ADJ13479589 · December 16, 2025

Applicant demonstrated injury AOE/COE to teeth based on the personal comfort doctrine and substantial medical evidence from QME Dr. Scorza; injury to other body parts deferred for further development.

From the decision · page 6Defendant argues in the Petition that Dr. Kyle did not waive the January 17, 2018 procedure due to an "Employee Courtesy," but only after applicant informed him about a suspected injury. (Defendant's Petition, at p. 5.) However, defendant put forth no evidence, including any witness testimony by Dr. Kyle, to support this argument. In contrast, a review of applicant's account history actually shows applicant's copays were waived throughout her employment. (Joint Exhibit UU, at pp. 6-7.) Therefore, we conclude that applicant demonstrated that her injury was AOE/COE.

Applicant was employed with a benefit package waiving copays for dental treatment by employer, which was voluntary but reasonably contemplated by employment.

Favours Applicant prevailed

This showed the injury was incidental to employment and employer derived benefit, supporting AOE/COE finding.

From the decision · page 5The sole issue to address in this case is whether applicant demonstrated that her injury of January 17, 2018 was AOE/COE. When applicant was first hired, defendant verbally informed the applicant that as part of her employment benefits package, if her spouse was insured, any of her copay and deductibles for dental treatment provided by the defendant would be waived. (Minutes of Hearing/Summary of Evidence (MOH/SOE), July 19, 2021, at p. 3.) Over the course of applicant's employment, applicant took advantage of this benefit several times for procedures like crowns, cleanings, and fillings. (Id. at p. 3.) Applicant never had to pay for any of the dental treatment she received with defendant. (Id. at p. 5.) Other employees were also given the same benefit as part of their employment with defendant. (Id. at p. 4.) On January 17, 2018, the day of the alleged injury, applicant worked but clocked out of work prior to the dental procedure. (Id. at p. 5.)

Applicant remained on employer premises after clocking out for dental implant procedure on January 17, 2018.

Favours Applicant prevailed

Being on premises and receiving treatment was considered within course of employment under personal comfort doctrine.

From the decision · page 6We continue to follow the logic of the Herrera panel and analyze the case under the personal comfort doctrine. As part of applicant's employment benefits, receiving dental treatment was incidental to applicant's employment and reasonably contemplated by the defendant. On the day of the injury, applicant remained on the premises after clocking out for the dental implant with the understanding any copay or deductible would be waived as in the past.

QME Dr. Jason Scorza opined injury symptoms were due to dental implant procedure injury to tooth #19.

Favours Applicant prevailed

Medical causation supported injury arising out of employment.

From the decision · page 3(QME), Jason A. Scorza, D.D.S. Dr. Scorza opined with reasonable medical probability that applicant's "symptoms related to her left IA nerve injury, including loss of some sensory and motor capabilities in her left jaw region, were a result of her injury when she had an implant placed to replace missing #19." (Joint Exhibit ZZ, PQME Report of Dr. Jason Scorza, dated October 15, 2020, at p. 9.)

Applicant's symptoms related to left IA nerve injury were a result of injury from dental implant procedure on tooth #19.

Supported injury causation to teeth from employment-related dental procedure.

From the decision · page 3(QME), Jason A. Scorza, D.D.S. Dr. Scorza opined with reasonable medical probability that applicant's "symptoms related to her left IA nerve injury, including loss of some sensory and motor capabilities in her left jaw region, were a result of her injury when she had an implant placed to replace missing #19." (Joint Exhibit ZZ, PQME Report of Dr. Jason Scorza, dated October 15, 2020, at p. 9.)

Labor Code section 3600(a)

Injury must arise out of and in the course of employment as defined by Labor Code section 3600(a).

The panel applied the two-prong test from LaTourette and personal comfort doctrine to determine injury AOE/COE.

From the decision · page 3DISCUSSION Whether an employee's injury arose out of and in the course of employment is generally a question of fact to be determined in light of the particular circumstances of the case. (Wright v. Beverly Fabrics (2002) 95 Cal.App.4th 346 [67 Cal.Comp.Cases 51].) Labor Code section 3600(a)2 provides for liability for injuries sustained "arising out of and in the course of the employment." Section 3600(a)(2) requires as a condition of compensation that "at the time of the injury, the employee is performing service growing out of and incidental to his or her employment and is acting within the course of his or her employment." (Lab. Code, § 3600(a)(2).) An employer is liable for workers' compensation benefits "without regard to negligence." (Lab. Code, § 3600(a).) An employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a), 3202.5.)

Applicant's account history showed copays were waived throughout employment, indicating employer benefit and voluntary treatment was reasonably contemplated by employment.

From the decision · page 6Defendant argues in the Petition that Dr. Kyle did not waive the January 17, 2018 procedure due to an "Employee Courtesy," but only after applicant informed him about a suspected injury. (Defendant's Petition, at p. 5.) However, defendant put forth no evidence, including any witness testimony by Dr. Kyle, to support this argument. In contrast, a review of applicant's account history actually shows applicant's copays were waived throughout her employment. (Joint Exhibit UU, at pp. 6-7.) Therefore, we conclude that applicant demonstrated that her injury was AOE/COE.