What the panel ordered
Petition for Reconsideration is denied.
Defendant City of Richmond seeks reconsideration of the October 11, 2024 Findings of Fact and Award (F&A) that found applicant sustained industrial injury and 33% permanent disability.
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 panel found Dr. Stark's opinion persuasive that the strict AMA Guides rating did not accurately reflect applicant's disability due to significant lifting capacity loss, and that the alternative rating by analogy to hernia injury was appropriate and supported by substantial medical evidence.
From the decision · page 2On October 11, 2024, the WCA issued his F&A, determining in relevant part that applicant's injury resulted in 33 percent permanent disability. The WCA's Opinion on Decision reviewed the reporting of both IME Dr. Stark as well as Dr. D'Amico but found the reporting of Dr. Stark to be the more persuasive. (Opinion on Decision, at pp. 6-8.) Dr. Stark determined that applicant's "strict" rating pursuant to the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition (AMA Guides), was eight percent impairment using a Diagnosis Related Estimate (DRE) approach. However, Dr. Stark further opined that the impairment derived from the DRE approach did not accurately represent applicant's functional loss, including applicant's losses in capacity for lifting. (Id. at p. 6.) Thus, Dr. Stark rated applicant's disability by analogy to hernia using AMA Guides Table 6-9 and assessed 15 percent impairment. (Ibid.) When adjusted by the Permanent Disability Rating Schedule, applicant's impairment rated to 33 percent permanent disability. (Finding of Fact No. 5; Award No. "a".)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Stark provided a strict AMA Guides rating but opined it did not accurately reflect applicant's disability due to significant lifting capacity loss.
Favours Applicant prevailed
This supported the alternative rating by analogy to hernia injury, which the panel found more accurate and persuasive.
From the decision · page 2On October 11, 2024, the WCA issued his F&A, determining in relevant part that applicant's injury resulted in 33 percent permanent disability. The WCA's Opinion on Decision reviewed the reporting of both IME Dr. Stark as well as Dr. D'Amico but found the reporting of Dr. Stark to be the more persuasive. (Opinion on Decision, at pp. 6-8.) Dr. Stark determined that applicant's "strict" rating pursuant to the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition (AMA Guides), was eight percent impairment using a Diagnosis Related Estimate (DRE) approach. However, Dr. Stark further opined that the impairment derived from the DRE approach did not accurately represent applicant's functional loss, including applicant's losses in capacity for lifting. (Id. at p. 6.) Thus, Dr. Stark rated applicant's disability by analogy to hernia using AMA Guides Table 6-9 and assessed 15 percent impairment. (Ibid.) When adjusted by the Permanent Disability Rating Schedule, applicant's impairment rated to 33 percent permanent disability. (Finding of Fact No. 5; Award No. "a".)
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.
Provided a strict AMA Guides rating of 8% impairment using DRE approach but opined it did not accurately reflect functional loss including lifting capacity; rated impairment by analogy to hernia injury at 15%, yielding 33% permanent disability after adjustment.
Dr. Stark explained why the strict AMA Guides rating was insufficient and provided an alternative rating within the AMA Guides that better reflected the applicant's disability, particularly loss of lifting capacity.
From the decision · page 2On October 11, 2024, the WCA issued his F&A, determining in relevant part that applicant's injury resulted in 33 percent permanent disability. The WCA's Opinion on Decision reviewed the reporting of both IME Dr. Stark as well as Dr. D'Amico but found the reporting of Dr. Stark to be the more persuasive. (Opinion on Decision, at pp. 6-8.) Dr. Stark determined that applicant's "strict" rating pursuant to the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition (AMA Guides), was eight percent impairment using a Diagnosis Related Estimate (DRE) approach. However, Dr. Stark further opined that the impairment derived from the DRE approach did not accurately represent applicant's functional loss, including applicant's losses in capacity for lifting. (Id. at p. 6.) Thus, Dr. Stark rated applicant's disability by analogy to hernia using AMA Guides Table 6-9 and assessed 15 percent impairment. (Ibid.) When adjusted by the Permanent Disability Rating Schedule, applicant's impairment rated to 33 percent permanent disability. (Finding of Fact No. 5; Award No. "a".)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Guzman III, 187 Cal.App.4th 820
A physician rebutting a strict AMA Guides rating must provide the strict rating, explain why it does not accurately reflect disability, provide an alternative rating within the AMA Guides, and explain why the alternative rating is more accurate.
Applied to evaluate the validity of Dr. Stark's alternative impairment rating.
From the decision · page 5If the physician expresses the opinion that the chapter applicable to a particular kind of injury does not describe the employee's injury, but all other chapters address completely different biological systems or body parts, it would likely be difficult to demonstrate that that alternative chapter supplies substantial, relevant evidence of an alternative WPI rating. In order to support the case for rebuttal, the physician must be permitted to explain why departure from the impairment percentages is necessary and how he or she arrived at a different rating. That explanation necessarily takes into account the physician's skill, knowledge, and experience, as well as other considerations unique to the injury at issue. In our view, a physician's explanation of the basis for deviating from the percentages provided in the applicable Guides chapter should not a priori be deemed insufficient merely because his or her opinion is derived from, or at least supported by, extrinsic resources.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's significant loss of lifting capacity was well-documented and supported the alternative impairment rating.
From the decision · page 2On October 11, 2024, the WCA issued his F&A, determining in relevant part that applicant's injury resulted in 33 percent permanent disability. The WCA's Opinion on Decision reviewed the reporting of both IME Dr. Stark as well as Dr. D'Amico but found the reporting of Dr. Stark to be the more persuasive. (Opinion on Decision, at pp. 6-8.) Dr. Stark determined that applicant's "strict" rating pursuant to the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition (AMA Guides), was eight percent impairment using a Diagnosis Related Estimate (DRE) approach. However, Dr. Stark further opined that the impairment derived from the DRE approach did not accurately represent applicant's functional loss, including applicant's losses in capacity for lifting. (Id. at p. 6.) Thus, Dr. Stark rated applicant's disability by analogy to hernia using AMA Guides Table 6-9 and assessed 15 percent impairment. (Ibid.) When adjusted by the Permanent Disability Rating Schedule, applicant's impairment rated to 33 percent permanent disability. (Finding of Fact No. 5; Award No. "a".)
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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.
- 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.
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