ADJ14498065 — California WCAB decision

ADJ14498065 · November 6, 2023

Reconsideration granted; Findings and Award affirmed except amended to defer the issue of whether applicant is entitled to more than 104 weeks of temporary disability under Lab. Code § 4656(c)(3) and to clarify that EDD’s recovery would come from indemnity owed to applicant

Issues decided

Medical opinions weighed

Authorities named

District office

Salinas

What the panel ordered

Petition for Reconsideration of WCJ’s Findings and Award of August 11, 2023; reconsideration granted and decision after reconsideration issued

Read the official decision →

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.

Temporary disabilityApplicant prevailed

Applicant entitled to temporary disability from March 11, 2022 and continuing, subject to the 104-week cap, less reimbursement to EDD for overlapping periods, and less permanent disability advances paid for the same period

From the decision · page 38. Applicant is entitled to temporary disability benefits commencing on March 11, 2022, less reimbursement to EDD for overlapping periods, and less permanent disability advances paid for the same period. The issue of whether applicant is entitled to more than 104 weeks of temporary disability benefits under Lab. Code, § 4656(c)(3) is deferred.

The rules the panel named

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

McAllister v. WCAB (1968) 69 Cal.2d 408; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604

Substantial medical evidence standard for medical opinions

Medical opinion must be predicated on reasonable medical probability, based on relevant facts, adequate medical histories or examinations, on correct legal theories, and not on surmise, speculation, conjecture, or guess

From the decision · page 6The court’s decision must be based upon substantial evidence. In order to constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. [McAllister v. WCAB (1968) 69 Cal.2d 408, 413, 416–417, 419;

Huston v. WCAB (1979) 95 Cal.App.3th 856

Temporary disability indemnity payable during healing period until worker recovers sufficiently to return to work or condition reaches permanent and stationary status

Applicant entitled to temporary disability from 3/11/22, subject to the 104-week cap, less reimbursement to EDD for overlapping periods, and less permanent disability advances paid for the same period

From the decision · page 7“In general, temporary disability indemnity is payable during the injured worker's healing period from the injury until the worker has recovered sufficiently to return to work, or until his/her condition reaches a permanent and stationary status.” (Huston v. WCAB (1979) 95 Cal.App.3th 856, 868;

Cruz v. Mercedes-Benz of San Francisco (2007) 72 Cal.Comp.Cases 1281

Amputations under Lab. Code § 4656(c)(2)(C) means severance or removal of limb, part of limb, or other body appendage

Applicant suffered an amputation and may fall within the enumerated categories in Lab. Code, § 4656(c)(3) for extension of temporary disability cap

From the decision · page 2In Cruz v. Mercedes-Benz of San Francisco (2007) 72 Cal.Comp.Cases 1281 [2007 Cal. Wrk. Comp. LEXIS 247] (Appeals Bd. en banc), we determined that “amputations,” as used in section 4656(c)(2)(C) meant severance or removal of limb, part of limb, or other body appendage.

ADJ14498065 · November 6, 2023

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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