What the panel ordered
Petition for reconsideration denied, Findings and Order affirmed.
Applicant seeks reconsideration of the Findings and Order issued by the WCJ on April 4, 2024, which found no compensable cumulative trauma injury and ordered that applicant take nothing.
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 and WCAB found that the medical opinions of AME Dr. Stark and AME Dr. Gupta were substantial evidence supporting no compensable cumulative trauma injury arising out of employment. Applicant failed to provide credible evidence to rebut these opinions.
From the decision · page 1Applicant seeks reconsideration of the Findings and Order (F&O), issued by the workers' compensation administrative law judge (WCJ) on April 4, 2024, wherein the WCJ found in pertinent part that during the period ending April 23, 2021, applicant did not sustain a cumulative trauma injury arising out of and in the course of employment (AOE/COE) to the head (in the form of headaches), the back, or to the neck, and thus ordered that applicant take nothing.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Stark's medical reports were well-reasoned, based on adequate history and examination, and provided reasoning behind conclusions, constituting substantial evidence against compensability.
Favours Defendant prevailed
The WCJ and WCAB relied on Dr. Stark's reports to deny compensability and deny reconsideration.
From the decision · page 2Here, Dr. Stark took applicant's medical history, examined applicant, reviewed extensive medical records and diagnostic reports, reviewed testimony, provided the underlying basis for his opinions, and set forth the reasoning behind his opinions. (Exhibit A, Dr. Stark's AME report dated September 10, 2022; Exhibit B, Dr. Stark's AME report dated November 23, 2023.)
Dr. Gupta's neurological evaluation found migraines and muscle contraction headaches not caused or aggravated by work activities, supporting no compensable injury.
Favours Defendant prevailed
The WCJ and WCAB relied on Dr. Gupta's opinion as substantial evidence to deny compensability.
From the decision · page 5Based upon the AME report of Pramila R. Gupta, M.D. dated June 12, 2023, I find that Applicant did not sustain a cumulative trauma injury to the head which arose out of and in occurred the course of employment with Centene Corporation. Specifically, Dr. Gupta found as follows:
Applicant provided no credible evidence to rebut the AME opinions or to support bias claim against Dr. Stark.
Favours Defendant prevailed
Lack of credible contrary evidence supported denial of reconsideration and affirmance of WCJ findings.
From the decision · page 4The Petition for Reconsideration does not allege that the order, decision, or award was procured by fraud. Nothing in the Petition for Reconsideration claims that the evidence does not justify the Findings of Fact or that the WCJ exceeded any statutory authority. Applicant simply disagrees with the AME and claims that the AME was biased. However, Applicant provided no evidence, credible or otherwise, to support the contention.
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.
Dr. Gupta found applicant has migraine and muscle contraction headaches not caused or aggravated by work activities. No indication of brain injury except headaches. Her opinion supported no compensable cumulative trauma injury.
Dr. Gupta's neurological evaluation and opinion supported no industrial injury causation. The WCJ and WCAB found her opinion substantial evidence.
From the decision · page 5Based upon the AME report of Pramila R. Gupta, M.D. dated June 12, 2023, I find that Applicant did not sustain a cumulative trauma injury to the head which arose out of and in occurred the course of employment with Centene Corporation. Specifically, Dr. Gupta found as follows:
Dr. Stark took medical history, examined applicant, reviewed extensive records and testimony, and concluded no industrial compensable injury to head, back, or neck. He noted psychological/motivational factors involved in presentation. His reports were substantial evidence.
Dr. Stark's reports were well-reasoned, based on adequate history and examination, and provided reasoning behind conclusions. The WCJ and WCAB relied on his reports as substantial evidence.
From the decision · page 2Here, Dr. Stark took applicant's medical history, examined applicant, reviewed extensive medical records and diagnostic reports, reviewed testimony, provided the underlying basis for his opinions, and set forth the reasoning behind his opinions. (Exhibit A, Dr. Stark's AME report dated September 10, 2022; Exhibit B, Dr. Stark's AME report dated November 23, 2023.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Bd. en banc)
To be substantial evidence, a medical opinion must be well-reasoned, based on an adequate history and examination, and disclose a solid underlying basis for the opinion.
The WCJ and WCAB applied this standard to evaluate the AME reports and found them substantial evidence.
From the decision · page 1To be substantial evidence, a medical opinion must be well-reasoned, based on an adequate history and examination, and it must disclose a solid underlying basis for the opinion. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Bd. en banc); see also E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687].) A medical report must also set forth the reasoning behind the physician's
Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]
A medical report must set forth the reasoning behind the physician's opinion and not merely conclusions to be substantial evidence.
The WCJ and WCAB applied this standard to the AME reports, finding the reasoning sufficient to constitute substantial evidence.
From the decision · page 2opinion and not merely their conclusions in order to be substantial evidence. (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]; Granado v. Workmen's Comp. Appeals Bd. (1970) 69 Cal.2d 399 [33 Cal.Comp.Cases 647]; Escobedo, supra.)
Labor Code, Section 3600
The employment must be a substantial contributing cause of the injury for compensability under Labor Code Section 3600.
The WCJ and WCAB applied this standard to determine that the applicant did not sustain an injury arising out of employment.
From the decision · page 4The basic California statutory requirement is that to be compensable, an injury must arise out of and in the course of the employment (See Labor Code, Section 3600). The phrase "arising out of employment" is the causal element and refers to the origin of the accident. That is, the employment must be said to be the cause of the injury. For an injury to "arise out of" the employment, it must occur by reason of a condition or incident of the employment. That is, the employment and the injury must be linked in some causal fashion. This has been referred to as proximate cause and
What proof carried it
The evidence the panel weighed, by kind.
Applicant provided no credible evidence to rebut AME opinions or to support bias claim against Dr. Stark.
From the decision · page 4The Petition for Reconsideration does not allege that the order, decision, or award was procured by fraud. Nothing in the Petition for Reconsideration claims that the evidence does not justify the Findings of Fact or that the WCJ exceeded any statutory authority. Applicant simply disagrees with the AME and claims that the AME was biased. However, Applicant provided no evidence, credible or otherwise, to support the contention.
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About this page
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