What the panel ordered
The WCAB granted the Petition for Reconsideration to correct a clerical error regarding the insurance carrier's identification and otherwise affirmed the WCJ's Findings and Order.
Defendant filed a Petition for Reconsideration of the WCJ's Findings and Order issued on May 28, 2024, which was considered and decided by the WCAB panel on August 19, 2024.
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 and WCAB found that the applicant has not reached psychiatric MMI due to lack of treatment and is entitled to retroactive and ongoing temporary total disability benefits based on the opinions of the treating psychiatrist and QME.
From the decision · page 5This matter proceeded to Trial on February 6, 2024, on the following issues: 1. Whether the applicant has reached maximum medical improvement status on a psychiatric basis. 2. Whether the applicant is entitled to retroactive temporary disability benefits and the amount thereof. 3. Whether defendants have complied with the IMR determination, dated September 29, 2021. All other issues were deferred and bifurcated. (MOH, 2:17-24).
Since the applicant is entitled to retroactive and continuing temporary disability benefits, the statutory increase under Labor Code section 4650(d) applies automatically as a penalty for late payments.
From the decision · page 7Lastly, Defendant contends that it is not liable for the statutory increase in benefits under Labor Code section 4650. Labor Code section 4650 benefits are the most common seen in workers' compensation. Labor Code section 4650(d) states, "If any indemnity payment is not made timely... the amount of the late payment shall be increased by 10 percent and shall be paid, without application, to the employee." The Labor Code § 4650(d) penalty is a self-executing, strict liability provision that applies to delays in payments of temporary or permanent disability payments. Rhiner v. WCAB (1993) 58 CCC 172, 183; State of California v. WCAB (Ellison) (1996) 61 CCC 325, 333; Christian v. WCAB (1997) 62 CCC 576, 586; Mote v. WCAB (1997) 62 CCC 891, 895. Under Labor Code § 4650(d), if a payment is late, that individual payment is automatically increased by 10 percent, and the penalty applies irrespective of the reason for delay. SCIF v. WCAB (Stuart) (1998) 63 CCC 916, 918. Clearly, if the applicant is entitled to retroactive and continuing Temporary Disability benefits, the applicant is also entitled to an increase in temporary disability indemnity payments pursuant to Labor Code § 4650(d).
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant has not reached psychiatric maximum medical improvement due to lack of treatment.
Favours Applicant prevailed
This fact supports entitlement to retroactive and ongoing temporary total disability benefits.
From the decision · page 2treatment in the form of cognitive behavior therapy, individual psychotherapy, and/or psychopharmacology management were denied. (Ex. 9, Deposition Transcript of Mohammed A. Shamie, May 17, 2023, p. 12:18-24; Ex. 19, Report of Mohammed A. Shamie, February 4, 2022, p. 5.) Yet, applicant's treating psychiatrist Dr. Shamie and the qualified medical evaluator (QME) in psychiatry David M. Reiss, M.D., both testified that absent treatment, applicant has not reached maximum medical improvement. (Ex. 9, p. 12:2-8; Ex. 1, Deposition Transcript of David M. Reiss, M.D., March 17, 2023, p. 39:3-4, 19-22.)
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.
Applicant is currently temporarily totally disabled and has a temporary work restriction to avoid power tools due to anxiety and PTSD triggered by their use. Treatment was denied, preventing MMI.
Treatment denial prevented reaching MMI; work restrictions due to psychiatric condition.
From the decision · page 2treatment in the form of cognitive behavior therapy, individual psychotherapy, and/or psychopharmacology management were denied. (Ex. 9, Deposition Transcript of Mohammed A. Shamie, May 17, 2023, p. 12:18-24; Ex. 19, Report of Mohammed A. Shamie, February 4, 2022, p. 5.) Yet, applicant's treating psychiatrist Dr. Shamie and the qualified medical evaluator (QME) in psychiatry David M. Reiss, M.D., both testified that absent treatment, applicant has not reached maximum medical improvement. (Ex. 9, p. 12:2-8; Ex. 1, Deposition Transcript of David M. Reiss, M.D., March 17, 2023, p. 39:3-4, 19-22.)
Applicant is not at psychiatric MMI without treatment; clinically not MMI until treatment is received; temporary work restriction to avoid stressful or traumatic environments.
Clarified that MMI status depends on receiving treatment; recommended work restrictions.
From the decision · page 2treatment in the form of cognitive behavior therapy, individual psychotherapy, and/or psychopharmacology management were denied. (Ex. 9, Deposition Transcript of Mohammed A. Shamie, May 17, 2023, p. 12:18-24; Ex. 19, Report of Mohammed A. Shamie, February 4, 2022, p. 5.) Yet, applicant's treating psychiatrist Dr. Shamie and the qualified medical evaluator (QME) in psychiatry David M. Reiss, M.D., both testified that absent treatment, applicant has not reached maximum medical improvement. (Ex. 9, p. 12:2-8; Ex. 1, Deposition Transcript of David M. Reiss, M.D., March 17, 2023, p. 39:3-4, 19-22.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4650(d)
Labor Code section 4650(d) penalty for late payment of temporary disability benefits
Applies automatically to late payments of temporary disability benefits, increasing the amount by 10 percent.
From the decision · page 7Lastly, Defendant contends that it is not liable for the statutory increase in benefits under Labor Code section 4650. Labor Code section 4650 benefits are the most common seen in workers' compensation. Labor Code section 4650(d) states, "If any indemnity payment is not made timely... the amount of the late payment shall be increased by 10 percent and shall be paid, without application, to the employee." The Labor Code § 4650(d) penalty is a self-executing, strict liability provision that applies to delays in payments of temporary or permanent disability payments. Rhiner v. WCAB (1993) 58 CCC 172, 183; State of California v. WCAB (Ellison) (1996) 61 CCC 325, 333; Christian v. WCAB (1997) 62 CCC 576, 586; Mote v. WCAB (1997) 62 CCC 891, 895. Under Labor Code § 4650(d), if a payment is late, that individual payment is automatically increased by 10 percent, and the penalty applies irrespective of the reason for delay. SCIF v. WCAB (Stuart) (1998) 63 CCC 916, 918. Clearly, if the applicant is entitled to retroactive and continuing Temporary Disability benefits, the applicant is also entitled to an increase in temporary disability indemnity payments pursuant to Labor Code § 4650(d).
What proof carried it
The evidence the panel weighed, by kind.
Testimony of treating psychiatrist Dr. Shamie and QME Dr. Reiss that applicant has not reached psychiatric MMI without treatment.
From the decision · page 2treatment in the form of cognitive behavior therapy, individual psychotherapy, and/or psychopharmacology management were denied. (Ex. 9, Deposition Transcript of Mohammed A. Shamie, May 17, 2023, p. 12:18-24; Ex. 19, Report of Mohammed A. Shamie, February 4, 2022, p. 5.) Yet, applicant's treating psychiatrist Dr. Shamie and the qualified medical evaluator (QME) in psychiatry David M. Reiss, M.D., both testified that absent treatment, applicant has not reached maximum medical improvement. (Ex. 9, p. 12:2-8; Ex. 1, Deposition Transcript of David M. Reiss, M.D., March 17, 2023, p. 39:3-4, 19-22.)
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About this page
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