What the panel ordered
Petition for reconsideration granted, WCJ's August 26, 2024 Findings and Order rescinded, matter returned to WCJ for further proceedings
Petition for reconsideration granted, WCJ's August 26, 2024 Findings and Order rescinded, matter returned to WCJ for further proceedings
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The WCJ's finding of no compensable psychiatric injury was rescinded due to lack of a QME evaluation, and the matter was returned for further proceedings to develop the record properly.
From the decision · page 4II. The determination of compensability, the existence or extent of permanent impairment, and limitations, if any, resulting from an injury all require a medical evaluation. When deciding a medical issue, including whether applicant sustained a compensable psychiatric injury, the WCJ must utilize expert medical opinion. (See Insurance Company of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905, 911-912 [46 Cal.Comp.Cases 913].) Here, applicant requested a QME panel in the specialty of psychiatry, the parties exercised their respective strikes, and Dr. Sidle remained. Thereafter, applicant filed a request for a new panel on the basis that Dr. Sidle had retired as a QME. At the time of trial, applicant alleged that she was still awaiting evaluation by a QME, which had not been authorized. (MOH/SOE, May 1, 2024 trial, p. 3.) As an unrepresented employee, applicant would require an evaluation by a QME to determine compensability, if any, and the existence or extent of permanent impairment.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant requested a QME panel in psychiatry and a panel was issued with Dr. Allan Sidle remaining after strikes.
Favours Applicant prevailed
A QME evaluation is required to determine compensability and extent of permanent impairment for psychiatric injury claims.
From the decision · page 2BACKGROUND We will briefly review the relevant facts. In case number ADJ13997458, applicant claimed injury to her back while employed as an administrative associate, during the period from March 3, 2016 to November 1, 2019. The parties settled case number ADJ13997458 by way of Compromise and Release (C&R) and an Order Approving Compromise and Release (OACR) issued on February 1, 2024. In the matter before us, case number ADJ14002457, applicant claimed injury to her psyche while employed by defendant as an administrative associate, during the period from March 3, 2016 to October 30, 2019. Defendant denied the claim. On or about December 3, 2021, applicant requested a QME panel in the specialty of psychiatry and a panel issued on the same date. After their respective strikes, Allan Sidle, M.D., remained. (Exhibit 2, Minutes of Hearing and Summary of Evidence (MOH/SOE), May 1, 2024 trial.) On or about December 12, 2023, applicant filed a request for a new panel on the basis that Dr. Sidle was unavailable, i.e., he had retired as a QME. On May 1, 2024 and July 18, 2024, the matter proceeded to trial on the following issues. Applicant appeared in pro per.
Applicant filed a request for a new QME panel due to Dr. Sidle's retirement and unavailability for evaluation.
Favours Applicant prevailed
Without an authorized QME evaluation, the WCJ's finding on compensability was premature and the record was insufficiently developed.
From the decision · page 2BACKGROUND We will briefly review the relevant facts. In case number ADJ13997458, applicant claimed injury to her back while employed as an administrative associate, during the period from March 3, 2016 to November 1, 2019. The parties settled case number ADJ13997458 by way of Compromise and Release (C&R) and an Order Approving Compromise and Release (OACR) issued on February 1, 2024. In the matter before us, case number ADJ14002457, applicant claimed injury to her psyche while employed by defendant as an administrative associate, during the period from March 3, 2016 to October 30, 2019. Defendant denied the claim. On or about December 3, 2021, applicant requested a QME panel in the specialty of psychiatry and a panel issued on the same date. After their respective strikes, Allan Sidle, M.D., remained. (Exhibit 2, Minutes of Hearing and Summary of Evidence (MOH/SOE), May 1, 2024 trial.) On or about December 12, 2023, applicant filed a request for a new panel on the basis that Dr. Sidle was unavailable, i.e., he had retired as a QME. On May 1, 2024 and July 18, 2024, the matter proceeded to trial on the following issues. Applicant appeared in pro per.
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.
Remained as the QME after panel strikes; applicant requested a new panel due to his retirement and unavailability for evaluation.
From the decision · page 2BACKGROUND We will briefly review the relevant facts. In case number ADJ13997458, applicant claimed injury to her back while employed as an administrative associate, during the period from March 3, 2016 to November 1, 2019. The parties settled case number ADJ13997458 by way of Compromise and Release (C&R) and an Order Approving Compromise and Release (OACR) issued on February 1, 2024. In the matter before us, case number ADJ14002457, applicant claimed injury to her psyche while employed by defendant as an administrative associate, during the period from March 3, 2016 to October 30, 2019. Defendant denied the claim. On or about December 3, 2021, applicant requested a QME panel in the specialty of psychiatry and a panel issued on the same date. After their respective strikes, Allan Sidle, M.D., remained. (Exhibit 2, Minutes of Hearing and Summary of Evidence (MOH/SOE), May 1, 2024 trial.) On or about December 12, 2023, applicant filed a request for a new panel on the basis that Dr. Sidle was unavailable, i.e., he had retired as a QME. On May 1, 2024 and July 18, 2024, the matter proceeded to trial on the following issues. Applicant appeared in pro per.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 3208.3(b)(1)
To establish industrial causation of a psychiatric injury, the injured worker must show by a preponderance of the evidence that actual events of employment predominantly caused the psychological injury.
The WCJ must determine whether the alleged psychiatric injury involves actual events of employment and if so, whether such events were the predominant cause, requiring competent medical evidence.
From the decision · page 4II. The determination of compensability, the existence or extent of permanent impairment, and limitations, if any, resulting from an injury all require a medical evaluation. When deciding a medical issue, including whether applicant sustained a compensable psychiatric injury, the WCJ must utilize expert medical opinion. (See Insurance Company of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905, 911-912 [46 Cal.Comp.Cases 913].) Here, applicant requested a QME panel in the specialty of psychiatry, the parties exercised their respective strikes, and Dr. Sidle remained. Thereafter, applicant filed a request for a new panel on the basis that Dr. Sidle had retired as a QME. At the time of trial, applicant alleged that she was still awaiting evaluation by a QME, which had not been authorized. (MOH/SOE, May 1, 2024 trial, p. 3.) As an unrepresented employee, applicant would require an evaluation by a QME to determine compensability, if any, and the existence or extent of permanent impairment.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's medical evidence did not constitute substantial medical evidence supporting psychiatric injury on an industrial basis
From the decision · page 2did not constitute substantial medical evidence and did not support the allegations of applicant's psychiatric injury on an industrial basis. (August 26, 2024 Findings and Order, Finding 5.) The WCJ also found that applicant did not sustain injury arising out of or in the course of employment to her psyche. (August 26, 2024 Findings and Order, Finding 6.)
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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.
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