California WCABPanel decision

ADJ11505778 · March 25, 2022

Petition for reconsideration granted; prior Findings and Order rescinded; matter returned to trial level for further proceedings and new decision.

Issues decided: 1
Medical opinions weighed: 1
Authorities named: 2
District office: Oxnard

What the panel ordered

Petition for reconsideration granted; prior Findings and Order rescinded; matter returned to trial level for further proceedings and new decision.

Read the official 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.

AOE/COERemandedneck · back

The PQME report was found to be flawed and not substantial evidence due to failure to address cumulative trauma and job duties, leading to rescission of the prior order and remand for further proceedings.

From the decision · page 3[35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627, 635 [35 Cal.Comp.Cases 16].)

The facts that decided it

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

PQME report failed to address cumulative trauma and job duties relevant to injury causation.

Private workspace

Your case already resembles someone else’s. Find whose.

Paste the dispute. The extractor builds the factors, the search finds the decisions the same facts won, and the matter stays saved. Free account.

Start a matter Search without an account →

The rules the panel named

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

Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113

A lien claimant must establish that the applicant sustained an industrial injury to recover medical treatment lien.

Lien claimant holds the burden of proof to establish all elements necessary to establish its claim.

From the decision · page 2A lien claimant holds the burden of proof to establish all elements necessary to establish its claim. (See Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113, 1117 (Appeals Board en banc).) Thus, to recover for a medical treatment lien, a lien claimant must establish that applicant sustained an industrial injury.

Rosas v. Workers' Comp. Appeals Bd.

A medical opinion must be predicated on reasonable medical probability to constitute substantial evidence.

Substantial medical evidence requires reasonable medical probability.

From the decision · page 3Applicant can establish that his job involved repetitive mentally or physically traumatic activities using lay evidence, including testimony from the applicant. However, the question of whether repetitive traumatic activities caused injury or a need for medical treatment can only be established with substantial medical evidence. To constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (Rosas v. Workers' Comp. Appeals Bd., supra, 16 Cal.App.4th 1692, 1700-1702, 1705 [58 Cal.Comp.Cases 313].) "A medical report predicated upon an incorrect legal theory and devoid of relevant factual basis, as well as a medical opinion extended beyond the range of the physician's expertise, cannot rise to a higher level than its own inadequate premises." (Zemke v. Workmen's Comp. Appeals Bd. (1968) 68 Cal.2d 794 [33 Cal Comp.Cases 358, 363].) A medical opinion is not substantial evidence if it is based on surmise, speculation. conjecture, or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93, 97.)

ADJ11505778 · March 25, 2022

What the panel ordered

What was disputed, and how it came out

The facts that decided it

Your case already resembles someone else’s. Find whose.

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page