments

The Court of Appeal recently handed down its ruling on whether or not an applicant’s claimed migraines are compensable.  Applicant initially proceeding on a claim of injury to the psyche, but understood very quickly that defendant had a fairly solid defense in the good-faith personnel action.  (Labor Code § 3208.3(h).)  In a monumental show of consistency and legitimacy of claim over “gaming the system,” applicant amended his application on the first day of trial to include migraines as a claimed injury.

3208.3(h) does not always work, as my wise and learned readers no doubt recall.  There are a lot of ways applicants attempt to slip around this broad and solid shield – including making regular efforts to use semantics with respect to what caused the injury.  It was complying with the good faith personnel action, not the communication of the action to the employee, after all.

In this case, applicant tried, with considerable success, to argue that his migraines were the result of a psychiatric injury.  Although the psychiatric injury itself, caused by “friction with his supervisor,” may be barred by the defense, the resulting migraines are not.

The workers’ compensation Judge awarded applicant compensation for the migraines, and the Workers’ Compensation Appeals Board denied defendant’s petition for reconsideration.  Most cases end here for a variety of reasons, and your perceptive blogger submits that it is most appropriate to applaud the County of San Bernardino, the employer in this case, for pressing on and petitioning the Court of Appeal for a writ of review.

One can not help but imagine that there was a spike in applicant’s migraines after the Court of Appeal decision came down, and I would therefore advise the Court of Appeal to retain a tort defense attorney, just in case.  No, migraines are not compensable when they are the result of a non-compensable psyche injury.

The Court of Appeal held “seldom are the effects of stress limited to injury to the psyche without resulting physical problems.”  The Court continued, “[i]t would be relatively easy for a claimant to avoid [the bar of 3208.3(h)] by asserting internal problems and symptoms, such as upset stomach, headache and sleeplessness, but not injury to the psyche per se.”

If I had a headache before reading this opinion, it has certainly cleared up – the Court of Appeal has given the defense community another brick to put in its wall.

Categories: 3208.3, Defenses Tags:

Post Termination Psyche Claims Barred? Not in My Workers’ Comp…

January 30th, 2012 No comments

Your loyal blogger seems regularly at odds with panel decisions on the meaning of Labor Code section 5412, specifically as to the term “in the exercise of reasonable diligence should have known.”

In your blogger’s simple and straightforward world, the statute means what it says.  So, for example, if you pick up a box at work, feel a sharp pain in your back, and then your back hurts from that point on, the exercise of reasonable diligence quickly helps you connect the dots – one does not need a rocket scientist, a brain surgeon, or even a chiropractor to conclude that the disability flowing from that instance is industrial.  But enough of Grinberg’s world, back to the world of California Workers’ Compensation.

In the case of Bertha Chan v. Carl Karcher Enterprises, the panel came down in favor of the applicant.

Applicant was allegedly enduring a campaign of physical and verbal sexual harassment by her immediate supervisor, when her employment was terminated in December 2007.  Applicant then filed an application one month later, alleging psychiatric injury as a result of the alleged harassment.
The treating physician and the Panel Qualified Medical Evaluator both found industrially caused injury. But what about Labor Code section 3208.3(e)?

A cumulative trauma can’t be sudden;
There was no notice to the employer of the injury;
There was no medical record of the impairment prior to the claim;
The trier of fact specifically found there was no sexual harassment; and
The exercise of reasonable diligence would have lead applicant to conclude that whatever impairment she had sustained was industrial.

After all, either applicant had sustained an impairment or she hadn’t – if she had, it happened at work before being fired; if she had not had any impairment by the time her employment was terminated, then something other than work caused it.
Assuming she had sustained some psyche injury prior to the termination of employment, then how could physical and verbal sexual harassment on an ongoing basis not be linked to the impairment?

Your garden variety defense attorney is thus forced to watch logic prove a blunt tool in situations such as these. It is worth noting that the defense attorney in this case, in the filed answer, acknowledged that there was no evidence presented at trial of the concurrence of applicant’s disability and knowledge of the industrial causation of the injury.  But actual knowledge isn’t the standard; the standard is known or should have known.  The defense has petitioned for reconsideration.  I hope you will join me in waiting to see if, perhaps, some new life could be breathed into this defense.

