Overview
In the recent Workers’ Compensation Appeals Board (WCAB) panel decision, Lira v. Cottage Health System, the Board clarified how to analyze cumulative trauma (“CT”) claims when an applicant alleges separate injury periods at different employers but maintains similar job duties with no real break in treatment or recovery. Below is a concise guide for claims adjusters on key issues, the factual backdrop, and best practices for handling CT disputes.
Facts of the Case
- Applicant’s Role: A phlebotomist employed successively by Sansum Santa Barbara Medical (2001–2006) and Cottage Health System (2009–2011).
- Alleged Injuries: The applicant claimed two separate cumulative trauma injuries: (1) from 2001–2006; and (2) from 2009–2011.
- Dispute: Despite the applicant’s claim of distinct injury periods, medical evidence showed she never fully recovered in the interim. She continued receiving medical treatment for her condition, including repetitive strain injuries and related symptoms.
- WCAB Holding: The WCAB determined there was one continuous period of cumulative trauma (rather than two) because her symptoms, medical care, and the essential nature of her job duties were essentially unbroken.
Key Takeaways for Claims Adjusters
- Continuous vs. Distinct CT Periods
- Lira underscores that persistent symptoms and medical care—with no genuine period of maximum medical improvement—often points to a single cumulative trauma.
- If you can prove a meaningful gap in treatment or true recovery, you may establish separate injuries, but if not, expect a single-CT finding.
- Applicable Case Law
- Austin (Western Growers Ins. Co. v. WCAB) supports a single CT claim when treatment and disability continue seamlessly.
- Coltharp (Aetna Cas. & Surety Co. v. WCAB) applies where there are separate, specific events or well-defined breaks in medical treatment and disability.
- Crucial Role of Labor Code §§ 5412 & 5500.5
- Labor Code § 5412 (Date of Injury): Pinpoint the moment the worker knew, or should have known, the injury was work-related. This date triggers the liability window.
- Labor Code § 5500.5 (Liability Period): Employers or carriers on the risk during the one year preceding that date may share in liability. Ensuring you identify the correct date of injury is fundamental for allocating exposure.
- Best Practices
- Investigate Gaps in Medical Treatment: Obtain a thorough record of care between alleged injury periods. If treatment was continuous, a single-CT argument is favored.
- Scrutinize Job Duties: Look for any material change in tasks or duties. In Lira, the applicant’s tasks remained largely the same, strengthening the single-CT conclusion.
- Document Notice and Knowledge: Keep meticulous track of when the applicant reported symptoms and how medical providers described causation—critical for establishing (or refuting) the date of injury.
Conclusion
The Lira decision highlights the WCAB’s emphasis on an applicant’s uninterrupted pattern of symptoms, treatment, and job duties when determining whether multiple alleged CT periods truly exist. Claims adjusters should gather and assess medical histories, treatment timelines, and any evidence of genuine recovery between employments to accurately evaluate CT liability.
Legal Disclaimer
This blog post is provided for informational purposes only and does not constitute legal advice. It does not create an attorney-client relationship between the reader and Yrulegui & Roberts. For legal advice regarding a specific situation or claim, please consult with a qualified attorney.
