What the panel ordered
The WCAB panel denied defendant's petition for reconsideration and upheld the WCJ's Findings of Fact and Award.
Defendant filed a petition for reconsideration of the WCJ's Findings of Fact and Award issued December 23, 2025, which was denied by the WCAB panel decision dated February 27, 2026.
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 QME's apportionment opinion was conclusory and lacked substantial evidence as it failed to explain how and why the nonindustrial conditions caused 20% of the disability, and it apportioned causation of the injury rather than the disability.
From the decision · page 10Miry's apportionment opinion did not rise to the level of substantial evidence as that term has come to be defined within the context of Labor Code section 4663. My conclusion here is driven by the lack of analysis on the part of the QME to explain how and why he believes the nonindustrial conditions are responsible for causing twenty percent of the current disability. Although he comments on apportionment in his June 2025 report (Joint Exhibit 1), Dr. Miry's explanation boils down to a rather conclusory statement attributing 20% apportionment to applicant's probable pre-existing degeneration. In fact, Dr. Miry states applicant had no work restrictions or impacted ADLs due to back symptoms. Moreover, the QME discusses apportionment in relation to the injury itself, rather than the disability it caused.
The defendant did not meet its burden of proof to establish entitlement to credit for overpayment due to delay in service of the QME report and lack of a petition for credit, and the applicant was not at fault for receiving payments in good faith.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25, 2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report, through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky, which may have possibly further delayed action by defendant. The applicant continued to receive temporary disability payments after the re-evaluation with the QME and had no reason to believe he was not entitled to them.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME Sayed Miry found applicant permanent and stationary as of June 27, 2025, with a 20% whole person impairment rating for lumbar spine.
Favours Applicant prevailed
This established the date after which temporary disability payments were not due, relevant to the credit for overpayment issue.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25, 2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report, through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky, which may have possibly further delayed action by defendant. The applicant continued to receive temporary disability payments after the re-evaluation with the QME and had no reason to believe he was not entitled to them.
The QME's apportionment opinion lacked substantial evidence as it failed to explain how and why the nonindustrial conditions caused 20% of the disability and apportioned causation of the injury rather than the disability.
Favours Applicant prevailed
This led to the finding that defendant did not meet its burden of proof for non-industrial apportionment under Labor Code section 4663.
From the decision · page 10Miry's apportionment opinion did not rise to the level of substantial evidence as that term has come to be defined within the context of Labor Code section 4663. My conclusion here is driven by the lack of analysis on the part of the QME to explain how and why he believes the nonindustrial conditions are responsible for causing twenty percent of the current disability. Although he comments on apportionment in his June 2025 report (Joint Exhibit 1), Dr. Miry's explanation boils down to a rather conclusory statement attributing 20% apportionment to applicant's probable pre-existing degeneration. In fact, Dr. Miry states applicant had no work restrictions or impacted ADLs due to back symptoms. Moreover, the QME discusses apportionment in relation to the injury itself, rather than the disability it caused.
Delay in service of the QME report until July 15, 2025, and service to an out-of-state address possibly caused further delay, which was not the applicant's fault.
Favours Applicant prevailed
This supported denial of credit for overpayment as the applicant received payments in good faith without wrongdoing.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25, 2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report, through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky, which may have possibly further delayed action by defendant. The applicant continued to receive temporary disability payments after the re-evaluation with the QME and had no reason to believe he was not entitled to them.
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.
Found applicant permanent and stationary as of June 27, 2025, with 20% whole person impairment for lumbar spine, recommended future medical treatment, and apportioned 20% of disability to preexisting degenerative condition and 80% to industrial injury.
The QME's apportionment opinion was conclusory and lacked substantial evidence as it failed to explain how and why the nonindustrial conditions caused 20% of the disability, and it apportioned causation of the injury rather than the disability.
From the decision · page 10Miry's apportionment opinion did not rise to the level of substantial evidence as that term has come to be defined within the context of Labor Code section 4663. My conclusion here is driven by the lack of analysis on the part of the QME to explain how and why he believes the nonindustrial conditions are responsible for causing twenty percent of the current disability. Although he comments on apportionment in his June 2025 report (Joint Exhibit 1), Dr. Miry's explanation boils down to a rather conclusory statement attributing 20% apportionment to applicant's probable pre-existing degeneration. In fact, Dr. Miry states applicant had no work restrictions or impacted ADLs due to back symptoms. Moreover, the QME discusses apportionment in relation to the injury itself, rather than the disability it caused.
