ADJ11275140 — California WCAB decision

What the panel ordered

Petition for Reconsideration granted, WCJ decision rescinded, matter returned to trial level for further proceedings and decision consistent with WCAB opinion

Petition for Reconsideration granted, WCJ decision rescinded, matter returned to trial level for further proceedings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.

Reconsideration / removalApplicant prevailedright leg · right knee · psychiatric injury

The WCAB granted reconsideration because the WCJ's decision lacked adequate findings and the record was incomplete, requiring further development including psychiatric and updated orthopedic PQME reports.

From the decision · page 1Applicant, in pro per, seeks reconsideration of the October 5, 2023 Findings and Award issued by the workers' compensation administrative law judge (WCJ). Therein, the WCJ found that applicant, sustained admitted industrial injury to his right leg and right knee while employed as a yard foreman on March 7, 2018, causing 23% permanent disability. While addressing the issue in the Opinion on Decision, the WCJ did not make findings with regards to disputed body parts. The WCJ did not address or make findings as to the issue of self-procured medial treatment.

The facts that decided it

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

The WCJ's decision did not make findings on disputed body parts or self-procured medical treatment.

Favours Applicant prevailed

This lack of findings indicated an incomplete record and inadequate decision, necessitating reconsideration.

From the decision · page 1Applicant, in pro per, seeks reconsideration of the October 5, 2023 Findings and Award issued by the workers' compensation administrative law judge (WCJ). Therein, the WCJ found that applicant, sustained admitted industrial injury to his right leg and right knee while employed as a yard foreman on March 7, 2018, causing 23% permanent disability. While addressing the issue in the Opinion on Decision, the WCJ did not make findings with regards to disputed body parts. The WCJ did not address or make findings as to the issue of self-procured medial treatment.

Psychiatric symptoms and treatment records related to the industrial injury were documented but not addressed.

Favours Applicant prevailed

The need to develop the record on psychiatric injury was a basis for granting reconsideration and returning the matter to trial.

From the decision · page 4II. While the Application for Adjudication of Claim in this matter has not been amended to include a psychiatric injury, treatment records document psychiatric symptoms and treatment that may be related to applicant's industrial injury. Because we have a duty to further develop the record where there is insufficient evidence on an issue and our rules allow for the amendment of pleadings subject to proof, we will grant reconsideration, rescind the WCJ's decision and return this matter to the trial level for the WCJ to conduct further proceedings as she determines necessary to develop the record on the issue of alleged psychiatric injury. This should include a psychiatric or psychological panel qualified (PQME) medical examination. In addition, we note that the most recent report from Dr. Schiffman is dated August 23, 2019. Therefore, an updated orthopedic PQME report should be obtained that reviews and incorporate the most recent treatment records.

The most recent orthopedic report was dated August 23, 2019, requiring an updated PQME report.

Favours Applicant prevailed

An updated medical evaluation was necessary for a complete and current record, supporting reconsideration.

From the decision · page 4II. While the Application for Adjudication of Claim in this matter has not been amended to include a psychiatric injury, treatment records document psychiatric symptoms and treatment that may be related to applicant's industrial injury. Because we have a duty to further develop the record where there is insufficient evidence on an issue and our rules allow for the amendment of pleadings subject to proof, we will grant reconsideration, rescind the WCJ's decision and return this matter to the trial level for the WCJ to conduct further proceedings as she determines necessary to develop the record on the issue of alleged psychiatric injury. This should include a psychiatric or psychological panel qualified (PQME) medical examination. In addition, we note that the most recent report from Dr. Schiffman is dated August 23, 2019. Therefore, an updated orthopedic PQME report should be obtained that reviews and incorporate the most recent treatment records.

The rules the panel named

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

Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473

Decisions must be based on admitted evidence in the record and must set forth reasons and evidence relied on for each issue.

The WCJ's decision lacked specificity and an adequate record, requiring reconsideration and further development.

From the decision · page 2I. Decisions of the Appeals Board "must be based on admitted evidence in the record." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc).) An adequate and complete record is necessary to understand the basis for the WCJ's decision. (Lab. Code, § 5313.) "It is the responsibility of the parties and the WCJ to ensure that the record is complete when a case is submitted for decision on the record. At a minimum, the record must contain, in properly organized form, the issues submitted for decision, the admissions and stipulations of the parties, and admitted evidence." (Hamilton, supra, 66 Cal.Comp.Cases at p. 475.) The WCJ's decision must "set[] forth clearly and concisely the reasons for the decision made on each issue, and the evidence relied on," so that "the parties, and the Board if reconsideration is sought, [can] ascertain the basis for the decision[.]...

Lab. Code, 5803

The WCAB has continuing jurisdiction and may rescind, alter, or amend any order, decision, or award for good cause.

The WCAB exercised its continuing jurisdiction to rescind the WCJ's decision and return the matter for further proceedings.

From the decision · page 3record open for review." (State Comp. Ins. Fund v. Industrial Acc. Com. (George) (1954) 125 Cal.App.2d 201, 203 [19 Cal.Comp.Cases 98].) Thus, once reconsideration has been granted, the Appeals Board has the full power to make new and different findings on issues presented for determination at the trial level, even with respect to issues not raised in the petition for reconsideration before it. (See Lab. Code, § 5907, 5908, 5908.5; see also Gonzales v. Industrial Acci. Com. (1958) 50 Cal.2d 360, 364.) ["[t]here is no provision in chapter 7, dealing with proceedings for reconsideration and judicial review, limiting the time within which the commission may make its decision on reconsideration, and in the absence of a statutory authority limitation none will be implied."]; see generally Lab. Code, § 5803 ["The WCAB has continuing jurisdiction over its orders, decisions, and awards.... At any time, upon notice and after an opportunity to be heard is given to the parties in interest, the appeals board may rescind, alter, or amend any order, decision, or award, good cause appearing therefor.].)

ADJ11275140 · December 26, 2023

What the panel ordered

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The facts that decided it

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