On 01/29/16, Applicant suffered burns to his feet while handling caustic materials at work.  The injury was accepted, and benefits were provided.  Ultimately, Applicant was evaluated by a PQME in podiatry.

On 12/27/17, Applicant sustained injuries to his left hand, fingers, and chest while using a table saw at home.  He claimed that this was a compensable consequence on the theory that the burns to his feet caused him to lose balance and suffer further injury.  On 6/07/18, Applicant fell in the street while walking home and sustained a back injury, a head injury, a broken orbital bone, and loss of consciousness.  He later claimed that this fall was another compensable consequence, alleging that the burns to his feet caused him to lose his balance and fall.   

Applicant’s counsel amended the claim to add the left hand, left fingers, chest, head, left eye, left orbital bone, and back.  Jason Buscaino, an experienced California workers’ compensation defense attorney, believed the newly alleged compensable consequence injuries were questionable, particularly Applicant’s fall in the street, as Applicant had originally reported to his PTP that he experienced non-industrial dizziness, which caused him to fall.  Interestingly, the PTP’s next report changed the narrative, indicating that Applicant lost his balance, causing him to fall and then feel dizzy.

As part of a diligent California workers’ compensation defense investigation of the newly alleged compensable consequence injuries, Jason secured records from Applicant’s private medical providers.  These medical records, particularly those from the emergency room visits, did not mention anything about the industrial burns to his feet but did detail different factual scenarios:             

As to the table saw incident, the records documented that the table saw propelled a wooden plank backwards toward the Applicant at a high rate of speed, causing injury; and as to the fall, the records documented that Applicant suffered a syncope episode, causing his collapse in the middle of the street, resulting in injuries. 

Jason filed a DOR for an MSC to either settle the case or set it for trial.  At the MSC, Applicant’s counsel sought an order allowing additional QME panels in orthopedic surgery, neurology, and ophthalmology.  Jason successfully argued that before allowing the three additional QME panels, the WCAB needed to first make the factual determination as to whether the subsequent incidents were related to the original injury.  The MSC judge agreed and allowed the case to be set for trial. 

At trial, Applicant and his wife maintained that the industrial burns to his feet caused him to lose his footing and slip, resulting in both the table saw incident and the fall.  When Jason cross-examined them, he used the emergency room records in a successful attack on the credibility of their testimonies.

The WCJ found permanent disability from the admitted injury to Applicant’s feet based on the podiatry PQME.  The WCJ also found that Applicant did not sustain injury to his left eye, left orbital bone, left hand, left middle fingers, left ribcage, and back as a compensable consequence. 

Applicant filed a petition for reconsideration.   In this instance, given their high level of confidence in the position taken at trial and the strength of the WCJ’s decision, no answer was filed.  The WCAB denied Applicant’s Petition for Reconsideration.  With the trial results upheld on appeal, Jason successfully shut down this claim and avoided at least three additional PQMEs, which would have prolonged the litigation, and potential additional exposure for benefits.

You can read redacted versions of the Report and Recommendation on Petition for Reconsideration, Opinion and Order Denying Petition for Reconsideration and Findings and Award and Opinion on Decision below.

Report and Recommendation on Petition for Reconsideration: Click here

Opinion and Order Denying Petition for Reconsideration: Click here

Findings and Award and Opinion on Decision: Click here

Media Contacts:
Company Name:  Dietz, Gilmor & Chazen, APC
Industry:  California workers’ compensation defense
Full Name:  David Jankosky, DGC Client Services (818-654-9911, Ex. 1231)
Email Address:  djankosky@dgcattorneys.com

Effective as of Monday, January 27, 2020 our new corporate office mailing address is 9665 Granite Ridge Drive, Suite 110, San Diego, CA 92123.
Please note all phone and fax numbers will remain the same.

In October 2018, while being counseled about his job performance and under the impression that he was going to be fired, the applicant reported to his supervisor that he had been injured at work on April 9, 2018 (back) and October 26, 2018 (back and leg).  The applicant began receiving treatment for the October 26, 2018 injury.  The April 9, 2018 injury was denied for lack of factual and medical evidence.  The matter was referred to DGC for defense handling.

After her initial review of the file and speaking with an employer witness, Clara Forman knew that the matter was ripe for litigating injury AOE/COE.  The applicant reported he injured his back on April 9, 2018 while helping to move large pipes with his supervisor and a co-worker.  The supervisor denied this incident took place.  The applicant alleged that the second injury occurred while walking down some stairs because he continued to have back pain from the first injury and as a result his leg gave out on him.  Clara’s plan was to prove that the first injury did not occur and that the applicant was not a credible witness, which ought to result in the judge concluding that the second injury did not occur either.

Shortly after the claims were reported, the insurer had assigned an investigator to interview (1) the applicant, who was not yet represented, (2) the applicant’s brother, who was a foreman with the employer, (3) the employee who was allegedly present on April 9, 2018, and (4) the supervisor.   Additionally, surveillance was conducted and captured the applicant performing roof work on his trailer.

