WCPanelIQ
PanelQMEMed-legalDenied

Ayala, Fernando

FERNANDO AYALA, Applicant vs. GARDENERS' GUILD AND FEDERAL INSURANCE COMPANY, ADMINISTERED BY GALLAGHER BASSETT, Defendants

ADJ number
ADJ16629567
Decision date
Nov 27, 2023
District office
San Francisco
WCJ
Lawrence Keller
Claim administrator
Gallagher Bassett (administering for Federal Insurance Company)
Commissioners
—

Injury / body parts: lumbar spine, abdomen (hernia), bilateral hands, bilateral hips, spine, bilateral shoulders, right shoulder, cervical spine, neck

LC §3600LC §3202.5LC §3208.3LC §4600LC §4650LC §5400LC §5401LC §5402LC §5403LC §5405LC §5705LC §5704LC §5903LC §5904LC §5952CCR §10955

Summary

Defendant Gardeners' Guild sought reconsideration of a WCJ's Findings of Fact that applicant Fernando Ayala sustained a specific injury AOE/COE to his lumbar spine on February 9, 2021, that the claim was not barred by the post-termination defense or statute of limitations, and that the record required further development regarding parts of body injured and a separate cumulative trauma claim. The Appeals Board treated the petition as a hybrid challenge—applying the reconsideration standard to the threshold AOE/COE finding and the removal standard to the interlocutory development-of-record findings. The Board adopted and incorporated the WCJ's Report, finding substantial medical evidence supported the specific injury and that applicant gave notice through crew leader Yepez to foreman Wilbar, satisfying the Labor Code section 3600(a)(10)(A) exception. Because defendant never provided a DWC-1 claim form despite having notice, it was precluded from asserting a statute of limitations defense. The Board denied reconsideration and removal.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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