What the panel ordered
Petition for Reconsideration granted; final decision deferred pending further review of the merits and the record.
Lien claimant Premier Psychological Services petitioned for reconsideration of the WCJ's March 8, 2024 Findings and Orders disallowing its lien. The WCAB granted reconsideration and deferred a final decision pending further review of the merits and the record.
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 WCAB found that further review of the record and the merits was necessary before a final decision could be made, and thus granted reconsideration and deferred the final decision.
From the decision · page 6For the foregoing reasons, IT IS ORDERED that applicant's Petition for Reconsideration is GRANTED. IT IS FURTHER ORDERED that a final decision after reconsideration is DEFERRED pending further review of the merits of the Petition for Reconsideration and further consideration of the entire record in light of the applicable statutory and decisional law.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The WCJ's analysis of Dr. Michaels' reporting may be insufficient to comply with Hamilton and Labor Code section 5313, and the record may not be complete or adequately analyzed regarding the lien and post-termination defense.
Favours neutral
These deficiencies led the WCAB to grant reconsideration and defer a final decision pending further review.
From the decision · page 3Here, it is unclear from our preliminary review of the evidence and the existing record whether the legal issues have been properly identified and addressed. Specifically, we are concerned about the possibility that the WCJ's analysis of Dr. Michaels' reporting is insufficient to comply with Hamilton and Labor Code section 5313. Furthermore, although the WCJ repeated his conclusion that defendant proved the post-termination defense of Labor Code section 3208.3, because the WCJ did not find injury in either claim, further analysis and findings may be required to support this conclusion of law in the event that it is necessary to support the disallowance of the lien. Finally, we note that the Petition for Reconsideration alleges that the WCJ failed to determine whether some portion of the lien might be payable as a medical-legal expense, rather than as medical treatment; our initial review of the record indicates the WCJ may not have sufficiently analyzed this claim.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566]
Decisions must be supported by substantial evidence, which is evidence that is reasonable, credible, and of solid value.
The WCAB referenced the substantial evidence standard as relevant to its review of the WCJ's decision and the sufficiency of Dr. Michaels' reporting.
From the decision · page 2It is well established that decisions by the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) "The term `substantial evidence' means evidence which, if true, has probative force on the issues. It is more than a mere scintilla, and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion...It must be reasonable in nature, credible, and of solid value." (Braewood Convalescent Hospital v. Workers' Comp. Appeals Bd. (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], emphasis removed and citations omitted.)
E.L. 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, 620-621 (Appeals Bd. en banc); Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93]
Medical evidence is required for compensability; medical opinions must be based on reasonable medical probability, adequate examination and history, and not be speculative.
The WCAB cited these standards in discussing the requirements for medical evidence and the evaluation of Dr. Michaels' reporting.
From the decision · page 2Medical evidence is required if there is an issue regarding the compensability of the claim. (Lab. Code, § 4060(c)(d), 4061(i), 4062.3(l).) A medical opinion must be framed in terms of reasonable medical probability, it must be based on an adequate examination and history, it must not be speculative, and it must set forth reasoning to support the expert conclusions reached. (E.L. 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, 620-621 (Appeals Bd. en banc).) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].) Defendant holds the burden of proof on apportionment of permanent disability. (Lab. Code, § 5705; see also Escobedo, supra, 70 Cal.Comp.Cases at p. 613.)
Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc); Lab. Code, § 5313; Cal. Code Regs., tit. 8, § 10787
The WCJ and Appeals Board must ensure the record is complete and decisions must clearly state reasons and evidence relied on.
The WCAB referenced these requirements in evaluating whether the WCJ's analysis and record were sufficient.
From the decision · page 2Further, decisions of the Appeals Board "must be based on admitted evidence in the record." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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