What the panel ordered
Findings and Order of March 13, 2025, rescinded; matter returned to trial level for further proceedings.
Petition for Reconsideration of the Findings and Order issued March 13, 2025, granted; WCJ's decision rescinded and matter returned for further proceedings.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 credibility determination was given great weight, but the PQME's opinion was found insufficiently supported due to incomplete record review and credibility issues, necessitating further development of the record and updated medical opinion.
From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
WCJ found applicant not credible due to contradicting statements and demeanor at trial.
Favours Defendant prevailed
This credibility finding influenced the initial denial of injury arising out of employment.
From the decision · page 4course of employment to her back. The WCJ ordered "[a]pplicant is to take nothing on her claim." In support, the WCJ stated in the Opinion on Decision, that "[a]pplicant was not credible. Her contradicting statements and her demeanor demonstrated to the Court that she was less than truthful during trial." (F&O, page 7.)
PQME rated applicant's credibility as moderate, indicating some doubt about applicant's statements.
Favours neutral
This affected the weight given to the PQME's opinion on industrial injury causation.
From the decision · page 3On May 4, 2023, PQME Dr. Ilkhchoui reported after the evaluation of applicant on February 3, 2023. The PQME reviewed and summarized treatment records from Kaiser covering the period before the alleged injury beginning June 25, 2020, to August 2, 2022, and after the alleged injury from August 9, 2022, to October 24, 2022. (Joint Exhibit 1, PQME Dr. Ilkhchoui, report of May 4, 2023, pages 7 to 18, pages 19 to 26.) Applicant was not at maximum medical improvement (MMI). He stated that: "I rate the applicant's credibility as moderate because she gave forth good effort during physical exam testing and was moderately accurate historian." He
PQME did not initially review all relevant Kaiser records, requiring further review and updated opinion.
Favours neutral
The incomplete record review necessitated remand for further development and updated medical opinion.
From the decision · page 4During deposition, the PQME did not recall seeing "a note at Page 386 through 389 of the Kaiser records" and stated it would be important for the PQME to look at them. (Joint Exhibit 2, Deposition of PQME Dr. Ilkchoui, MD, October 24, 2024, page 7, lines 9 to 25, page 8, lines 1 to 4.) The following exchange between counsel also occurred:
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.
Applicant's need for medical care stems from the industrial injury of August 8, 2022; applicant's credibility rated as moderate.
PQME opinion based on medical record review and applicant evaluation, but credibility issues noted by WCJ and Appeals Board.
From the decision · page 3On May 4, 2023, PQME Dr. Ilkhchoui reported after the evaluation of applicant on February 3, 2023. The PQME reviewed and summarized treatment records from Kaiser covering the period before the alleged injury beginning June 25, 2020, to August 2, 2022, and after the alleged injury from August 9, 2022, to October 24, 2022. (Joint Exhibit 1, PQME Dr. Ilkhchoui, report of May 4, 2023, pages 7 to 18, pages 19 to 26.) Applicant was not at maximum medical improvement (MMI). He stated that: "I rate the applicant's credibility as moderate because she gave forth good effort during physical exam testing and was moderately accurate historian." He
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 3600
To be compensable, an injury must arise out of and occur in the course of employment.
The Appeals Board reviewed the evidence under this standard to determine compensability of the back injury.
From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)
Lab. Code, 3202.5
The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence.
The Appeals Board applied this standard to assess the evidence presented by the applicant.
From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)
McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417
Medical evidence that industrial causation was reasonably probable constitutes substantial evidence for a finding of injury AOE/COE.
The Appeals Board considered this case law in evaluating the medical evidence for causation.
From the decision · page 6To be compensable, an injury must arise out of and occur in the course of employment. (Lab. Code, § 3600.) The employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5, 5705.) Medical evidence that industrial causation was reasonably probable, although not certain, constitutes substantial evidence for a finding of injury AOE/COE. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 417 [33 Cal.Comp.Cases 660].) "That burden manifestly does not require the applicant to prove causation by scientific certainty." (Rosas v. Worker's Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1701 [58 Cal.Comp.Cases 313].)
What proof carried it
The evidence the panel weighed, by kind.
WCJ found applicant not credible due to contradicting statements and demeanor at trial.
From the decision · page 4course of employment to her back. The WCJ ordered "[a]pplicant is to take nothing on her claim." In support, the WCJ stated in the Opinion on Decision, that "[a]pplicant was not credible. Her contradicting statements and her demeanor demonstrated to the Court that she was less than truthful during trial." (F&O, page 7.)
PQME rated applicant's credibility as moderate, indicating some doubt about applicant's statements.
From the decision · page 3On May 4, 2023, PQME Dr. Ilkhchoui reported after the evaluation of applicant on February 3, 2023. The PQME reviewed and summarized treatment records from Kaiser covering the period before the alleged injury beginning June 25, 2020, to August 2, 2022, and after the alleged injury from August 9, 2022, to October 24, 2022. (Joint Exhibit 1, PQME Dr. Ilkhchoui, report of May 4, 2023, pages 7 to 18, pages 19 to 26.) Applicant was not at maximum medical improvement (MMI). He stated that: "I rate the applicant's credibility as moderate because she gave forth good effort during physical exam testing and was moderately accurate historian." He
PQME did not review all relevant Kaiser records initially, requiring further review and updated opinion.
From the decision · page 4During deposition, the PQME did not recall seeing "a note at Page 386 through 389 of the Kaiser records" and stated it would be important for the PQME to look at them. (Joint Exhibit 2, Deposition of PQME Dr. Ilkchoui, MD, October 24, 2024, page 7, lines 9 to 25, page 8, lines 1 to 4.) The following exchange between counsel also occurred:
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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- 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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