ADJ13057141 — California WCAB decision

What the panel ordered

The Workers' Compensation Appeals Board affirmed the WCJ's Findings and Award of October 12, 2020, denying compensable permanent disability due to overlap and apportionment under Labor Code section 4664.

Applicant sought reconsideration of the Findings and Award issued on October 12, 2020, which found industrial injury to psyche but no compensable permanent disability due to apportionment under Labor Code section 4664. The WCJ recommended denial of reconsideration.

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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/COEApplicant prevailedpsyche

The injury was found compensable as a violent act under Labor Code section 3208.3(b)(2), supported by the QME's description and the circumstances of the incident.

From the decision · page 10of an angry parent whose behavior was alarming enough to get her escorted away by police, and on that basis can only conclude that her words were "violent" and "vehemently or passionately threatening." Presumably, defendant understood them that way, up until the time of the MSC, and paid benefits accordingly. (Defendant also stated at trial that it had not ceased providing medical treatment. It did not specify whether this was for the 2019 injury, or that in 2008, or both.) The injury is compensable.

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.

QMERelied upon

Found 11% whole-person impairment with 75% stemming from the 2019 injury and the rest from the 2008 injury; diagnosed chronic PTSD in partial remission, major depressive disorder, and obesity; concluded 2019 injury aggravated and reactivated the 2008 PTSD.

Dr. Robbins' reports supported the finding of overlap and apportionment under Labor Code section 4664.

From the decision · page 8In the current matter, the parties have engaged a qualified medical evaluator (QME), Dr. Robbins, who has authored three reports. In the first, dated September 23, 2019, he equivocated about permanent and stationary status, clarifying in a supplemental report dated November 13, 2019, that applicant's condition had not stabilized and he would need to see her again after some months had passed after her return to work. In his ultimate report, dated March 4, 2020, the QME found her maximally improved, with a GAF score of 65, plus additional impairment for sleep difficulties, amounting to 11% whole-person impairment, of which 75% stems from the 2019 injury and the rest from that in 2008. His diagnoses are "chronic posttraumatic stress disorder, in partial remission," "major depressive disorder, recurrent episode in partial remission," and obesity.

AMEGiven great weight

Reported in 2009 a GAF score of 60 with 15% permanent impairment and apportioned 10% to nonindustrial causes; in 2016 found no signs of PTSD and recommended limiting further treatment.

Dr. Lieberman's evaluations provided background on the 2008 injury and its resolution, relevant to the apportionment analysis.

From the decision · page 8This is set against a background that includes an earlier incident in which a custodian, disguised with wig and sunglasses and reportedly armed with a semi-automatic weapon, attacked her from behind and pistol-whipped her, causing lacerations and lasting psychological trauma diagnosed as post-traumatic stress disorder or PTSD. Applicant missed relatively little time from work, however, though she did continue in therapy and took prescription medications for a time. The parties engaged an agreed medical evaluator (AME), Dr. Richard Lieberman, who reported on November 10, 2009, that applicant's injury had stabilized, with a GAF6 score of 60 or 15% permanent impairment, of which he apportioned 10% to nonindustrial causes. The workers' compensation case resolved by a stipulated award of 27% permanent disability with a need for further medical treatment. It appears that defendant came to question its ongoing liability for medical care (no other issue remained), and Dr. Lieberman rexamined the applicant in 2016, concluding in his report of June 16, 2016, that she no longer showed signs of PTSD. The AME at this point did find a GAF score of 64 and recommended limiting further treatment.

ADJ13057141 · May 16, 2024

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

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