What the panel ordered
Petition for Reconsideration denied.
Petition for Reconsideration filed by defendant Inglewood Unified School District, P.S.I., administered by Keenan & Associates, denied by the WCAB panel after review and adoption of the WCJ report.
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 medical opinion of PQME Michael Luciano, M.D., was found not to be substantial medical evidence supporting apportionment due to lack of sufficient records and reliance on conjecture. The defendant failed to meet its burden of proof for apportionment.
From the decision · page 1Labor Code1 section 4663(a) provides that "[a]pportionment of permanent disability shall be based on causation." (Lab. Code, § 4663(a).) Section 4664(a) states that "[t]he employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment." (Lab. Code, § 4664(a).) The defendant has the burden of proof on the issue of apportionment. (Kopping v. Workers' Comp. Appeals Bd. (2006) 142 Cal.App.4th 1099, 1114 [71 Cal.Comp.Cases 1229].)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant did not provide sufficient medical records to support apportionment and relied on conjecture regarding prior injuries and incidents.
Favours Applicant prevailed
Without adequate records, the medical opinion on apportionment was not substantial evidence, leading to denial of apportionment.
From the decision · page 11The Court appreciates that the doctor attempts to define apportionment with a paucity of records and a history as defined both by the applicant herself in-person and defendant by letter. This does not appear to be sufficient.
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.
Found no substantial medical evidence supporting apportionment due to lack of sufficient records and reliance on conjecture; found permanent disability causally related to the industrial injury; noted some resolved injuries to right shoulder, elbow, and wrist.
The opinion was not framed in terms of reasonable medical probability with adequate records and was based on surmise and conjecture, thus not substantial evidence for apportionment.
From the decision · page 2We agree with the WCJ that the opinion of panel qualified medical examiner (PQME) Michael Luciano, M.D., is not substantial medical evidence supporting a finding of apportionment. (Hegglin v. Workers' Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]; Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc) [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].) In order to consist of substantial medical evidence on the issue of apportionment, a medical opinion
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4663(a)
Apportionment of permanent disability shall be based on causation.
Defendant has the burden of proof on apportionment; medical opinion must be framed in terms of reasonable medical probability and supported by adequate records.
From the decision · page 1Labor Code1 section 4663(a) provides that "[a]pportionment of permanent disability shall be based on causation." (Lab. Code, § 4663(a).) Section 4664(a) states that "[t]he employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment." (Lab. Code, § 4664(a).) The defendant has the burden of proof on the issue of apportionment. (Kopping v. Workers' Comp. Appeals Bd. (2006) 142 Cal.App.4th 1099, 1114 [71 Cal.Comp.Cases 1229].)
What proof carried it
The evidence the panel weighed, by kind.
From the decision · page 1We have given the WCJ's credibility determinations great weight because the WCJ had the opportunity to observe the demeanor of the witnesses. (Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500].) Furthermore, we conclude there is no evidence of considerable substantiality that would warrant rejecting the WCJ's credibility determinations. (Id.)
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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.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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