What the panel ordered
Petition for Reconsideration denied
Petition for Reconsideration of the Findings and Award issued by the WCJ on May 4, 2023
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 lien claimant failed to prove injury AOE/COE by substantial medical evidence, as the PQME's and other medical reports were incomplete and lacked adequate reasoning, and the applicant did not testify.
From the decision · page 3Having reviewed Mummaneni's reports, we agree with the WCJ that the PQME's reporting is incomplete and not substantial medical evidence regarding causation. Dr. Mummaneni's discussion regarding cause of disability does not explain his reasoning or analysis for reaching his conclusion of "at least [] 1% causation". Dr. Shen's opinions are not based on pertinent facts, nor are they based on an adequate medical history, and none of the reports set forth the reasoning behind his opinions. Thus, his reports are not substantial evidence upon which a finding of cumulative injury, AOE/COE can be based. Lien claimant presented no additional evidence other than their own reports to support that the injury was industrial in nature. Dr. Andrew Shen issued two reports. (L.C. Exh. 2, March 12, 2019 and December 20, 2018 by Dr. Andrew Shen.) Neither report is a comprehensive med-legal evaluation. Likewise, the reports by applicant's secondary treating physicians: Stanley S. Wong, DAOM L.Ac. (Acupuncturist) (Exh. 4) and Henry Kan, DC (Chiropractor) (Exh. 3) do not constitute comprehensive med-legal evaluations. The applicant was not called to testify. Absent stipulations regarding the alleged injury and the injured body parts, a lien claimant must prove that applicant sustained an injury AOE/COE. "
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
PQME Dr. Mummaneni's reports lacked explanation and reasoning for causation percentage.
Favours Defendant prevailed
Without adequate reasoning, the reports are not substantial evidence to prove injury AOE/COE.
From the decision · page 3Having reviewed Mummaneni's reports, we agree with the WCJ that the PQME's reporting is incomplete and not substantial medical evidence regarding causation. Dr. Mummaneni's discussion regarding cause of disability does not explain his reasoning or analysis for reaching his conclusion of "at least [] 1% causation". Dr. Shen's opinions are not based on pertinent facts, nor are they based on an adequate medical history, and none of the reports set forth the reasoning behind his opinions. Thus, his reports are not substantial evidence upon which a finding of cumulative injury, AOE/COE can be based. Lien claimant presented no additional evidence other than their own reports to support that the injury was industrial in nature. Dr. Andrew Shen issued two reports. (L.C. Exh. 2, March 12, 2019 and December 20, 2018 by Dr. Andrew Shen.) Neither report is a comprehensive med-legal evaluation. Likewise, the reports by applicant's secondary treating physicians: Stanley S. Wong, DAOM L.Ac. (Acupuncturist) (Exh. 4) and Henry Kan, DC (Chiropractor) (Exh. 3) do not constitute comprehensive med-legal evaluations. The applicant was not called to testify. Absent stipulations regarding the alleged injury and the injured body parts, a lien claimant must prove that applicant sustained an injury AOE/COE. "
Lien claimant did not present additional substantial evidence beyond their own reports.
Favours Defendant prevailed
No other substantial evidence was presented to support the injury was industrial in nature.
From the decision · page 3Having reviewed Mummaneni's reports, we agree with the WCJ that the PQME's reporting is incomplete and not substantial medical evidence regarding causation. Dr. Mummaneni's discussion regarding cause of disability does not explain his reasoning or analysis for reaching his conclusion of "at least [] 1% causation". Dr. Shen's opinions are not based on pertinent facts, nor are they based on an adequate medical history, and none of the reports set forth the reasoning behind his opinions. Thus, his reports are not substantial evidence upon which a finding of cumulative injury, AOE/COE can be based. Lien claimant presented no additional evidence other than their own reports to support that the injury was industrial in nature. Dr. Andrew Shen issued two reports. (L.C. Exh. 2, March 12, 2019 and December 20, 2018 by Dr. Andrew Shen.) Neither report is a comprehensive med-legal evaluation. Likewise, the reports by applicant's secondary treating physicians: Stanley S. Wong, DAOM L.Ac. (Acupuncturist) (Exh. 4) and Henry Kan, DC (Chiropractor) (Exh. 3) do not constitute comprehensive med-legal evaluations. The applicant was not called to testify. Absent stipulations regarding the alleged injury and the injured body parts, a lien claimant must prove that applicant sustained an injury AOE/COE. "
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.
The work contributed at least 1% causation to the applicant's lumbar issues and specific injury, but the report lacked sufficient reasoning to be substantial evidence.
The PQME's reporting is incomplete and does not explain the reasoning behind the causation percentage, thus not substantial evidence.
