Court Opinion

ID: 9745681
Source: CourtListenerOpinion
Date Created: 2023-08-26 23:17:27.557696+00
Date Added: 2024-06-11T07:25:04.056758
License: Public Domain

EPSTEIN, P. J.,
Concurring and Dissenting. — The majority opinion affirms the order of the Workers’ Compensation Appeals Board (Appeals Board) rejecting the statute of limitations defense raised by petitioner California Insurance Guarantee Association (CIGA). It does so on two grounds. The first is that the failure of the employer to furnish the employee (applicant) with the statutory notice of his right to proceed under the workers’ compensation law tolled running of the one-year period within which a claim must be filed. (See Lab. Code, §§ 5401, subd. (a), 5405, subd. (a); all further statutory citations are to this code.) The second is that CIGA’s conduct in failing to acknowledge coverage for the accident at issue estops it from asserting the limitations defense. Based on the record before us (and, more particularly the absence of a further record on the issue), I agree that we must uphold the ruling of the Appeals Board on estoppel. But I cannot accept the conclusion of my colleagues that the limitations period continued to be tolled once applicant’s attorney took action on his behalf before the Appeals Board hearing officer with respect to the claim at issue.
*867The basic facts are amply and fairly set out in the majority opinion. As pertinent here, they show that applicant suffered an industrial injury in 1996, for which he filed a timely workers’ compensation claim, and that he suffered another injury in 1997 for which he did not file a claim until 2004. His employer never sent him the notification required by section 5401. On August 27, 2002, at a hearing on the 1996 injury, applicant’s attorney asked that the matter be continued so that he could file an amended application to assert a claim based on the 1997 injury. This request was granted, and the matter was taken off calendar so that the amended application could be filed. It was finally filed more than a year and one-half later. Both sides agree that the limitations period was tolled until the August 2002 hearing. The issues in this case are whether there was a tolling after that, and whether CIGA is estopped to assert the statute of limitations.
1. Estoppel Due to Conduct of CIGA
The order from which CIGA prosecutes this appeal arose from a majority decision of the Appeals Board upholding the post-reconsideration findings and award of the workers’ compensation judge. That decision and its affirmance by the Appeals Board were entirely based on estoppel against CIGA for failing to admit coverage until shortly before the amended application was filed. The record we have is sparse as to how the applicant was prejudiced by CIGA’s failure to acknowledge coverage. But what we have does not negate the existence of sufficient grounds to support an estoppel. As the majority points out, it is CIGA’s burden, as the party seeking to overturn the final adjudication, to demonstrate that the decision is unsupported with respect to estoppel. CIGA has failed to do so, an omission that compels affirmance of the Appeals Board order it attacks. It is for that reason that I concur in the majority opinion on estoppel against CIGA, and the resulting adjudication affirming the order.
2. Failure to Provide Notice of Workers’ Compensation Rights
In Kaiser Foundation Hospitals v. Workers’ Comp. Appeals Bd. (1985) 39 Cal.3d 57 [216 Cal.Rptr. 115, 702 P.2d 197] (Kaiser), our Supreme Court dealt with then-recent changes in the workers’ compensation law with respect to limitations periods as they applied to the mandatory notification of rights to employees claiming injury. It held that failure to provide the notification results in a tolling of the one-year limitations period until the applicant gains actual knowledge that he or she may be entitled to benefits under the workers’ compensation system, so long as the employee is prejudiced by the failure to give notice. Prejudice is presumed from lack of notification. As the majority points out, the court used the phrase “actual knowledge,” in contrast to constructive knowledge, several times over the course of the *868opinion. From this, the majority concludes that knowledge by applicant’s attorney cannot be imputed to applicant.
CIGA advanced three theories why the tolling should have ended no later than the August 27, 2002 hearing. I agree with my colleagues that two of them — applicant’s receipt of benefits from the 1996 injury, showing that he was aware of the workers’ compensation law, and the fact that he retained counsel with respect to that injury — do not suffice. We differ about the third: the actions of his attorney at the August 2002 hearing.
The Kaiser court was not faced with, and did not specifically address, the case of an applicant who is represented by an attorney in proceedings under the workers’ compensation law in which the attorney takes action on the applicant’s behalf with respect to the particular injury at issue. The majority argues that knowledge of the attorney cannot be imputed to the employee, because it would amount only to “constructive knowledge” by the latter. The case they cite for this proposition, Herman v. Los Angeles County Metropolitan Transportation Authority (1999) 71 Cal.App.4th 819 [84 Cal.Rptr.2d 144], arises out of another context (the Administrative Procedure Act). It is distinguishable because it dealt with a statute that required notification to a party, as distinguished from the attorney for a party. (Herman, at p. 829.) Kaiser does not involve such a statute.
But even accepting the implicit conclusion of the majority that the Supreme Court sought to establish a bright-line rule under which an attorney’s knowledge, by itself, is not enough to stop tolling of the statute, applying the rule to this case goes beyond its logic. The purpose of notification is, of course, to inform the worker that he or she may have rights to benefits under the workers’ compensation law, so that he or she may take steps to retain counsel, or to act in propria persona, in filing and pursuing a claim. That objective is satisfied when the worker retains counsel and the attorney retained takes steps before the Appeals Board to advance the applicant’s claim for benefits with respect to the particular injury at issue.
That is what happened here. Counsel for applicant (the same attorney representing him on this appeal) appeared at a workers’ compensation hearing concerning the 1996 injury and asked that the matter go over so that he could amend the application to add a claim for benefits for the 1997 injury. As summarized by the dissenting member of the Appeals Board, it appeared that “applicant’s attorney knew the separate 1997 injury was responsible for applicant’s back problem since at least July 2001. He was instructed by the WCJ to file a new application in August 2002. Applicant did not file the application until, at earliest, March 8, 2004. Any tolling of the statute of limitations, that may initially have been justified in this case, had certainly long expired.”
*869I find it difficult to conclude that the Supreme Court intended that the tolling rule it announced in Kaiser would continue to apply once the applicant’s retained attorney appears in workers’ compensation proceedings on his behalf and takes action with respect to the particular injury.
The dissenting Appeals Board member saw no reasonable explanation for the delay in filing from August 27, 2002, to March 8, 2004. Whether there is such justification depends on the basis for an estoppel against CIGA. And for that, as already indicated, CIGA has not presented an adequate record to justify reversal of the Appeals Board’s decision.
For these reasons I would affirm the decision of the Appeals Board, but only on the basis given by that board — that CIGA was estopped to claim application of the limitations statute.