Categories: 3208.3, Tactics and Strategy Tags:

Psyche Claims: Divide and Conquer

January 27th, 2012 No comments

This is an interesting one, but it takes some clarity of thought to keep the party names straight.  Given that today is Friday, your ever-accommodating blogger simply replaced the names with party 1, 2, 3, etc.

Applicant is employed by Party 1, and sustains injuries to his back with three specific dates of injury and one cumulative trauma.  Applicant later leaves the employ of Party 1 and goes to work for Party 2, for whom he is still employed roughly two months later when he sustains another injury in a vehicle accident.

The Agreed Medical Evaluator on the case opines that 65% of applicant’s impairment was caused by the injury sustained while working for Party 2, and the remaining 35% spread out among the injuries sustained while working for Party 1.  With me so far?

Party 1 – 4 orthopedic injuries – 35% impairment causation

Party 2 – 1 orthopedic injury – 65% impairment causation

Applicant then amends his claim to include a psyche injury based on the orthopedic injuries.

The psyche AME concurs with the orthopedic AME in terms of causation.  So Party 1 and Party 2 raise their respective defenses.

Party 1 claims that the injuries sustained while applicant was in its employ are not the “predominant cause” of applicant’s psyche injury, as required by Labor Code section 3208.3(b)(1), and Party 2 claimed that applicant had not been employed for six months at the time of his injury, as required by Labor Code section 3208.3(d).

The Workers’ Compensation Judge knocked out the defense of Party 2, presumably because of the “sudden and extraordinary employment condition,” to wit, a car accident, that is not reasonably to be expected from landscaping work.  But, the WCJ did acknowledge and approve of Party 1’s “predominant cause” defense.

The Workers’ Compensation Appeals Board affirmed and the Court of Appeal denied review.  (Monty Lewis v. Workers’ Compensation Appeals Board (2011)).

Just a thought – let’s say applicant worked for four employers, one after another, and sustained an injury while working for each one.  If the evaluating physician apportioned 25% causation to each employer from the inevitable psyche injury, would the “predominant cause” defense bar the claim?

If the answer is yes, then no matter how legitimate the claim or debilitating the injury, the fact that multiple employers contributed to the impairment would help prevent liability for any of them.  A worthwhile defense to explore in similar circumstances, and a reason for multiple employers to pool their resources and spread causation out thinner than “predominant cause” can tolerate.

Categories: 3208.3, Defenses, Tactics and Strategy Tags:

A Pro-Per Denial of Benefits

January 23rd, 2012 No comments

Applicant Massoud Kaabinejadian sustained a devastating psychiatric injury and was then persecuted by his employer for reporting said injury, which resulted in him courageously and rightly filing a workers’ compensation claim and a Labor Code section 132a petition as well.

He was so righteous and justified, he needed no attorney to plead his case.  To his shock and dismay, and to the shame of California’s workers’ compensation system, his case failed because of one missing and yet totally unnecessary element.  As discovery and trial revealed, Mr. Kaabinejadian’s case lacked that hairline tether connecting his legal theory to the law.

In the case of Kaabinejadian v. Rabobank and Chubb Group of Insurance Companies, applicant was hired as a senior vice president of credit at employer Rabobank.  Applicant’s job was to review loan applications and make recommendations to approve (or not approve) the loans.

After several months of friction in which applicant repeatedly denied loans previously approved by subordinate loan officers, applicant’s superiors decided that it was time to let this less-than-six month employee go.  At the time of this decision, applicant was already scheduled to meet with his superiors at another office location to participate in new-employee interviews.  His superiors decided to terminate his employment at the time of his arrival, rather than have him make a separate trip or to go to his office location.

The Workers’ Compensation Judge first noted that applicant was pleading his psychiatric injury as a cumulative trauma, allegedly incurred from the first day worked (April 3, 2006) to the last day worked (July 5, 2006) and “continuing thereafter.”  Given that this provided less than six months of employment, the WCJ correctly reasoned that applicant’s psyche claim could only proceed if it was the result of a “sudden and extraordinary employment condition,” which a cumulative trauma could not be.

In other words:

–it can’t be a generic psyche injury because applicant was not employed for at least six months, so his claim was barred by Labor Code section 3208.3;

–it couldn’t be “sudden and extraordinary” because it was a cumulative trauma; and

–if it was a specific injury and incorrectly plead as a cumulative trauma, the only specific injury could have been the termination of employment, which the WCJ described as part of “normal, regular or routine exchanges between employees and the employer … [b]assically, [applicant] was particularly upset and offended by the way in which he was terminated.”

