What the panel ordered
Petition for Reconsideration granted; F&O rescinded; case remanded to WCJ for further proceedings and new decision
Petition for Reconsideration granted, Findings of Fact and Order (F&O) of August 22, 2023 rescinded, matter returned to WCJ for further proceedings and new decision
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.
The WCJ's denial was based on lack of a formal psychiatric diagnosis by the AME, Dr. Bassett, and insufficient medical evidence to establish industrial injury. The WCAB found the medical evidence incomplete and insufficient to support the denial, granting reconsideration and remanding for further development of the record.
From the decision · page 3In her June 11, 2021 report, Dr. Bassett discusses decedent's psychological distress, emotional downward spiral, and emotional symptoms. (Board Exhibit X.)....[However], Dr. Bassett does not opine that any of decedent's symptoms met any of the diagnostic criteria for a disorder. Dr. Bassett mentions emotions in her reporting, but does not provide a formal diagnosis of any psychiatric condition which caused either disability or a need for treatment....No medical evidence was offered to substantiate that decedent had a diagnosed psychiatric injury. Without a psychiatric diagnosis, there is no industrial injury pursuant to Labor Code Section 3208.3(a) and therefore, decedent's suicide cannot be found to be a compensable consequence.
The WCJ found no industrial injury under Government Code section 21166 due to lack of psychiatric diagnosis and non-industrial motivation for death. The WCAB agreed the evidence was insufficient and remanded for further development.
From the decision · page 4section 21166. (F&O, p. 2.) In the Opinion on Decision, the WCJ explained that, again, Dr. Bassett's reporting failed to provide any psychological diagnosis. The WCJ also found that the evidence showed that decedent's death was non-industrial for the purposes of Government Code section 21166, based upon Dr. Bassett's testimony that decedent's suicide "was motivated by monetary concerns for his family...." (Opinion on Decision, pp. 4-5, quoting Board Exh. Y, p. 15; see Pearl v. Workers' Comp. Appeals Bd. (2001) 26 Cal.4th 189, 194 [66 Cal.Comp.Cases 823] [for the purposes of the Public Employees' Retirement Law (Gov. Code, § 20000 et seq.), an injury is compensable if the "industrial component was `real and measurable.'"].)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Bassett did not provide a formal psychiatric diagnosis of decedent's condition, which is required under Labor Code section 3208.3(a) to establish industrial injury.
Favours Applicant prevailed
Without a formal diagnosis, the WCJ could not find compensability for the psychiatric injury or death by suicide.
From the decision · page 3In her June 11, 2021 report, Dr. Bassett discusses decedent's psychological distress, emotional downward spiral, and emotional symptoms. (Board Exhibit X.)....[However], Dr. Bassett does not opine that any of decedent's symptoms met any of the diagnostic criteria for a disorder. Dr. Bassett mentions emotions in her reporting, but does not provide a formal diagnosis of any psychiatric condition which caused either disability or a need for treatment....No medical evidence was offered to substantiate that decedent had a diagnosed psychiatric injury. Without a psychiatric diagnosis, there is no industrial injury pursuant to Labor Code Section 3208.3(a) and therefore, decedent's suicide cannot be found to be a compensable consequence.
The medical evidence was incomplete and insufficient to support the WCJ's denial of compensability, requiring further development of the record.
Favours Applicant prevailed
The WCAB granted reconsideration and remanded the case for further proceedings to develop the medical record.
From the decision · page 5However, applicant argues, and we agree, that the reporting and testimony of Dr. Bassett was incomplete and did not constitute substantial medical evidence upon which the WCJ could rely to reach any decision on industrial injury.
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.
Decedent's suicide was predominantly caused by industrial factors, specifically personnel actions he was facing. Did not diagnose a formal psychiatric disorder. Testified that death was motivated by monetary concerns for family, a non-industrial factor.
The WCJ relied on Dr. Bassett's report and testimony but found it incomplete due to lack of formal diagnosis and insufficient explanation, leading to denial of compensability. The WCAB found the report incomplete and insufficient to support denial, requiring further development.
From the decision · page 3forensic psychiatry, Katalin Bassett, M.D., as well as deposition testimony from Dr. Bassett.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Braewood Convalescent Hosp. v. Workers' Comp. Appeals Bd. (1983) 34 Cal.3d 159
Substantial evidence means evidence which, if true, has probative force on the issues and is more than a mere scintilla; it must be reasonable, credible, and of solid value.
The WCJ's decision must be supported by substantial evidence in light of the entire record.
From the decision · page 4Hence, our inquiry in this instance is whether there is substantial evidence based on the entire record to support the WCJ's finding that decedent did not sustain a psychiatric injury AOE/COE and that decedent's death was non-industrial. (Garza v. Workmen's Comp. Appeals Bd. (Garza) (1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500] ["[A]ny award, order or decision of the board must be supported by substantial evidence in the light of the entire record"].) It is well established that decisions by WCJs and the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (Lamb) (1974)
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)
Medical opinion must be predicated on reasonable medical probability and not be based on speculation or guess; it must set forth reasoning behind the opinion.
The medical evidence was found incomplete and insufficient to support the WCJ's denial; further development of the record was required.
From the decision · page 5In addressing the concept of substantial medical evidence, the Appeals Board explained in its en banc decision, Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc) (Escobedo):
What proof carried it
The evidence the panel weighed, by kind.
Dr. Bassett's report and testimony lacked a formal psychiatric diagnosis and sufficient explanation to support compensability denial
From the decision · page 3In her June 11, 2021 report, Dr. Bassett discusses decedent's psychological distress, emotional downward spiral, and emotional symptoms. (Board Exhibit X.)....[However], Dr. Bassett does not opine that any of decedent's symptoms met any of the diagnostic criteria for a disorder. Dr. Bassett mentions emotions in her reporting, but does not provide a formal diagnosis of any psychiatric condition which caused either disability or a need for treatment....No medical evidence was offered to substantiate that decedent had a diagnosed psychiatric injury. Without a psychiatric diagnosis, there is no industrial injury pursuant to Labor Code Section 3208.3(a) and therefore, decedent's suicide cannot be found to be a compensable consequence.
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About this page
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