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 (en banc)
A medical opinion on apportionment must be well-reasoned, based on adequate history and examination, and disclose a solid underlying basis for the opinion to be substantial evidence.
The QME's apportionment opinion was conclusory and lacked substantial evidence as it failed to explain how and why the nonindustrial conditions caused 20% of the disability.
From the decision · page 10Miry's apportionment opinion did not rise to the level of substantial evidence as that term has come to be defined within the context of Labor Code section 4663. My conclusion here is driven by the lack of analysis on the part of the QME to explain how and why he believes the nonindustrial conditions are responsible for causing twenty percent of the current disability. Although he comments on apportionment in his June 2025 report (Joint Exhibit 1), Dr. Miry's explanation boils down to a rather conclusory statement attributing 20% apportionment to applicant's probable pre-existing degeneration. In fact, Dr. Miry states applicant had no work restrictions or impacted ADLs due to back symptoms. Moreover, the QME discusses apportionment in relation to the injury itself, rather than the disability it caused.
Nunes v. State of California, Dept. of Motor Vehicles (2023) 88 Cal.Comp.Cases 894 (en banc)
The defendant has the burden of establishing the percentage of permanent disability caused by nonindustrial factors under Labor Code section 4663.
Defendant's burden of proof as to apportionment was not met due to lack of substantial evidence in the QME's opinion.
From the decision · page 10Miry's apportionment opinion did not rise to the level of substantial evidence as that term has come to be defined within the context of Labor Code section 4663. My conclusion here is driven by the lack of analysis on the part of the QME to explain how and why he believes the nonindustrial conditions are responsible for causing twenty percent of the current disability. Although he comments on apportionment in his June 2025 report (Joint Exhibit 1), Dr. Miry's explanation boils down to a rather conclusory statement attributing 20% apportionment to applicant's probable pre-existing degeneration. In fact, Dr. Miry states applicant had no work restrictions or impacted ADLs due to back symptoms. Moreover, the QME discusses apportionment in relation to the injury itself, rather than the disability it caused.
Cordes v. General Dynamics-Astronautics (1966) 31 Cal.Comp.Cases 429
A credit for overpayment under Labor Code section 4909 is discretionary and not a legal entitlement; the Appeals Board weighs equities in each case.
The Appeals Board exercised discretion to deny credit for overpayment due to delay in service and lack of petition for credit.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25, 2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report, through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky, which may have possibly further delayed action by defendant. The applicant continued to receive temporary disability payments after the re-evaluation with the QME and had no reason to believe he was not entitled to them.
What proof carried it
The evidence the panel weighed, by kind.
Delay in service of QME report until July 15, 2025, after the June 27, 2025 evaluation, and service to an out-of-state address possibly causing further delay.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25, 2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report, through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky, which may have possibly further delayed action by defendant. The applicant continued to receive temporary disability payments after the re-evaluation with the QME and had no reason to believe he was not entitled to them.
Applicant received temporary disability payments in good faith with no wrongdoing, unaware of permanent and stationary status at the time.
From the decision · page 4Here, we do not find that the WCJ abused her discretion in finding that defendant is not entitled to a credit for temporary disability indemnity paid from June 27, 2025 through July 25, 2025. Panel qualified medical evaluator (QME), Sayed Miry, D.C., re-evaluated the applicant on June 27, 2025 and found him permanent and stationary as of the date of the re-evaluation. (Joint Exhibit #1, Report of QME Sayed Miry D.C., June 27, 2025, at p. 44.) However, the report, through no fault of any party, was not served onto the parties until July 15, 2025. In addition, the claims administrator, Sedgwick, was served at an out-of-state address in Lexington, Kentucky, which may have possibly further delayed action by defendant. The applicant continued to receive temporary disability payments after the re-evaluation with the QME and had no reason to believe he was not entitled to them.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
- If you are named in this decision and want this page removed, write to privacy@similarcase.com.