Regarding the 132a claim, the WCJ reminded applicant that the burden is on the employee to prove discrimination, and documentation established the pre-existing intent to fire applicant well before any claim of injury was made.

The Workers’ Compensation Appeals Board was no more generous with defendant’s money than the WCJ had been, denying applicant’s petition for reconsideration and incorporating the WCJ’s report.

Categories: 132a, 3208.3, Defenses Tags:

Good Faith Personnel Action Causes Psyche Injury

January 5th, 2012 No comments

Many years ago, I worked in a broom factory (not really, but go with the story).  We would carve our brooms by hand every day – it was a slow and painful process.  One day, the factory owner, Gus, decided to install fancy, shiny new machines that greatly increased the efficiency of the operation.  But the machines were new, and shiny, and scary – a lot of us took the retraining in stride, but one of my co-workers, Jasper, just couldn’t handle the new way things were being done.  And when the economy turned, and the broom factory fell on hard times, the lay offs began.

Jasper kept his job, but he just couldn’t handle the pressure of learning the new machinery and doing the work in a changing environment.  So what did Jasper do?  If your answer is anything other than filing a claim for injury to the psyche (and hypertension), including (1) additional retraining; (2) finding a different job with the broom factory; or (3) quitting and looking for a job with a more traditional broom factory, you probably are not an applicant’s attorney.

Arthur Ecker (The Tribune v. Workers’ Compensation Appeals Board, writ denied), worked for the Tribune as a circulations sales manager.  He claimed to have sustained injury to his psyche and circulatory system over an eleven month period in 2008, proceeding on a theory that the injury resulted from the stress of having to take on new job duties.

Those job duties, of course, were to use computers and Excel spreadsheets.  The Agreed Medical Evaluator and the primary treating physician found that “the requirements of the job were essentially beyond applicant’s capabilities.”

Defendant raised the good faith personnel action defense of Labor Code section 3208.3.  After all, decreases in circulation had lead to a 2/3rd reduction in staff and everyone had to cross-train in responsibilities.  Sadly, the Workers’ Compensation Judge, the WCAB and the Court of Appeal were not convinced by defendant’s arguments.

The WCJ wrote in his Report on Petition for Reconsideration, that he does not doubt the changes in applicant’s duties were not “inappropriate or improper [in] purpose.”  By the WCJ’s reasoning, it was the consequences of the changes that caused applicant’s injury.

By that rationale, when does section 3208.3 apply?  Your less-than-persuaded blogger reckons (as we used to say in the old broom factory) that if applicant’s psyche injury had resulted immediately upon hearing the news of his change in duties, the WCJ would have allowed the defense to stand.

In any case, fair readers, be on your guard against this creeping incursion into the defense of 3208.3.  Perhaps we will see a case with a different result and the force of binding authority soon, correcting this interpretation.

Categories: 3208.3, Defenses, Tactics and Strategy Tags:

What Constitutes a “Lawful” Personnel Action?

September 16th, 2011 2 comments

Applicant, a psychiatric nurse, filed a psyche claim after repeatedly being told by a supervisor (a psychiatric technician) to administer a drug at a more frequent rate than that prescribed by the treating physician.  The disagreement had to do with the meaning of “24 hour period.”  The technician incorrectly believed that a 24-hour period ran from midnight to midnight, rather than an actual 24 hour cycle beginning with the first administration of a drug.

The Workers’ Compensation Judge interpreted applicant’s claim as hurt feelings based on resentment at being under the supervision of a technician, and found applicant had suffered no actual injury.  Applicant filed a petition for reconsideration.

The Workers’ Compensation Appeals Board denied applicant’s petition, adopting the WCJ’s opinion and concluding that defendant’s conduct was a lawful, good-faith personnel action and regarded applicant’s claim as a means of confronting the defendant hospital over the issue of its chain of command.

The Court of Appeals took a different approach to this matter.  In its opinion, the Court annulled the decision of the WCAB and remanded the case to determine if the action of defendant, through its supervising technician, was, indeed, lawful.

