ADJ10202584 — California WCAB decision

What the panel ordered

The petition for reconsideration is denied, affirming the award of death benefits to the decedent's widow based on substantial evidence linking the death to industrial injury.

Defendant filed a timely petition for reconsideration of the May 28, 2024 Findings and Award Re: Death Benefits, challenging the sufficiency of evidence linking the decedent's death to his employment and asserting res judicata and collateral estoppel defenses.

Read the official decision →

This docket was decided more than once. Shown here is the latest released decision; we also hold April 6, 2022.

What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

Death benefitsApplicant prevailedlumbar spine · neck · bilateral shoulders · thoracic spine · bilateral upper extremities · bilateral knees · bilateral hands · sleep disorder · psyche · cardiopulmonary system

The WCJ found substantial evidence linking the decedent's death to industrial injury, specifically psychological injury and its sequelae, supported by reasoned medical opinions of Dr. Pietruszka and Dr. Lamm, and rejected the defendant's arguments based on outdated or insufficient medical evidence.

The facts that decided it

What the panel did with the medical opinions

The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.

otherRelied upon · internal medicine

Opined that the decedent's industrial psychological injury and related conditions contributed to his death from acute cardiopulmonary arrest.

His report linked work-related psychological stress and industrial sleep disorder with the decedent's death, providing a reasoned medical opinion supporting causation.

From the decision · page 12The reports of Dr. Pietruszka and Dr. Lamm linked work-related psychological stress and an industrial sleep disorder with the applicant's death, which is an issue that was not even considered by Dr. Hirsch. Defendant has urged that since Dr. Hirsh was the Agreed Medical Evaluator (AME) in internal medicine, and he found no industrial injury in the form of liver cancer, chronic lung disease, or umbilical hernia, and because no internal injury was found or awarded based on Dr. Hirsch's opinions, it follows that there should be no finding of an industrial death. However, applicant's counsel has correctly pointed out that Dr. Hirsch's opinions are outdated and not substantial evidence, because his last report was from 2017 and his last deposition was taken on May 2, 2018, both before applicant's death. Accordingly, Dr. Hirsch never directly addressed the applicant's death and its causes. The opinion on decision agreed with applicant's counsel that this is indeed a fatal shortcoming in the expert opinion of Dr. Hirsch on the subject of applicant's death. Dr. Hirsch never addressed Mr.

PTPRelied upon · psychology

As treating physician, agreed that the decedent's psychological injury and chronic stress contributed to his death, supporting the award of death benefits.

Dr. Lamm reviewed all relevant evidence and concurred with Dr. Pietruszka's findings, providing a reasoned opinion linking psychological injury to death.

From the decision · page 13not serve to bar the new issue of whether a previously awarded injury to the psyche caused sequelae that subsequently resulted in applicant's death, these doctrines do appear to [undermine] defendant's arguments that question whether the reports of Dr. Lamm are admissible or can be used as a legally sufficient basis to support an award of compensable injury, when her reports have previously been used to establish a now-final award of injury to the psyche. Dr. Lamm was not a consulting physician merely obtained pursuant to Labor Code § 4605; as explained in the prior Findings and Award of May 19, 2023, she was...a treating physician for applicant's previouslydenied injury to the psyche. As a treating physician, Dr. Lamm properly requested an internal medicine consult, which was then obtained through Dr. Pietruszka and properly reviewed by Dr. Lamm. To the extent that Dr.

AMERejected · internal medicine

Found no industrial injury related to liver cancer, chronic lung disease, or umbilical hernia; opinions considered outdated and not substantial evidence regarding death causation.

His last report was from 2017 and deposition from 2018, before the decedent's death, and he did not address the cause of death directly.

From the decision · page 9With respect to the medical evidence, the Findings and Award of death benefits relied upon the reports of Dr. Pietruszka and Dr. Lamm, which linked work-related psychological stress and an industrial sleep disorder with the applicant's death. Defendant urged that since Dr. Hirsh was the Agreed Medical Evaluator (AME) in internal medicine, and he found no industrial injury in the form of liver cancer, chronic lung disease, or umbilical hernia, and because no internal injury was found or awarded based on Dr. Hirsch's opinions, it follows that there should be no finding of an industrial death, but the opinion on decision explained that Dr. Hirsch's opinions are outdated and not substantial evidencebecause his last report was from 2017 and his last deposition was taken

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Escobedo v. Marshalls (2007) 70 Cal. Comp. Cases 604; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408

Substantial evidence must support WCAB decisions, requiring medical opinions to be based on reasonable medical probability and proper reasoning.

