What the panel ordered
The Workers' Compensation Appeals Board affirms the Joint Findings and Order of January 14, 2020, denying the petition for reconsideration and upholding the WCJ's finding that additional medical evidence is necessary to determine injury AOE/COE.
Petition for reconsideration of the Joint Findings and Order issued by the WCJ on January 14, 2020, challenging the finding that applicant did not meet burden of proof of injury AOE/COE in case ADJ12387385; the WCJ found further medical development necessary; the WCAB applies removal standard and denies reconsideration.
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 WCJ found insufficient medical evidence to determine injury AOE/COE and ordered further medical development; the WCAB affirmed this finding, denying defendant's petition for reconsideration as removal was not justified and reconsideration was an adequate remedy.
From the decision · page 4Turning to defendant's Petition, defendant asks that we find that, because of the lack of medical evidence, applicant did not meet his burden of proof that he sustained injury AOE/COE. The WCJ determined that that the medical record needs to be developed by use of a PQME, AME or "regular physician" appointed by the WCJ, in order to prove or disprove a contested injury. (Report, p. 3.) The WCJ's finding that additional medical evidence is necessary to develop the record is not a threshold issue. Although the decision contains a finding that is final, the petitioner is only challenging an interlocutory finding/order in the decision. Therefore, we will apply the removal standard to our review. (See Gaona, supra.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
There was insufficient medical evidence to determine injury AOE/COE at the time of the WCJ's decision.
Favours Defendant prevailed
This lack of evidence justified the WCJ's order for further medical development and denial of defendant's petition for reconsideration.
From the decision · page 4Turning to defendant's Petition, defendant asks that we find that, because of the lack of medical evidence, applicant did not meet his burden of proof that he sustained injury AOE/COE. The WCJ determined that that the medical record needs to be developed by use of a PQME, AME or "regular physician" appointed by the WCJ, in order to prove or disprove a contested injury. (Report, p. 3.) The WCJ's finding that additional medical evidence is necessary to develop the record is not a threshold issue. Although the decision contains a finding that is final, the petitioner is only challenging an interlocutory finding/order in the decision. Therefore, we will apply the removal standard to our review. (See Gaona, supra.)
Applicant's counsel attempted to obtain medical evidence including scheduling a QME appointment with Dr. Vivik Solanki, which defendant objected to.
Favours Applicant prevailed
This showed applicant's diligence in developing the record, undermining defendant's claim of prejudice if the record remained open.
From the decision · page 5Defendant contends that applicant failed to exercise due diligence with respect to presenting medical evidence and, as such, the record should not remain open. (Telles Transport, Inc. v. Workers' Comp. Appeals Bd. (2001) 92 Cal.App.4th 1159 [66 Cal.Comp.Cases 1290].) Defendant's reliance on Telles is misplaced. Here, it appears that applicant requested a QME panel to develop medical evidence and scheduled an appointment for applicant with panel QME Dr. Vivik Solanki. However, defendant objected to the appointment. In contrast to Telles, the record here suggests that applicant's counsel attempted to obtain substantial evidence to support applicant's claim.
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.
Scheduled as a panel QME to develop medical evidence for injury AOE/COE determination; appointment was stayed pending resolution of employment and AOE/COE issues.
From the decision · page 2Discovery is still ongoing and has not concluded. Applicant was scheduled to see dental PQME, Dr. Solanki on November 18, 2019. On October 18, 2019, Defendant objected to the appointment until the threshold issue injury AOE/COE has been resolved. To this date there is no Med Legal evaluation addressing causation, additional discovery is required to develop the record.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §§ 5701, 5906; McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117; Kuykendall v. Workers' Comp. Appeals Bd. (2000) 79 Cal.App.4th 396; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389; Old Republic Ins. Co. v. Workers' Comp. Appeals Bd. (2020) 85 Cal.Comp.Cases 504
The WCJ has a duty to further develop the medical record when there is insufficient evidence on a threshold issue of injury AOE/COE.
The WCJ's order for further medical development was proper and supported by these authorities.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's counsel attempted to obtain substantial medical evidence including scheduling a QME appointment with Dr. Vivik Solanki; defendant objected to the appointment.
From the decision · page 5Defendant contends that applicant failed to exercise due diligence with respect to presenting medical evidence and, as such, the record should not remain open. (Telles Transport, Inc. v. Workers' Comp. Appeals Bd. (2001) 92 Cal.App.4th 1159 [66 Cal.Comp.Cases 1290].) Defendant's reliance on Telles is misplaced. Here, it appears that applicant requested a QME panel to develop medical evidence and scheduled an appointment for applicant with panel QME Dr. Vivik Solanki. However, defendant objected to the appointment. In contrast to Telles, the record here suggests that applicant's counsel attempted to obtain substantial evidence to support applicant's claim.
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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.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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