ADJ10450982 — California WCAB decision

What the panel ordered

Petition for reconsideration granted solely to amend decision to find lien claimant did not meet burden of proof on injury AOE/COE; otherwise WCJ decision affirmed.

Petition for reconsideration filed by lien claimant Optimal Health Institute after trial decision finding no injury AOE/COE; WCJ decision adopted and reconsideration granted solely to make explicit finding on injury AOE/COE issue.

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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.

AOE/COEDefendant prevailedright wrist · eyes · hands/fingers · digestive system

Lien claimant did not meet burden of proof on injury AOE/COE due to insufficient and contradictory medical evidence, including reports not addressing causation or proper diagnosis, and some reports treating a different person.

From the decision · page 35. Lien claimant did not meet its burden of proof on the issue of injury arising out of and occurring in the course of employment (AOE/COE) in either Case. No. ADJ10450982 or Case No. ADJ10450937.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

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.

PTPRejected

Medical reports by Dr. Shen were found not to be substantial medical evidence for causation or diagnosis due to contradictory histories, lack of diagnosis, and failure to address activities of daily living or employment history.

Reports contained contradictory dates of injury onset, typographical errors, no diagnosis for right wrist, and no acknowledgment of multiple claims.

From the decision · page 6The applicant was examined on August 7, 2017 by the same physician in order to address his cumulative trauma injury claim. The Lien claimant produced a report regarding that examination (Exhibit 4), which describes the injury as continuous repetitive movements with the right arm and wrist and degreasing a fryer causing injury to the eyes. Page 2 of that report indicates onset of pain was gradual and first noticed on March 4, 2016. The medical report does not explain how pain can come on gradually but first noticed on the first day of employment. Further, exhibit 3's initial evaluation for the right hand specific injury indicates the pain came on gradually and was first noticed on May 5, 2016. The discrepancy is not addressed in either medical report. Both medical reports contain the same typographical errors such as "Weak right hand grip when compared to the right." Once again, like Exhibit 3, Exhibit 4 has no diagnosis except for "other visual disturbances."

PTPGiven great weight

Initial treating physician who provided treatment including nerve conduction studies, x-rays, MRIs, medication and physical therapy; treatment was objected to by defendant as outside MPN and claims denied.

Treatment provided but denied by defendant; no further medical opinion detailed in the record.

From the decision · page 4Applicant was sent for treatment by his original attorney to Edward Stokes MD in June 2016. On July 7, 2016, Dr. Stokes sent a request for authorization for upper extremity EMG/NCS, wrist MRI, an eye exam, dermatology evaluation, transdermal creams, physical therapy, wrist brace and Motrin. Defendant objected to the treatment being provided by Dr. Stokes as outside of their MPN. One month later, in August 2016 Defendant denied the claims.

The rules the panel named

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

Lab. Code, 4600(a), 4903(b); Kunz v. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588 (en banc); Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Martin) (1985) 39 Cal.3d 57

Lien claimant must prove injury arising out of and in the course of employment by preponderance of evidence to recover for medical treatment.

Applied to determine lien claimant's burden of proof on injury AOE/COE.

From the decision · page 1A lien for medical treatment is allowable only when the treatment rendered is reasonably required to cure or relieve an injured worker from the effects of an industrial injury. (Lab. Code, § 4600(a), 4903(b).) A defendant will not be liable for a medical treatment where there is no industrial injury. (Kunz v. Patterson Floor Coverings (2002) 67 Cal.Comp.Cases 1588, 1593 (en banc).) Therefore, where a lien claimant, rather than the injured worker, litigates the issue of entitlement to payment for industrially-related medical treatment, the lien claimant stands in the shoes of the injured worker and the lien claimant must establish injury by preponderance of evidence. (Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Martin) (1985) 39 Cal.3d 57, 67 [50 Cal.Comp.Cases 411]; Kunz, supra, 67 Cal.Comp.Cases at p. 1592.)

Lab. Code 5952(d); Lamb v. Workers' Comp. Appeals Bd. (1974) 11 Cal.3d 274; Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159

Appeals Board decisions must be supported by substantial evidence in light of the entire record.

Applied to evaluate the sufficiency of medical evidence for injury AOE/COE.

From the decision · page 2Moreover, any award, order or decision of the Appeals Board must be supported by substantial evidence in light of the entire record. (Lab. Code § 5952(d); Lamb v. Workers' Comp. Appeals Bd. (1974) 11 Cal.3d 274, 280 [39 Cal.Comp.Cases 310].) The term "substantial evidence" means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.... It must be reasonable in nature, credible, and of solid value. (Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566].)

ADJ10450982 · December 10, 2021

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

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