It's been a wild ride
It's been a wild ride

Just over a month after oral argument the Court of Appeal has issued their ruling, reversing the en banc decisions of the Workers’ Compensation Appeals Board, annulled the award of permanent disability to Ms. Ogilvie, and remanding the case for further proceedings. 1

So, what does this new Ogilvie decision mean for us?

  1. The calculations from the en banc decisions of Ogilvie I/II are no longer valid.
  2. An injured worker can still rebut a scheduled rating in accordance with [Download not found] and [Download not found].
  3. An injured worker may rebut a scheduled rating in one of three ways:
    1. Demonstrating “a factual error in the application of a formula or the preparation of the schedule.”  (Ogilvie III, p10-11).  Given the examples provided, probably references proving a defect in the [Download not found] itself.
    2. Demonstrating impairments via [Download not found]-style analysis that “the employee will have a greater loss of future earnings than reflected in a rating because, due to the industrial injury, the employee is not amenable to rehabilitation.”  (Ogilvie III, p12).  However, the increased disability must not be “due to nonindustrial factors such as general economic conditions, illiteracy, proficiency to speak English, or an employee’s lack of education.”
    3. Demonstrating “the claimant’s disability has been aggravated by complications not considered within the sampling used to compute the adjustment factor.”  (Ogilvie III, p13).  This appears to be a two-step process of having to prove a complex injury and then proving that the sample for the adjustment factor didn’t account for such injuries or complications.

Download [Download not found] aka Ogilvie III right now!

  1. Photo courtesy of mpieracci []

Double dip done right
Double dip done right

Some commentators have suggested that the recent Duncan v. WCAB (X.S.) case creates a “double dip” for injured workers entitled to permanent total disability benefits. 1  While I would take issue with much of that commentary, I would agree that permanent total disability benefits are affected by changes in the state average weekly wage twice under Duncan v. WCAB (X.S.).  Of the four benefits in California workers’ compensation system that are affected by changes in the SAWW, only permanent total disability benefits are affected twice.

It took the patient guidance of a very smart friend to help me to understand how this works:

  • When determining the proper starting rate for a permanent total disability case, you must first turn to Cal. Labor Code § 4453(a)(10).  This statute dictates that the limits (as in the statutory minimum and statutory maximum limits) are to be increased by the increase in the state average weekly wage (or SAWW).
  • However, according to Cal. Labor Code § 4659(c) as interpreted by Duncan v. WCAB (X.S.), the benefit rates themselves are then increased by the increase in the state average weekly wage (or SAWW).

Is it “double dipping” to have both the upper/lower limits and benefit rates increased by the SAWW?

Perhaps, but that’s what the two statutes say and what the Court of Appeals has decided.

  1. Photo courtey of alex012 []

Smith/Amar Reversed
Smith/Amar Reversed

Oral argument on Smith v. WCAB (California Youth Authority) went forward on Smith out that on April 7, 2009.  Today, we have the result – Smith/Amar has been unanimously reversed by the California Supreme Court in case number S150528.  Download a copy and read it for yourself here:

For more background on Smith/Amar, check out my prior post discussing the oral argument.

California Court of Appeals, Sixth Appellate District
California Court of Appeals, Sixth Appellate District

Just when you thought things couldn’t get any crazier in workers’ compensation than Ogilvie, Almaraz/Guzman, Benson, and XyzzxSJO2.  Yesterday I found out that on April 7, 2009 the case of Smith v. WCAB (California Youth Authority) is on calendar for oral argument.  As with Almaraz/Guzman, Smith v. WCAB dealt with similar legal issues across two particular workers’ compensation cases.  In case you missed it, here’s the court of appeal decision:

Smith involved an informal denial of medical treatment without a formal petition to terminate medical care under L.C. 4607, after an award of permanent disability. Eight years after Smith’s  award, SCIF refused to authorize epidural injections.  Smith’s attorney sought utilization review, Smith was reexamined by the AME who said the injections were necessary to relieve from the effects of the industrial injury.  Although SCIF then authorized the injections without the need for a hearing, Smith’s attorney sought fees under L.C. 4607.

The WCJ denied Smith’s attorney’s petition for fess since there was no formal petition to terminated medical care.  The WCAB denied reconsideration on the grounds that SCIF’s was not denying all medical treatment.

Amar is substantially similar to Smith, except that in Amar the workers’ compensation judge took the extra step of opining that SCIF’s denial of medical treatment was made in good faith, not unreasonable, and not improper.

However, the 2nd Appellate Court reversed the WCAB in Smith and Amar, stating in relevant part:

“We see no difference when a carrier informally denies some of the treatment that is a necessary part of medical care previously awarded. This is tantamount to a petition to deny medical care even though the carrier continues to provide treatment for some of applicant’s medical care.”

“Insurance carriers who fail to provide previously awarded medical care may not avoid attorney fees to successful applicants’ attorneys through the expedient of an informal denial, even when they do so in good faith.”

I would love to watch the oral argument on this case – but Los Angeles is a bit of a hike for me. 1  I am very very interested to see how this case shakes out.

  1. I last watched oral argument on the Mt. Diablo Unified School District v. WCAB (Rollick) case back on 8/5/2008.  It was particularly interesting for me since I was familiar with the applicant attorney, defense attorney, and facts of that case.  If nothing else, its always fun to watch judges get snarky. []

California Court of Appeals, First Appellate District
California Court of Appeals, First Appellate District

The First Appellate District of the Court of Appeal of the State of California has affirmed the Workers’ Compensation Appeals Board in Benson v. WCAB and the Permanente Medical Group, affirmed (2/10/2009).  The Court of Appeals held, in relevant part, that “[t]he Wilkinson doctrine is inconsistent with the apportionment reforms enacted by Senate Bill No. 899.”

The basic upshot is that barring “limited circumstances” each distinct industrial injury will require its own Award.

First Ogilvie and Almaraz/Guzman, now Benson?  Its been an exciting two weeks to be a Workers’ Compensation attorney.

Office of the Clerk
Office of the Clerk