Settlement of workers' compensation case doesn't bar claim involving another injury

HR leaders should be familiar with res judicata, especially when it comes to employment law

Settlement of workers' compensation case doesn't bar claim involving another injury

The doctrine of res judicata – also known as claim preclusion – would not apply in a case where two workers’ compensation claims involved different injuries, a panel of the Workers’ Compensation Appeals Board of California recently said.

In Graves vs. CoorsTek, Inc.; Travelers Property Casualty Company of America, a man filed his first claim for workers’ compensation benefits in October 2012. He alleged that he sustained cumulative injury to certain body systems and his psyche while the defendant employed him as a supervisor from Oct. 1, 2011 to Oct. 1, 2012.

Read more: Workers' Compensation Appeals Board dismisses petition

In January 2014, the worker signed a compromise and release settling the first claim in connection with specific body parts, including his neck, back, circulatory system, and digestive system. On the same day, the workers’ compensation administrative law judge approved this settlement.

In November 2013, the worker filed a second application for benefits. He alleged that he suffered cumulative injury to various body parts, including his respiratory system, chest, and nervous system, while the defendant employed him as a team leader from Jan. 28, 2008 to Sept. 27, 2012.

In April 2015, the qualified medical examiner took the applicant’s detailed history, reviewed his medical records including his spirometry results and radiology reports, performed a physical examination, and drafted an initial medical-legal evaluation.

In February 2020, the workers’ compensation administrative law judge found that res judicata barred the applicant’s claims because the applicant had resolved the claim via a compromise and release and had obtained an award in a prior case for injuries arising out of and in the course of employment with the same company.

The worker asked for reconsideration of the judge’s findings. He argued that, because he did not include respiratory injury in his former settlement, the judge’s decision was wrong.

The panel of the Workers’ Compensation Appeals Board of California rescinded the judge’s findings and returned the matter to the trial level for further proceedings and for the issuance of a new decision.

The doctrine of res judicata was not applicable in this case, where two workers’ compensation claims involved different injuries, the panel said. The worker’s respiratory injury was not part of the 2014 agreement. The employer offered no medical opinion providing that, at the time of the settlement, the applicant sustained an injury to his respiratory system.

The panel held that, upon return of the matter to the trial level, the parties should ask the medical examiner to submit a supplemental report with updated medical records because he said, in his April 2015 report, that he was waiting to review a scan’s results and that the cause of the applicant’s restrictive lung disease was unclear.

According to the panel, the medical examiner’s opinions in the 2015 report failed to constitute substantial medical evidence to support a finding of injury arising out of and in the course of employment, lacked a solid underlying basis, and were speculative.

While the applicant reported various respiratory symptoms since at least 2010 and believed these symptoms to be industrially related in October 2013, his belief about industrial causation did not amount to knowledge because he was not a trained medical professional, the panel said.

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