ADJ13110945 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied; original WCJ decision affirmed.

Petition for Reconsideration filed by Defendant after WCJ decision; WCAB panel 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.

AOE/COEApplicant prevailedright shoulder

The PQME Dr. Falkinstein's report was substantial evidence proving the applicant suffered an industrial injury on November 12, 2019, and needs medical treatment. The WCJ properly relied on this report, and the petitioner's arguments lacked merit.

From the decision · page 4Applicant's injury was evaluated on July 17, 2020 by Dr. Yuri Falkinstein, M.D. as the Panel Qualified Medical Examiner. Dr. Falkinstein gave his expert opinion that Applicant experienced a period of temporary and required medical treatment in the form of surgery and post-operative rehabilitation as a result of her employment on November 12, 2019. He also found Applicant has not reached Maximum Medical Improvement and recommended a re- evaluation after she receives treatment. Dr. Falkinstein's report established Applicant suffered a specific industrial injury.

The facts that decided it

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code Section 5705

The burden of proving industrial causation rests with the applicant by a preponderance of the evidence.

Applied to require applicant to prove injury causation.

From the decision · page 1The burden of proving industrial causation of injury rests with the applicant, and the applicant must carry this burden by a preponderance of the evidence. (Lab. Code, § 5705.) Moreover, all awards, orders and decisions of the Appeals Board must be supported by substantial evidence in light of the entire record. (Lab. Code § 5952(d); Lamb v. Workers' Comp. Appeals Bd. (1974) 11 Cal.3d 274, 280 [39 Cal.Comp.Cases 310].) To be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416§ 17, 419 [33 Cal.Comp.Cases 660].) A physician's report must also be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc), 70 Cal.Comp.Cases 1506 (writ den.).)

Labor Code Section 5952(d)

All awards, orders and decisions must be supported by substantial evidence in light of the entire record.

Applied to require substantial evidence for findings and awards.

From the decision · page 1The burden of proving industrial causation of injury rests with the applicant, and the applicant must carry this burden by a preponderance of the evidence. (Lab. Code, § 5705.) Moreover, all awards, orders and decisions of the Appeals Board must be supported by substantial evidence in light of the entire record. (Lab. Code § 5952(d); Lamb v. Workers' Comp. Appeals Bd. (1974) 11 Cal.3d 274, 280 [39 Cal.Comp.Cases 310].) To be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416§ 17, 419 [33 Cal.Comp.Cases 660].) A physician's report must also be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc), 70 Cal.Comp.Cases 1506 (writ den.).)

E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922

A medical opinion must be predicated on reasonable medical probability and not be speculative.

Applied to evaluate the medical opinion's reliability and reasoning.

From the decision · page 1The burden of proving industrial causation of injury rests with the applicant, and the applicant must carry this burden by a preponderance of the evidence. (Lab. Code, § 5705.) Moreover, all awards, orders and decisions of the Appeals Board must be supported by substantial evidence in light of the entire record. (Lab. Code § 5952(d); Lamb v. Workers' Comp. Appeals Bd. (1974) 11 Cal.3d 274, 280 [39 Cal.Comp.Cases 310].) To be considered substantial evidence, a medical opinion "must be predicated on reasonable medical probability." (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416§ 17, 419 [33 Cal.Comp.Cases 660].) A physician's report must also be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions. (Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 612 (Appeals Board en banc), 70 Cal.Comp.Cases 1506 (writ den.).)

ADJ13110945 · May 26, 2021

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

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