Labor Code § 3208.3 governs psyche claims, and subsection (h) provides a defense against those psychiatric injuries substantially caused by “a lawful, nondiscriminatory, good faith personnel action.”

At least in this case, the good faith personnel action defense to a psyche claim turns on the meaning of the word “lawful.”  The psyche technician’s interpretation of “24 hours” seems at odds with the definition used in the practice of medicine, and likely the common sense meaning of the term (imagine a patient, in following the prescription of 1 pill every 24 hours, taking one pill ten minutes before midnight and another twenty minutes later.).

That being said, does such a mistake and deviation from generally accepted practice somehow make the supervisor’s actions anything other than lawful?  At most, this seems like an act of negligence.

Hopefully, lawful and correct will remain two distinct terms and the good-faith personnel defense will be one less chip worse for the wear.  Let’s all keep our eyes open for how this case turns out.

Categories: 3208.3, Defenses, Develop the Record Tags:

When “Employment” Begins

August 22nd, 2011 No comments

A recent writ denied case addressed the details of one of the defenses to psyche claims.  Labor Code § 3208.3 provides that psyche claims can not proceed if the employee has been employed less than (not necessarily continuous) six months.  The exception to this is a sudden and extraordinary event.  An earlier blog post covers this exception.

The skinny:  Employment starts with the first day of actual service – not the technical hire date, preparation dates, or anything else.  If Employee is “hired” and begins work the next week, the next week is the first day of employment for purposes of § 3208.3.

In the case of Hamilton v. WCAB, applicant Jill Hamilton was hired on September 14, 2008 to work as a home mortgage assistant, and began work on September 15, 2008, all after filing an online application for the job on August 6, 2008.  Applicant’s last day of work (and earning wages) was on March 12, 2009, and she was taken off the company books on January 25, 2010.

08/06/08– Applies for the job

09/14/08– Official hire date

09/15/08– First day of work

03/12/09– Last day of actual work/earning wages

01/25/10– Removed from company books

As in all things, timing is everything – had applicant started work just a few days earlier, her psyche claim would have survived § 3208.3.

Knowing this, applicant argued that in early September of 2008, she went, at her own expense, to an office in Ventura to pick up a laptop for her training program.  Although she was not compensated for her time, she claimed that this was her first work-related act, so her “employment” commenced sometime (any time that it might please the court) before September 12, 2008.

The Workers’ Compensation Judge found that applicant began working more than six months before March 12, 2008, and therefore was entitled to proceed on her psyche claim.

The Workers’ Compensation Appeals Board granted defendant’s petition for reconsideration, taking a position contrary to the WCJ’s.  Relying on previous case law, the WCAB found that employment begins with actual work, and does not include time off for disability.  Rather, what counts is the “days of actual service” and not those “days of employment where there was no actual performance of services.”

On appeal, applicant’s Petition for Writ of Review was denied.

Before you follow this next tidbit, bear in mind that this is a crazy idea and using it might incur ridicule, discipline, penalties, or even sanctions!  Of course, if you pull this one off, your name will live forever in endless glory.  When signing autographs, don’t forget to tell the fawning fans where you first got the idea for this maneuver.  That being said, let’s walk down “what if” road.

What if we took the language of this opinion one step further.  Averaging six months to 180 days, can we say that vacations, holidays, and weekends don’t count?  Can we argue that applicant is barred against a psyche claim until he or she has worked an actual 180 days (not counting weekends, holidays, etc.?)

After all, if the job is causing a psyche claim, shouldn’t not being on the job slow the progress of the injury?

It’s unlikely to work, but could provide an interesting chance to test the limits of § 3208.3.

Categories: 3208.3, Defenses, Tactics and Strategy Tags:

Crazy for Drycleaning

August 16th, 2011 No comments

I recently started using a dry-cleaner near my office for my shirts.  Before, I used to wash and iron them at home, but the service is ridiculously affordable and convenient.  Little did I know, before reading about the story of Hilda Bonilla, that the work can be very dangerous.

Hilda, a dry cleaner, was injured when an ironing press came down on her hand at work.  The burn mark quickly appeared, followed by a claim for injury to her skin, psyche, nervous system, internal organs, and sleep.

The skinny: for a psyche claim for an employee working the job less than six months, the injury must be caused by an event that is both sudden AND extraordinary – the type of injury that regularly happens at this job, no matter how suddenly, does not qualify.