After applicant became represented, Clara took his deposition.  Among other things, he testified that he had not done any roof repairs to his trailer during the time in question.

Clara filed a DOR for a priority conference, which was continued, over her objection, to allow applicant’s attorney to thoroughly review the surveillance footage and the deposition transcript.

At the continued priority conference, the applicant dismissed his attorney and said he would represent himself.  The case was continued to an MSC to allow the applicant to obtain his file from his former attorney.

At the MSC, the applicant stated that he had audio evidence that would prove his injuries and listed numerous audios as trial exhibits, to which Clara objected.  The applicant did not serve any exhibits prior to the trial.

On the first day of trial, applicant said that the audio evidence was on three different phones.  After discussing the admissibility of the audio exhibits, the trial judge stated she was going to allow the applicant some leeway and continue the trial so he could serve the audio.  To avoid the continuance, Clara waived service of the audio and requested the opportunity to review the audio with the applicant and the Information and Assistance Officer. During the review, it became apparent the applicant had recorded the discussions without the knowledge of the other participants.  After further discussion with the judge, she ruled that the audio exhibits were inadmissible because he had violated California law since the speakers were not aware they were being recorded.

The applicant and his witness, a former co-worker, testified.  Clara impeached the applicant with his deposition testimony on several points.  The applicant’s witness made statements that were inconsistent with what he previously stated to the investigator.   Given these contradictions, defendant could call the investigator as an impeachment witness.

On the second day of trial, the applicant’s two witnesses – his brother, who had been a foreman with the employer, and his former co-worker – testified.  The defense witnesses who testified were the supervisor and the two investigators.  One investigator testified about the surveillance.  The other one testified about his interviews of the applicant, the applicant’s brother, and the applicant’s former co-worker.  The defense witnesses’ testimonies significantly and credibly contradicted the testimonies of the applicant and his witnesses.

The trial judge issued Findings and Orders that applicant take nothing because he did not meet his burden of proving industrial injury.  After analyzing the evidence in detail, she concluded that there was no credible evidence to show that applicant sustained an injury on either April 9, 2018 or October 26, 2018.

You can read redacted versions of the Minutes of Hearing, Summary of Evidence, and Order of Consolidation, Minutes of Hearing and Summary of Evidence and Findings and Order below.

Minutes of Hearing, Summary of Evidence, and Order of Consolidation: Click here

Minutes of Hearing and Summary of Evidence: Click here

Findings and Order and Opinion on Decision: Click here

Media Contacts:
Company Name:  Dietz, Gilmor & Chazen, APC
Full Name:  David Jankosky, DGC Client Services (818-654-9911, Ex. 1231)
Email Address:  djankosky@dgcattorneys.com

Faced with a CT injury claim based on an orthopedic AME report and CIGA’S attempt to shift liability to his legally uninsured client, Robert Diaz de Leon went to trial on the issues of injury AOE/COE as to the applicant and “other insurance” as to CIGA.  At stake was significant exposure: to the applicant for a minimum of 28% permanent disability ($26,212) after multiple shoulder surgeries and continuing/future medical treatment; to CIGA for reimbursement of at least $66,881; and to various lien claimants, including EDD, whose lien was about $12,012.00.

Robert was armed with a PQME report by an orthopedist who found no injury caused by the applicant’s concurrent part-time employment with the client, the applicant’s testimony (from CIGA’s two depositions and the deposition taken by Robert) to the effect that she did not have any injury or problems from her job duties with the client, and legal arguments supporting the position that the client was not “other insurance” for CIGA’s purposes.  The WCJ found that the PQME report was better reasoned and more persuasive than the AME’s report (the applicant and CIGA were the parties to the AME in the three specific injury claims against the other employer).  This medical evidence and the applicant’s trial testimony, which was consistent with her deposition testimony, led to the WCJ’s finding that no CT injury resulted from the applicant’s employment with the client.

A “take nothing” was issued. In addition, the WCJ agreed with Robert’s legal argument that the client did not qualify as “other insurance” and found that the legally uninsured employer was not “other insurance” under Insurance Code sec. 1063.1(c)(9).  Therefore, CIGA was not entitled to shift liability to, or obtain reimbursement from, the client.

Neither the applicant nor CIGA filed a petition for reconsideration.

You can read redacted versions of the Amended Minutes of Hearing and Summary of Evidence and Findings of Fact and Opinion on Decision below.

Amended Minutes of Hearing and Summary of Evidence:  Click here

Findings of Fact and Opinion on Decision:  Click here

Media Contacts:
Company Name:  Dietz, Gilmor & Chazen, APC
Full Name:  David Jankosky, DGC Client Services (818-654-9911, Ex. 1231)
Email Address:  djankosky@dgcattorneys.com