From the decision · page 3Having reviewed Mummaneni's reports, we agree with the WCJ that the PQME's reporting is incomplete and not substantial medical evidence regarding causation. Dr. Mummaneni's discussion regarding cause of disability does not explain his reasoning or analysis for reaching his conclusion of "at least [] 1% causation". Dr. Shen's opinions are not based on pertinent facts, nor are they based on an adequate medical history, and none of the reports set forth the reasoning behind his opinions. Thus, his reports are not substantial evidence upon which a finding of cumulative injury, AOE/COE can be based. Lien claimant presented no additional evidence other than their own reports to support that the injury was industrial in nature. Dr. Andrew Shen issued two reports. (L.C. Exh. 2, March 12, 2019 and December 20, 2018 by Dr. Andrew Shen.) Neither report is a comprehensive med-legal evaluation. Likewise, the reports by applicant's secondary treating physicians: Stanley S. Wong, DAOM L.Ac. (Acupuncturist) (Exh. 4) and Henry Kan, DC (Chiropractor) (Exh. 3) do not constitute comprehensive med-legal evaluations. The applicant was not called to testify. Absent stipulations regarding the alleged injury and the injured body parts, a lien claimant must prove that applicant sustained an injury AOE/COE. "
Issued two reports that were not comprehensive med-legal evaluations and not substantial evidence for injury AOE/COE.
Reports were not comprehensive med-legal evaluations and lacked substantial evidence quality.
From the decision · page 3Having reviewed Mummaneni's reports, we agree with the WCJ that the PQME's reporting is incomplete and not substantial medical evidence regarding causation. Dr. Mummaneni's discussion regarding cause of disability does not explain his reasoning or analysis for reaching his conclusion of "at least [] 1% causation". Dr. Shen's opinions are not based on pertinent facts, nor are they based on an adequate medical history, and none of the reports set forth the reasoning behind his opinions. Thus, his reports are not substantial evidence upon which a finding of cumulative injury, AOE/COE can be based. Lien claimant presented no additional evidence other than their own reports to support that the injury was industrial in nature. Dr. Andrew Shen issued two reports. (L.C. Exh. 2, March 12, 2019 and December 20, 2018 by Dr. Andrew Shen.) Neither report is a comprehensive med-legal evaluation. Likewise, the reports by applicant's secondary treating physicians: Stanley S. Wong, DAOM L.Ac. (Acupuncturist) (Exh. 4) and Henry Kan, DC (Chiropractor) (Exh. 3) do not constitute comprehensive med-legal evaluations. The applicant was not called to testify. Absent stipulations regarding the alleged injury and the injured body parts, a lien claimant must prove that applicant sustained an injury AOE/COE. "
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal.Comp.Cases 1588 (WCAB en banc); Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113 (WCAB en banc); Labor Code 3202.5; Labor Code 5705
Lien claimant must prove injury AOE/COE by preponderance of the evidence to recover payment for medical treatment.
Lien claimant stands in the shoes of the injured employee and must prove all elements necessary to establish the lien, including injury AOE/COE.
From the decision · page 3We observe that it is the lien claimants that carry the burden of proving injury AOE/COE. In Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal.Comp.Cases 1588, 1592 (WCAB en banc), we held that when a lien claimant litigates the issue of entitlement to payment for industrially related medical treatment, the lien claimant stands in the shoes of the injured employee and the lien claimant must prove by preponderance of the evidence all of the elements necessary to the establishment of its lien. In Torres v. AJC Sandblasting (2012) 77 Cal.Comp.Cases 1113, (WCAB en banc), we held that in an AOE/COE denied case, lien claimant has the burden of proving injury arising out of and in the course of employment, as a prerequisite to recovery. (Lab. Code § 3202.5; 5705.)
Labor Code 4600
Medical treatment reasonably required to cure or relieve the injured worker from the effects of the injury shall be provided by the employer.
Since injury AOE/COE was not proven, there is no legal basis for treatment to be reasonably required.
From the decision · page 3(a) Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of the worker's injury shall be provided by the employer.... (Lab. Code, § 4600.)
What proof carried it
The evidence the panel weighed, by kind.
PQME's reports lacked adequate reasoning and were incomplete
From the decision · page 3Having reviewed Mummaneni's reports, we agree with the WCJ that the PQME's reporting is incomplete and not substantial medical evidence regarding causation. Dr. Mummaneni's discussion regarding cause of disability does not explain his reasoning or analysis for reaching his conclusion of "at least [] 1% causation". Dr. Shen's opinions are not based on pertinent facts, nor are they based on an adequate medical history, and none of the reports set forth the reasoning behind his opinions. Thus, his reports are not substantial evidence upon which a finding of cumulative injury, AOE/COE can be based. Lien claimant presented no additional evidence other than their own reports to support that the injury was industrial in nature. Dr. Andrew Shen issued two reports. (L.C. Exh. 2, March 12, 2019 and December 20, 2018 by Dr. Andrew Shen.) Neither report is a comprehensive med-legal evaluation. Likewise, the reports by applicant's secondary treating physicians: Stanley S. Wong, DAOM L.Ac. (Acupuncturist) (Exh. 4) and Henry Kan, DC (Chiropractor) (Exh. 3) do not constitute comprehensive med-legal evaluations. The applicant was not called to testify. Absent stipulations regarding the alleged injury and the injured body parts, a lien claimant must prove that applicant sustained an injury AOE/COE. "
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