ADJ20949280 · July 9, 2026

The WCAB found that the PQME's medical reports lacked substantial evidence due to insufficient reasoning for causation percentages and remanded for further medical evidence and analysis.

From the decision · page 7Section 3208.3 requires as a condition of compensation that an injured worker prove by a preponderance of the evidence that actual events of employment predominantly caused the psychological injury. (Lab. Code, § 3208.3(b)(1).) This requires the WCJ to determine whether actual events of employment occurred, and it requires a psychologist or psychiatrist to determine whether actual events of employment were a predominant cause of an injury to the psyche. (Rolda v. Pitney Bowes, Inc. (2001) 66 Cal.Comp.Cases 241, 245 (Appeals Board en banc).) The phrase “predominant as to all causes” means that “the work-related cause has greater than a 50 percent share of the entire set of causal factors.” (Dep't of Corr. v. Workers' Comp. Appeals Bd. (Garcia) (1999) 76 Cal.App.4th 810, 816 [64 Cal.Comp.Cases 1356].) In order to apply this standard, the evaluating physician must take a history of all events alleged to have contributed to the psychiatric injury, then render an opinion as to causation in terms of first whether

Dr. Allen's medical reports lacked sufficient reasoning and explanation for the assigned causation percentages of psychiatric injury.

Favours Defendant prevailed

This lack of substantial medical evidence led the WCAB to remand the case for further medical evidence and analysis.

From the decision · page 9(1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93, 97].) It is well established that there must be some solid basis in a medical report for the doctor’s ultimate opinion. The Appeals Board may not blindly accept a medical opinion which lacks a solid underlying basis, and must carefully judge its weight and credibility. (National Convenience Stores v. Workers’ Comp. Appeals Bd. (Kesser) (1981) 121 Cal.App.3d 420, 426 [46 Cal.Comp.Cases 783].) In other words, the Appeals Board must look to the underlying facts of a medical opinion to determine whether or not that opinion constitutes substantial evidence, and accordingly, the expert’s opinion is no better than the facts on which it is based. (Turner v. Workers’ Comp. Appeals Bd. (1974) 42 Cal.App.3d 1036, 1044 [39 Cal.Comp.Cases 780].) These requirements apply to all medical evidence, including a physician’s analysis of the good faith personnel action defense under section 3208.3 and Rolda, supra. In this case, Dr. Allen’s two reports fail to provide substantial medical evidence due to the lack of reasoning in support of the percentages of causation that she assigned. To justify and explain the assignment of 35 percent of all causes of injury to applicant’s receipt of a warning from

Diagnosed Undifferentiated Anxiety Disorder; opined work stress predominated as cause of psychiatric injury with specific percentages assigned to manager's behavior, disciplinary write-up, and coworker conflict; supplemental report maintained opinion but did not request neurological evaluation.

The opinion was found lacking in substantial evidence due to insufficient explanation of causation percentages and mechanism of injury, leading to remand for further medical evidence.

From the decision · page 2Applicant worked as a waitress for defendant from November 15, 2010 through May 9, 2025, during which time she claims to have sustained injury arising out of and in the course of employment to her head and nervous system, which is parenthetically specified to mean “stress and psych[e].” Over the course of three days of trial proceedings, the WCJ heard testimony from seven witnesses and admitted sixteen exhibits into evidence. Of the exhibits in evidence, only two are medical reports: an October 9, 2025 evaluation report and a December 1, 2025 supplemental report from Panel Qualified Medical Evaluator (PQME) Ann E. Allen, M.D., a psychiatrist.

Interpreted MMPI-3 results supporting applicant's credible portrayal of emotional complaints.

Supported credibility of applicant's history as a fair historian with consistent and spontaneous responses.

From the decision · page 4The coworker changed her ways and was no longer a source of stress, but still contributed to the initiation of her anxiety problems. Consideration was given to the credibility of the applicant's history in the analysis of medical-legal issues. She appeared to be a fair historian; she was not overly dramatic or emotive, and her responses were spontaneous and natural. Results of the MMPI-3, as interpreted by Yossef Ben-Porath, Ph.D., suggested that she was accurately portraying her emotional complaints. Her history was internally consistent throughout the interview. Thus, there was sufficient reason to accept

Labor Code section 3208.3

Labor Code section 3208.3 requires proof that actual events of employment predominantly caused the psychiatric injury, and provides a good faith personnel action defense.

The WCJ must determine whether actual events of employment occurred and whether they predominantly caused the psychiatric injury; the defense requires proof that personnel action was lawful, nondiscriminatory, and in good faith, and a psychologist or psychiatrist must determine causation percentages.

From the decision · page 7Section 3208.3 requires as a condition of compensation that an injured worker prove by a preponderance of the evidence that actual events of employment predominantly caused the psychological injury. (Lab. Code, § 3208.3(b)(1).) This requires the WCJ to determine whether actual events of employment occurred, and it requires a psychologist or psychiatrist to determine whether actual events of employment were a predominant cause of an injury to the psyche. (Rolda v. Pitney Bowes, Inc. (2001) 66 Cal.Comp.Cases 241, 245 (Appeals Board en banc).) The phrase “predominant as to all causes” means that “the work-related cause has greater than a 50 percent share of the entire set of causal factors.” (Dep't of Corr. v. Workers' Comp. Appeals Bd. (Garcia) (1999) 76 Cal.App.4th 810, 816 [64 Cal.Comp.Cases 1356].) In order to apply this standard, the evaluating physician must take a history of all events alleged to have contributed to the psychiatric injury, then render an opinion as to causation in terms of first whether

Pasquotto v. Hayward Lumber (2006) 71 Cal.Comp.Cases 223 (Appeals Board en banc)

A petition for reconsideration reopens the entire record for further consideration and determination by the Appeals Board.

The Appeals Board has full power to make new and different findings on issues presented at trial, even if not raised in the petition for reconsideration.

From the decision · page 6As we noted in Pasquotto v. Hayward Lumber (2006) 71 Cal.Comp.Cases 223 (Appeals Board en banc), a petition for reconsideration gives the Appeals Board authority to make new and different findings on any issues submitted for decision at trial, and not just on those issues that are specifically discussed in the petition: The Labor Code provides that "all judicial powers" and original jurisdiction in workers' compensation matters are vested with the Appeals Board itself. (Lab. Code, §§ 111(a), 5300, 5301.) The WCJs conduct trials and make initial determinations pursuant to a delegation by the Appeals Board. (Lab. Code, §§ 5309, 5310; Cal. Code Regs., tit. 8, § 10348.) A decision of a WCJ only becomes the decision of the Appeals Board if reconsideration is not granted. (Lab. Code, § 5900 et seq.; Cal. Code Regs., tit. 8, § 10348.) Moreover, section 5906 provides that "[u]pon the filing of a petition for reconsideration... the appeals board may, with or without further proceedings and with or without notice affirm, rescind, alter, or amend the order, decision, or award

Applicant's credible and consistent history supported by MMPI-3 results interpreted by Yossef Ben-Porath, Ph.D.

From the decision · page 4The coworker changed her ways and was no longer a source of stress, but still contributed to the initiation of her anxiety problems. Consideration was given to the credibility of the applicant's history in the analysis of medical-legal issues. She appeared to be a fair historian; she was not overly dramatic or emotive, and her responses were spontaneous and natural. Results of the MMPI-3, as interpreted by Yossef Ben-Porath, Ph.D., suggested that she was accurately portraying her emotional complaints. Her history was internally consistent throughout the interview. Thus, there was sufficient reason to accept