What the panel ordered
Findings and Award of December 2, 2025 affirmed except for deferred issues; matter returned for further proceedings
Petition for reconsideration granted; issues of injury to other body parts, MMI, permanent disability, compensability of April 16, 2023 injury, and attorney's fees deferred for further proceedings
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 issue of attorney's fees was deferred for further proceedings.
From the decision · page 910. The issue of attorney's fees is deferred.
The QME's opinion that the April 16, 2023 left shoulder injury was non-industrial was conclusory and lacked substantial medical evidence, given the applicant's continuous treatment history for the left wrist and hand prior to the 2023 injury, necessitating further development of the record.
From the decision · page 6Here, the existing record is insufficient on the issue of whether the April 16, 2023 left shoulder injury was a compensable consequence of the June 11, 2017 industrial injury to the left hand, left index finger, and left wrist. The QME concluded that `[t]he left shoulder condition is non-industrial as it happened from the fall that occurred on April 16, 2023." (Joint Exhibit #A3, at p. 19.) However, we find the QME's opinion on causation of the left shoulder injury to be conclusory and to not constitute substantial medical evidence. In the supplemental report issued after the May 23, 2024 re-evaluation, the QME reviewed medical records spanning from June 10, 2019 to July 19, 2023. (Id. at pp. 9-18.) The QME opined there was no medical evidence to support that the "June 11, 2017 injury, contributed to occurrence of the April 16, 2023, accident in terms of weakness or inability to engage in the function of the hand operating the motorbike." (Id. at p.
The issue of injury to other body parts was deferred for further proceedings.
From the decision · page 9FINDINGS OF FACT 1. applicant, then 30 years of age, sustained a specific
The issue of maximum medical improvement was deferred for further proceedings.
From the decision · page 9*** 6. The issue of the date when applicant reached maximum medical
The issue of permanent disability was deferred for further proceedings.
From the decision · page 97. The issue of permanent disability is deferred.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The QME's opinion that the April 16, 2023 left shoulder injury was non-industrial was conclusory and lacked substantial medical evidence.
Favours Applicant prevailed
This led to the decision to defer the issue for further development of the record.
From the decision · page 6Here, the existing record is insufficient on the issue of whether the April 16, 2023 left shoulder injury was a compensable consequence of the June 11, 2017 industrial injury to the left hand, left index finger, and left wrist. The QME concluded that `[t]he left shoulder condition is non-industrial as it happened from the fall that occurred on April 16, 2023." (Joint Exhibit #A3, at p. 19.) However, we find the QME's opinion on causation of the left shoulder injury to be conclusory and to not constitute substantial medical evidence. In the supplemental report issued after the May 23, 2024 re-evaluation, the QME reviewed medical records spanning from June 10, 2019 to July 19, 2023. (Id. at pp. 9-18.) The QME opined there was no medical evidence to support that the "June 11, 2017 injury, contributed to occurrence of the April 16, 2023, accident in terms of weakness or inability to engage in the function of the hand operating the motorbike." (Id. at p.
Applicant had a long history of treatment and symptoms to his left wrist and hand prior to the April 16, 2023 injury.
Favours Applicant prevailed
This contradicted the QME's opinion and supported the need for further record development.
From the decision · page 619.) However, the QME appears to ignore the medical history and the records that show applicant had been continuously obtaining treatment for his left wrist and left hand prior to the injury in April 2023. Applicant saw his primary treating physician (PTP), Richard D. Scheinberg, M.D., on February 27, 2023, which was less than two months before the April 16, 2023 injury. (Id. at pp. 11-12.) In the progress report, the PTP notes that "[t]the patient continues to have primarily radial sided left wrist pain. He is functioning adequately at work, but continues to have pain. He indicates his left wrist seizes up on him. He also says he gets left hand severe numbness at night." (Id. at pp. 11-12.) An examination demonstrated tenderness primarily over the first dorsal
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 left shoulder injury from April 16, 2023 was non-industrial and not a compensable consequence of the June 11, 2017 injury.
The QME concluded the left shoulder condition was non-industrial as it resulted from the fall on April 16, 2023, but the opinion was found conclusory and lacking substantial medical evidence due to ignoring the applicant's continuous treatment history.
From the decision · page 2(Joint Exhibit A1; Exhibit 3; Joint Exhibit A3.) In the May 23, 2024 supplemental report, the QME noted that "applicant sustained injuries to the left shoulder, one on April 17, 2023, when he was riding a motorbike with his left hand on the clutch, downshifting when the clutch froze up and the hand seized. He lost control of the bike and fell, striking the handlebars with his left shoulder, rolling six to eight times with eight." (Joint Exhibit A3, QME Report by Mark Bernhard, D.O., dated May 23, 2024, at p. 3.) Dr. Bernhard did not find the left shoulder injury from April 16, 2023 to be industrial. (Id. at p. 19.)
Applicant continued to have left wrist pain and numbness, with the wrist seizing up, prior to the April 16, 2023 injury.
The PTP's medical history contradicted the QME's opinion and supported further development of the record.
From the decision · page 619.) However, the QME appears to ignore the medical history and the records that show applicant had been continuously obtaining treatment for his left wrist and left hand prior to the injury in April 2023. Applicant saw his primary treating physician (PTP), Richard D. Scheinberg, M.D., on February 27, 2023, which was less than two months before the April 16, 2023 injury. (Id. at pp. 11-12.) In the progress report, the PTP notes that "[t]the patient continues to have primarily radial sided left wrist pain. He is functioning adequately at work, but continues to have pain. He indicates his left wrist seizes up on him. He also says he gets left hand severe numbness at night." (Id. at pp. 11-12.) An examination demonstrated tenderness primarily over the first dorsal
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Wilson v. State Cal Fire (2019) 84 Cal.Comp.Cases 393 (Appeals Bd. en banc)
An injury must be proximately caused by the employment to be compensable; a compensable consequence injury is the direct and natural result of a prior industrial injury.
Applied to determine compensability of the April 16, 2023 injury as a compensable consequence of the June 11, 2017 injury.
From the decision · page 5As we stated in our en banc opinion in Wilson v. State Cal Fire (2019) 84 Cal.Comp.Cases
What proof carried it
The evidence the panel weighed, by kind.
Applicant's continuous treatment history and symptoms to left wrist and hand prior to April 16, 2023 injury
From the decision · page 619.) However, the QME appears to ignore the medical history and the records that show applicant had been continuously obtaining treatment for his left wrist and left hand prior to the injury in April 2023. Applicant saw his primary treating physician (PTP), Richard D. Scheinberg, M.D., on February 27, 2023, which was less than two months before the April 16, 2023 injury. (Id. at pp. 11-12.) In the progress report, the PTP notes that "[t]the patient continues to have primarily radial sided left wrist pain. He is functioning adequately at work, but continues to have pain. He indicates his left wrist seizes up on him. He also says he gets left hand severe numbness at night." (Id. at pp. 11-12.) An examination demonstrated tenderness primarily over the first dorsal
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About this page
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