What the panel ordered
Findings, Award and Orders issued on November 10, 2020, rescinded; matter returned to WCJ for further proceedings
Petition for reconsideration granted; decision after reconsideration issued rescinding prior Findings, Award and Orders and returning matter to trial level for further proceedings
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 QME's psychiatric injury causation opinion was conclusory, failed to comply with Rolda requirements, and did not provide substantial evidence to support the WCJ's finding of compensable psychiatric injury; therefore, the decision was rescinded and remanded for further proceedings.
From the decision · page 6Here the QME's reporting does not adequately address causation of applicant's psychological injury. The QME initially opined that applicant's psychological injury was caused by her 2017 injury, however, applicant sustained two injuries in 2017, a specific and a cumulative. The QME failed to address which 2017 injury caused the psychological sequala. The QME's opinion on causation was conclusory, without explanation, and failed to comply with the specific requirements of Rolda. The WCJ's decision to assign disability to one of the 2017 injuries and not the other was not based upon substantial evidence.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The QME's opinion on psychiatric injury causation was conclusory, lacked explanation, and failed to comply with Rolda requirements.
Favours Defendant prevailed
This lack of substantial medical evidence undermined the WCJ's finding of compensable psychiatric injury and led to rescission and remand for further proceedings.
From the decision · page 6Here the QME's reporting does not adequately address causation of applicant's psychological injury. The QME initially opined that applicant's psychological injury was caused by her 2017 injury, however, applicant sustained two injuries in 2017, a specific and a cumulative. The QME failed to address which 2017 injury caused the psychological sequala. The QME's opinion on causation was conclusory, without explanation, and failed to comply with the specific requirements of Rolda. The WCJ's decision to assign disability to one of the 2017 injuries and not the other was not based upon substantial evidence.
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.
Initially opined that the applicant sustained a compensable psychiatric injury causally related to the February 24, 2017 work injury, but failed to specify which 2017 injury caused the psychiatric sequela and later refused to address predominant causation, rendering the opinion conclusory and insufficient under Rolda requirements.
The QME's opinion was conclusory, lacked explanation, and did not comply with Rolda requirements for psychiatric injury causation, thus not constituting substantial evidence to support the WCJ's finding.
From the decision · page 6Here the QME's reporting does not adequately address causation of applicant's psychological injury. The QME initially opined that applicant's psychological injury was caused by her 2017 injury, however, applicant sustained two injuries in 2017, a specific and a cumulative. The QME failed to address which 2017 injury caused the psychological sequala. The QME's opinion on causation was conclusory, without explanation, and failed to comply with the specific requirements of Rolda. The WCJ's decision to assign disability to one of the 2017 injuries and not the other was not based upon substantial evidence.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
A medical opinion must be framed in terms of reasonable medical probability, not speculative, based on pertinent facts and adequate examination and history, and must set forth reasoning in support of its conclusions.
The QME's opinion was conclusory and lacked explanation, failing to meet this standard, thus not constituting substantial evidence.
From the decision · page 4To constitute substantial evidence "... a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).) "When the foundation of an expert's testimony is determined to be inadequate as a matter of law, we are not bound by an apparent conflict in the evidence created by his bare conclusions." (People v. Bassett (1968) 69 Cal.2d 122, 139.)
Rolda v. Pitney Bowes, Inc. (2001) 66 Cal.Comp.Cases 241
The QME failed to perform a Rolda analysis and did not provide substantial medical evidence of predominant causation.
From the decision · page 4In Rolda v. Pitney Bowes, Inc. (2001), 66 Cal.Comp.Cases 241, 245-246 (Appeals Board en banc), we addressed the factors that a psychological evaluator must consider in opining on causation of psychological injury and disability under section 3208.3. Per Rolda, the evaluator is required to list all factors causing psychological injury, address the percentage of causation that each factor contributes to psychological injury, list all factors causing psychological permanent disability, and address the percentage of causation that each factor contributes to permanent disability.
What proof carried it
The evidence the panel weighed, by kind.
QME's psychiatric injury causation opinion was conclusory and failed to comply with Rolda requirements
From the decision · page 6Here the QME's reporting does not adequately address causation of applicant's psychological injury. The QME initially opined that applicant's psychological injury was caused by her 2017 injury, however, applicant sustained two injuries in 2017, a specific and a cumulative. The QME failed to address which 2017 injury caused the psychological sequala. The QME's opinion on causation was conclusory, without explanation, and failed to comply with the specific requirements of Rolda. The WCJ's decision to assign disability to one of the 2017 injuries and not the other was not based upon substantial evidence.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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