The Workers’ Compensation Judge found all injuries, the psyche as well, to be compensable.  Defendant petition for reconsideration, arguing that Labor Code § 3208.3(d) barred Hilda’s claim.

§ 3208.3 governs psyche claims, and specifically bars all claims of psychiatric injury for those employees with less than six months (total, not necessarily continuous) time on the job, unless the injury is caused by a sudden and extraordinary event.

Does the ironing press you were using a second ago coming down on your hand count as “a sudden and extraordinary event”?  If it does, is there any specific injury (rather than cumulative trauma) that isn’t a sudden and extraordinary event?

The record reflected ample witness testimony that burns were common, and that employees had to be careful lest they suffer burns from the equipment.

The WCAB granted reconsideration, reasoning that the event may have been horrible and happened suddenly, but the phenomenon of being burned while working at a dry cleaner was not extraordinary, as required by the statute.  By contrast, a gas explosion or workplace violence would qualify as such.

Hilda petitioned for a writ of review.  The result?  WRIT DENIED!  (Bonilla v. Workers’ Compensation Appeals Board (Cameo Cleaners))

Categories: 3208.3, Defenses Tags:

Defining the Scope of the Good-Faith Personnel Action Defense

July 27th, 2011 1 comment

In a recent case, County of Sacramento v. WCAB (Michael Brooks) (2011) 13 WCAB Rptr. 193 , the Workers’ Compensation Appeal Board interpreted the good-faith personnel action defense, further clarifying its scope.  (Sorry folks, no good news is headed our way on this one…)

In California Workers’ Compensation practice, recent years have seen a growing number of psyche claims tacked on to other injuries, but sometimes as stand-alone injuries as well.  In both cases , the insurer/employer should look closely at the good-faith personnel action defense of Labor Code § 3208.3(h).

Essentially, an otherwise compensable psychiatric injury shall not be compensable for an injury “substantially caused by a lawful, nondiscriminatory, good faith personnel action.”

In the Brooks case, the applicant, a Supervising Deputy Probation Officer with the County of Sacramento Probation Department filed a complaint against a subordinate for excessive force in subduing a juvenile inmate.  An investigation followed, during which Mr. Brooks perceived a total lack of support from his supervisors and employers, and the over-enthusiastic employee filed a grievance against the applicant..

After filing an application, the parties used an Agreed Medical Evaluator who found that applicant’s psychiatric impairment, Adjustment Disorder with Depressed and Anxious Mood, was caused, in equal parts, by (1) the filing of the grievance; (2) defendant’s investigation; and (3) his feelings of being unsupported.

The Workers’ Compensation Judge found that the defense of good-faith personnel action was not met and made an award in favor of applicant.  Defendant filed for reconsideration.

On reconsideration, the WCAB affirmed the WCJ’s decision, finding two of the components causing the impairment did not qualify as good-faith personnel actions, so only 33% of the causation qualified for the defense, rendering the § 3208.3(h) inapplicable.

As the WCAB reasoned, the term “personnel action” as used in § 3208.3(h) is “conduct attributable to management in managing its business.”  The WCAB expressly rejected the position that the scope of “personnel action” encompasses “all actions by any level of personnel in the employment situation.”  (13 WCAB Rptr. 193, 194).  Among those actions not covered by the defense are the actions of one employee against a fellow or lesser employee, unless authorized or ratified by management.

Therefore, the WCAB concluded, while the investigation was a good faith personnel action, the grievance filed by applicant and applicant’s own feelings in response to his perceptions regarding management were not good-faith personnel actions.

Defendant has filed a Petition for Writ of Review, which was issued on June 23, 2011.

In reading these facts, I can’t help but think that the Board erred in its conclusion.  I agree that the process of filing a grievance might not be covered by the defense of § 3208.3, and no one is contesting the finding that management’s investigation falls well within the scope of the same.

But defendant’s approach to handling this matter, and the degree of support provided to applicant throughout the process, is a good faith personnel action in and of itself.  Therefore, applicant’s reactions to this good faith personnel action should be folded into the personnel action, and thereby be covered by the defense.

After all, every time the good faith personnel action defense has been used successfully, there must have been some reaction from the applicant to the action itself.  Perhaps the Court of Appeals shall see it the same way as does your humble author?

Categories: 3208.3, Defenses Tags: