Workers' compensation judge initially ruled worker suffered 23% permanent disability
SK Floor Covering – the defendant in the recent workers’ compensation case of Ruiz vs. SK Floor Covering and State Compensation Insurance Fund – employed the applicant as a carpet installer from July 2016 to July 2017.
The applicant claimed injuries to his left shoulder, chest, low back, both knees, both ankles, psyche, and nose or sense of smell. In January 2021, the workers' compensation administrative law judge made a finding confirming the injuries in the body parts that the applicant claimed. The judge awarded him 23% permanent disability.
The applicant asked for a reconsideration. In April 2021, a panel of the Workers’ Compensation Appeals Board of California affirmed the judge’s findings and award.
In December 2021, the applicant filed a petition to reopen. He claimed additional injuries to his throat, chest, liver, coccyx, and hips. He also alleged that he had sores on his hands and feet. He said that he needed medical treatment for various body parts.
A week later, the company objected to the petition to reopen and filed a declaration of readiness to proceed regarding the petition.
Last August, the workers’ compensation administrative law judge found that the applicant failed to prove the injuries to the additional body parts claimed and failed to submit evidence showing that he sustained new and further disability.
The applicant again sought reconsideration. He made the following arguments:
- He submitted evidence showing that his liver and kidneys were swollen due to the medication he took for his injury, but this evidence was not accepted into the record
- He developed sores on his legs, feet, and hands
- He was denied psychiatric treatment
- He was not allowed to ask for additional evidence from his doctors to support his claims
The panel of California’s Workers’ Compensation Appeals Board reconsidered the matter, canceled the August 2022 findings and order, and returned the matter to the judge to conduct further proceedings and to issue a new decision.
The panel ruled that the Appeals Board committed an error when it failed to act on the applicant’s petition within 60 days of its filing. The applicant was not at fault for this delay. Thus, the time to act had tolled, the panel said.
The claims administrator failed to conduct a reasonable and timely investigation after being notified that the applicant was claiming entitlement to workers’ compensation benefits, the panel added.
The panel noted that the applicant’s petition to reopen raised issues about the extent of the permanent impairment caused by his injuries. Specifically, the petition alleged that he developed internal medicine problems, including liver damage, due to pain medication for his industrial injury; that he had sores on hands and feet due to the medication; and that the loss of sensation in his right foot was related to his right knee injury.
Under section 4061(i) of California’s Labor Code, the defendant could not properly file a declaration of readiness to proceed with the petition to reopen until a treating physician and a qualified medical evaluator issued a medical evaluation.
Therefore, the panel found it necessary to return the matter to the judge for further development of the record so that the parties could comply with the requirements of section 4061(i) and Administrator Rule 10109.
