What the panel ordered
Petition for reconsideration granted in part, Findings of Fact 2 and 5 vacated, matter remanded for further development on temporary disability and attorney fees; other findings affirmed
Petition for reconsideration filed by defendant challenging findings on temporary disability and internal medicine consultation authorization; WCJ report recommended granting reconsideration in part and affirming in part
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 court found substantial evidence supporting the need for an internal medicine consultation to evaluate diabetes causation and treatment related to the industrial injury and denied reconsideration on this issue.
From the decision · page 9It is well settled that a defendant is liable for treatment for a nonindustrial condition if it is reasonable and necessary to aid in the treatment of an injured workers' injuries. If there is a dispute regarding whether applicant's diabetic condition was aggravated or accelerated by the industrial injury then the treating physician would be allowed at defendant's expense to refer the applicant to a secondary treating physician in internal medicine for a medical-legal evaluation on the issue of causation of that body part.
The court found conflicting evidence on applicant's employment status during the claimed temporary disability period, leading to vacating the finding and remanding for further development.
From the decision · page 8Given the conflicting information between the applicant's testimony and the medical record regarding applicant's employment status, the court agrees that its finding that the injury caused temporary disability from 03/18/2020 through 01/13/2021 less amounts earned and amounts paid by defendant, and attorney fees should be vacated and the matter returned to the trial level for further development of the record on those issues.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant admitted cumulative trauma injury to thoracic spine, right shoulder and right elbow
Favours Applicant prevailed
Made the issue of injury cause moot for temporary disability
From the decision · page 6Since defendant has admitted that applicant sustained a cumulative trauma injury to thoracic spine, right shoulder and right elbow, the issue is moot.
Conflicting evidence on applicant's employment status during temporary disability period
Favours Defendant prevailed
Led to vacating the finding on temporary disability and remanding for further development
From the decision · page 8Given the conflicting information between the applicant's testimony and the medical record regarding applicant's employment status, the court agrees that its finding that the injury caused temporary disability from 03/18/2020 through 01/13/2021 less amounts earned and amounts paid by defendant, and attorney fees should be vacated and the matter returned to the trial level for further development of the record on those issues.
Medical evidence supports need for internal medicine consultation to evaluate diabetes causation and treatment
Favours Applicant prevailed
Supported denial of reconsideration on internal medicine consultation authorization
From the decision · page 9It is well settled that a defendant is liable for treatment for a nonindustrial condition if it is reasonable and necessary to aid in the treatment of an injured workers' injuries. If there is a dispute regarding whether applicant's diabetic condition was aggravated or accelerated by the industrial injury then the treating physician would be allowed at defendant's expense to refer the applicant to a secondary treating physician in internal medicine for a medical-legal evaluation on the issue of causation of that body part.
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.
Initially reported specific injury date 01/22/2019, later agreed injury was cumulative trauma; recommended internal medicine consultation for diabetes causation evaluation; reports contain conflicting information on applicant's work status.
Court found some merit in defendant's contention of conflicting work status information but accepted cumulative trauma injury admission making temporary disability issue moot for injury cause; recommended internal medicine consult for diabetes causation.
From the decision · page 4Defendant contends that the opinions of primary treating physician Dr. Evan Marlowe do not constitute substantial medical evidence because they are based an inadequate medical history,
Declared applicant permanent and stationary as of 02/20/2020 due to inability to undergo right shoulder surgery because of uncontrolled diabetes; recommended surgery but delayed due to diabetes.
Court relied on Longacre's report to support need for internal medicine consultation to manage diabetes before surgery.
From the decision · page 8Applicant testified that she initially treated with Dr. Matthew Longacre (Orthopedic Surgeon) for her work injury. Defendant's Exhibits "J" through "S" consist of medical reports from Dr. Longacre dated from 02/20/2020 through 05/16/2019, respectively. Applicant testified that Dr. Longacre recommended that she undergo right shoulder surgery after undergoing various types of treatment. Applicant testified that she was in preparation for having right shoulder surgery around 12/12/2019 but did not undergo the surgery because of poorly controlled pre-existing diabetes. (MOH/SOE 04/01/2021 Trial, at 8:1-11.)
Found cumulative trauma injury and permanent and stationary status as of 02/20/2020.
Court noted Milling's QME report supported cumulative trauma injury admission, making injury cause issue moot.
From the decision · page 5Defendant argues that the reports of the prior primary treating physician, Dr. Matthew Longacre dated from 06/13/2019 through 2/20/2020 (Defendant's Exhibit's "S' through "J") and the QME report from Dr. Paul Milling dated 06/15/2020 (Defendant's Exhibit "I") find that applicant did sustain a cumulative trauma injury and the applicant's condition became permanent and stationary on 02/20/2020.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Defendant's liability for treatment of nonindustrial conditions if reasonable and necessary to aid treatment of industrial injury
Applied to support authorization of internal medicine consultation for diabetes evaluation related to industrial injury
From the decision · page 9It is well settled that a defendant is liable for treatment for a nonindustrial condition if it is reasonable and necessary to aid in the treatment of an injured workers' injuries. If there is a dispute regarding whether applicant's diabetic condition was aggravated or accelerated by the industrial injury then the treating physician would be allowed at defendant's expense to refer the applicant to a secondary treating physician in internal medicine for a medical-legal evaluation on the issue of causation of that body part.
California Labor Code
Labor Code section 4662 regarding temporary disability indemnity
Applied in analysis of temporary disability entitlement
From the decision · page 4Defendant has filed a timely and verified petition for reconsideration wherein they dispute the Findings, Award and Order dated 04/26/2021 finding that the injury caused temporary disability from 03/18/2020 through 01/13/2021 less amounts earned by applicant and amounts paid by defendant, and that defendant is obligated to authorize applicant to undergo an internal medicine consultation. Defendant contends that the finding on these issues is not based on substantial medical evidence.
What proof carried it
The evidence the panel weighed, by kind.
Conflicting information on applicant's employment status during temporary disability period
From the decision · page 7Defendant contends that Dr. Marlowe's reports contain conflicting and inconsistent information whether applicant is working. The Court believes this contention has merit.
Admission of cumulative trauma injury to thoracic spine, right shoulder and right elbow
From the decision · page 6Since defendant has admitted that applicant sustained a cumulative trauma injury to thoracic spine, right shoulder and right elbow, the issue is moot.
Medical evidence supporting need for internal medicine consultation for diabetes evaluation
From the decision · page 9It is well settled that a defendant is liable for treatment for a nonindustrial condition if it is reasonable and necessary to aid in the treatment of an injured workers' injuries. If there is a dispute regarding whether applicant's diabetic condition was aggravated or accelerated by the industrial injury then the treating physician would be allowed at defendant's expense to refer the applicant to a secondary treating physician in internal medicine for a medical-legal evaluation on the issue of causation of that body part.
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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.
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