ADJ10546340 — California WCAB decision

What the panel ordered

Petition for reconsideration granted; WCJ's August 24, 2022 Findings of Fact and Order rescinded; matter returned to WCJ for further proceedings and new decision.

Applicant sought reconsideration of the WCJ's August 24, 2022 Findings of Fact and Order which denied the injury claim; the WCJ report recommended denial of the petition; the Appeals Board granted reconsideration, rescinded the F&O, and returned the matter to the WCJ for further proceedings.

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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.

Psyche AOE/COERemandedpsyche

Dr. Sherman's reports were not based on complete records and thus did not constitute substantial evidence; the record must be further developed including personnel and hospital records; the Labor Code section 5402 presumption applicability must also be determined.

From the decision · page 4Here, Dr. Sherman repeatedly requested that he be provided the Mission Community Hospital treatment records and applicant's personnel records including witness statements. Absent his review of those records, his reports are not based on pertinent facts and an accurate history, so they do not constitute substantial evidence. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).)

The rules the panel named

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

Rolda v. Pitney Bowes (2001) 66 Cal.Comp.Cases 241 (Appeals Board en banc)

To determine compensability of psychiatric injury, the WCJ must apply the four-part Rolda test considering actual events, predominant cause, lawful personnel actions, and substantial cause.

The decision explains the Rolda test and requires medical evidence for causation and substantial cause determinations.

From the decision · page 3The WCJ, after considering all the medical evidence, and the other documentary and testimonial evidence of record, must determine: (1) whether the alleged psychiatric injury involves actual events of employment, a factual/legal determination; (2) if so, whether such actual events were the predominant cause of the psychiatric injury, a determination which requires medical evidence; (3) if so, whether any of the actual employment events were personnel actions that were lawful, nondiscriminatory and in good faith, a factual/legal determination; and (4) if so, whether the lawful, nondiscriminatory, good faith personnel actions were a "substantial cause" of the psychiatric injury, a determination which requires medical evidence. Of course, the WCJ must then articulate the basis for his or her findings in a decision which addresses all the relevant issues raised by the criteria set forth in Labor Code section 3208.3. (Rolda v. Pitney Bowes (Rolda) (2001) 66 Cal.Comp.Cases 241, 247 (Appeals Board en banc)

Labor Code section 5402

Labor Code section 5402 presumes compensability if liability is not rejected within 90 days after claim filing, rebuttable only by evidence discovered after 90 days.

The decision notes the absence of claim form and denial notice evidence, requiring further development on this presumption.

From the decision · page 4It is also important to note that pursuant to Labor Code section 5402: If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division. The presumption of this subdivision is rebuttable only by evidence discovered subsequent to the 90-day period. (Lab. Code, § 5402(b).)

ADJ10546340 · November 14, 2022

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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