What the panel ordered
WCJ decision of February 21, 2020 rescinded; case remanded to trial level for further proceedings and decision.
Petition for Reconsideration granted; WCJ decision of February 21, 2020 rescinded; matter remanded to WCJ for further proceedings.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 found that the opinions of the internal AME, Dr. Richard Hyman, and the neurologic Panel QME, Dr. Lawrence Richman, were not substantial evidence to support the apportionment of the internal disability and neurologic disability respectively.
From the decision · page 3a) That this WCJ erred in relying on the opinions of the internal AME, Richard Hyman, M.D., on the issue of apportionment of applicant's internal disability; and
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The opinions of Dr. Richard Hyman, the internal AME, were found not to be substantial evidence by the WCJ.
Favours Applicant prevailed
This led to the rejection of the apportionment of applicant's internal disability based on his opinions.
From the decision · page 4In this case, after review of applicant's Petition for Reconsideration and further review of the evidence, this WCJ agrees that the opinions of Richard Hyman, M.D., the AME in the field of internal medicine, are in fact not substantial evidence.
Dr. Lawrence Richman refused to address apportionment of neurologic disability independent from Dr. Hyman's opinions.
Favours Applicant prevailed
This refusal resulted in the lack of substantial medical evidence to support apportionment of neurologic disability.
From the decision · page 4Furthermore, Dr. Richman, in his May 1, 2017 report (Joint Exhibit V), apportioned 100% of applicant's neurologic impairment to the stroke on July 10, 2015. At the time of his cross- examination on December 4, 2017 (Joint Exhibit X), he confirmed that the stroke was related to the atrial fibrillation due to its embolic nature but he refused to address apportionment of applicant's neurologic disability independent from Dr. Hyman's opinions. Based on the medical evidence, there is no doubt that the stroke was the causation of applicant's neurologic injury but Dr. Richman must address causation of applicant's neurologic disability, which he kept on punting to either the Trier-of-Fact or Dr. Hyman. Dr. Richman's opinions regarding causation of disability are not substantial medical evidence either.
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 opinions on apportionment of applicant's internal disability, which were found not to be substantial evidence by the WCJ.
The WCJ found Dr. Hyman's opinions unpersuasive and not substantial evidence for apportionment.
From the decision · page 3a) That this WCJ erred in relying on the opinions of the internal AME, Richard Hyman, M.D., on the issue of apportionment of applicant's internal disability; and
Apportioned 100% of neurologic impairment to stroke but refused to address apportionment of neurologic disability independent from Dr. Hyman's opinions; opinions not substantial evidence.
Dr. Richman did not provide substantial medical evidence on causation of neurologic disability and deferred to Dr. Hyman or the Trier-of-Fact.
From the decision · page 4Furthermore, Dr. Richman, in his May 1, 2017 report (Joint Exhibit V), apportioned 100% of applicant's neurologic impairment to the stroke on July 10, 2015. At the time of his cross- examination on December 4, 2017 (Joint Exhibit X), he confirmed that the stroke was related to the atrial fibrillation due to its embolic nature but he refused to address apportionment of applicant's neurologic disability independent from Dr. Hyman's opinions. Based on the medical evidence, there is no doubt that the stroke was the causation of applicant's neurologic injury but Dr. Richman must address causation of applicant's neurologic disability, which he kept on punting to either the Trier-of-Fact or Dr. Hyman. Dr. Richman's opinions regarding causation of disability are not substantial medical evidence either.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal. App. 3d 775, 782; 51 Cal. Comp. Cases 114
Ordinarily, the opinions of the AME are followed unless good cause exists to find the AME's opinion unpersuasive.
The WCJ found good cause to reject the AME's opinion as not substantial evidence.
From the decision · page 4The parties presumably choose an AME because of the AME's expertise and neutrality. (Power v. Workers' Comp. Appeals Bd. (1986) 179 Cal. App. 3d 775, 782; 51 Cal. Comp. Cases 114) Ordinarily, we will follow the opinions of the AME unless good cause exists to find the AME's opinion unpersuasive. (Ibid.)
What proof carried it
The evidence the panel weighed, by kind.
Dr. Lawrence Richman refused to address apportionment of neurologic disability independent from Dr. Hyman's opinions, leading to lack of substantial evidence.
From the decision · page 4Furthermore, Dr. Richman, in his May 1, 2017 report (Joint Exhibit V), apportioned 100% of applicant's neurologic impairment to the stroke on July 10, 2015. At the time of his cross- examination on December 4, 2017 (Joint Exhibit X), he confirmed that the stroke was related to the atrial fibrillation due to its embolic nature but he refused to address apportionment of applicant's neurologic disability independent from Dr. Hyman's opinions. Based on the medical evidence, there is no doubt that the stroke was the causation of applicant's neurologic injury but Dr. Richman must address causation of applicant's neurologic disability, which he kept on punting to either the Trier-of-Fact or Dr. Hyman. Dr. Richman's opinions regarding causation of disability are not substantial medical evidence either.
The WCJ found the opinions of Dr. Richard Hyman, the internal AME, not to be substantial evidence.
From the decision · page 4In this case, after review of applicant's Petition for Reconsideration and further review of the evidence, this WCJ agrees that the opinions of Richard Hyman, M.D., the AME in the field of internal medicine, are in fact not substantial evidence.
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About this page
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