The WCJ applied these standards to evaluate the medical evidence linking the decedent's death to industrial injury, finding the reports of Dr. Pietruszka and Dr. Lamm met the criteria.

From the decision · page 11The gravamen of defendant's petition for reconsideration is centered upon the concept that there is no substantial evidence linking the applicant's death with conditions arising out of and in the course of employment. The Workers' Compensation Appeals Board (WCAB) has held, en banc, that "it is well established that any decision of the WCAB must be supported by substantial evidence." (Escobedo v. Marshalls (2007) 70 Cal. Comp. Cases 604, 620, citing Labor Code § 5952(d), Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal. Comp. Cases 310], Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312,317 [35 Cal. Comp. Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627,635 [35 Cal. Comp. Cases 16].) "In this regard, it has been long established that, in order to constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability." (Escobedo, cited above, 70 Cal. Comp. Cases 604, 620, citing McAllister v.

Labor Code Section 4605

Labor Code Section 4605 governs the use of medical reports in workers' compensation cases.

The reports of Dr. Lamm and Dr. Pietruszka were considered in light of LC 4605, with Dr. Lamm as treating physician properly reviewing Dr. Pietruszka's consulting opinion.

From the decision · page 13not serve to bar the new issue of whether a previously awarded injury to the psyche caused sequelae that subsequently resulted in applicant's death, these doctrines do appear to [undermine] defendant's arguments that question whether the reports of Dr. Lamm are admissible or can be used as a legally sufficient basis to support an award of compensable injury, when her reports have previously been used to establish a now-final award of injury to the psyche. Dr. Lamm was not a consulting physician merely obtained pursuant to Labor Code § 4605; as explained in the prior Findings and Award of May 19, 2023, she was...a treating physician for applicant's previouslydenied injury to the psyche. As a treating physician, Dr. Lamm properly requested an internal medicine consult, which was then obtained through Dr. Pietruszka and properly reviewed by Dr. Lamm. To the extent that Dr.

What proof carried it

The evidence the panel weighed, by kind.

Medical recordsfavours Applicant prevailed

Reports of Dr. Pietruszka and Dr. Lamm linking work-related psychological stress and industrial sleep disorder with the decedent's death

From the decision · page 12The reports of Dr. Pietruszka and Dr. Lamm linked work-related psychological stress and an industrial sleep disorder with the applicant's death, which is an issue that was not even considered by Dr. Hirsch. Defendant has urged that since Dr. Hirsh was the Agreed Medical Evaluator (AME) in internal medicine, and he found no industrial injury in the form of liver cancer, chronic lung disease, or umbilical hernia, and because no internal injury was found or awarded based on Dr. Hirsch's opinions, it follows that there should be no finding of an industrial death. However, applicant's counsel has correctly pointed out that Dr. Hirsch's opinions are outdated and not substantial evidence, because his last report was from 2017 and his last deposition was taken on May 2, 2018, both before applicant's death. Accordingly, Dr. Hirsch never directly addressed the applicant's death and its causes. The opinion on decision agreed with applicant's counsel that this is indeed a fatal shortcoming in the expert opinion of Dr. Hirsch on the subject of applicant's death. Dr. Hirsch never addressed Mr.

Medical recordsfavours Defendant prevailed

Outdated and insufficient medical opinions of Dr. Hirsch not addressing death causation

From the decision · page 12The reports of Dr. Pietruszka and Dr. Lamm linked work-related psychological stress and an industrial sleep disorder with the applicant's death, which is an issue that was not even considered by Dr. Hirsch. Defendant has urged that since Dr. Hirsh was the Agreed Medical Evaluator (AME) in internal medicine, and he found no industrial injury in the form of liver cancer, chronic lung disease, or umbilical hernia, and because no internal injury was found or awarded based on Dr. Hirsch's opinions, it follows that there should be no finding of an industrial death. However, applicant's counsel has correctly pointed out that Dr. Hirsch's opinions are outdated and not substantial evidence, because his last report was from 2017 and his last deposition was taken on May 2, 2018, both before applicant's death. Accordingly, Dr. Hirsch never directly addressed the applicant's death and its causes. The opinion on decision agreed with applicant's counsel that this is indeed a fatal shortcoming in the expert opinion of Dr. Hirsch on the subject of applicant's death. Dr. Hirsch never addressed Mr.

ADJ10202584 · August 23, 2024