What the panel ordered
The August 30, 2021 Findings and Order is rescinded and the matter is returned to the trial level for further proceedings consistent with the opinion after reconsideration.
Petition for reconsideration of the August 30, 2021 Findings and Order by the WCJ, which found no injury arising out of and in the course of employment; WCAB granted reconsideration and rescinded the WCJ's decision, returning the matter for further proceedings.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 finding that the applicant failed to prove injury AOE/COE to the foot and toes on May 27, 2017, is not supported by any medical evidence. The record lacks medical-legal or treating physician evaluation on causation. The WCAB has a duty to develop the record when medical evidence is absent or insufficient, so the matter is remanded for further proceedings to obtain a PQME opinion on causation.
From the decision · page 7Here, the WCJ's finding that applicant failed to meet his burden of proof that he sustained injury on May 27, 2017 AOE/COE is not supported by any medical evidence. Although we acknowledge the WCJ's reservations regarding applicant's lack of credibility, the WCJ's determination is not dispositive. There is no medical evidence in the record with respect to whether the applicant sustained an industrial injury on May 27, 2017. Applicant was never evaluated by a medical-legal evaluator nor a treating physician regarding the alleged injury. The only medical
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
There is no medical evidence in the record addressing causation of the alleged injury on May 27, 2017.
Favours Applicant prevailed
Without medical evidence on causation, the WCJ's finding of no injury AOE/COE is unsupported and the matter must be remanded for further development.
From the decision · page 7Here, the WCJ's finding that applicant failed to meet his burden of proof that he sustained injury on May 27, 2017 AOE/COE is not supported by any medical evidence. Although we acknowledge the WCJ's reservations regarding applicant's lack of credibility, the WCJ's determination is not dispositive. There is no medical evidence in the record with respect to whether the applicant sustained an industrial injury on May 27, 2017. Applicant was never evaluated by a medical-legal evaluator nor a treating physician regarding the alleged injury. The only medical
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302
Burden of proof for injury arising out of and in the course of employment is by a preponderance of the evidence.
Applicant must prove injury AOE/COE by preponderance of evidence.
From the decision · page 5An employee bears the burden of proving injury arising out of and in the course of
Lab. Code, §§ 4060(c)(d), 4061(i), 4062.3(l)
Medical evidence is required to establish compensability when causation is disputed.
Medical opinion must be based on adequate examination and history, framed in reasonable medical probability, and not speculative.
From the decision · page 6Our system is based on medical evidence. (Peter Kiewit Sons v. Industrial Acc. Com. (1965) 234 Cal.App.2d 831, 838-839 [30 Cal.Comp.Cases 188]; (City & County of San Francisco v. Industrial Acc. Com. (Murdock) (1953) 117 Cal.App.2d 455 [18 Cal.Comp.Cases 103]; Bstandig v. Workers' Comp. Appeals Bd. (1977) 68 Cal.App.3d 988 [42 Cal.Comp.Cases 114].) Medical evidence is required if there is an issue regarding the compensability of the claim. (Lab. Code, § 4060(c)(d), 4061(i), 4062.3(l).) A medical opinion must be framed in terms of reasonable medical probability, it must be based on an adequate examination and history, it must not be speculative, and it must set forth reasoning to support the expert conclusions reached. (E.L. Yeager Construction v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928 [71 Cal.Comp.Cases 1687]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 620-621 (Appeals Bd. en banc).) "Medical reports and opinions are not substantial evidence if they are known to be erroneous, or if they are based on facts no longer germane, on inadequate medical histories and examinations, or on incorrect legal theories. Medical opinion also fails to support the Board's findings if it is based on surmise, speculation, conjecture or guess." (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162, 169 [36 Cal.Comp.Cases 93].)
Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Bd. en banc)
Decision must be based on admitted evidence and supported by substantial evidence.
Decision must refer to evidence forming basis of decision to allow meaningful reconsideration.
From the decision · page 6As explained in Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Bd. en banc), a decision "must be based on admitted evidence in the record" (Id. at p. 478) and must be supported by substantial evidence. (Lab. Code, § 5903, 5952, subd. (d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workers' Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) An adequate and complete record is necessary to understand the basis for the WCJ's decision. (Lab. Code, § 5313; see also Cal. Code Regs., tit. 8, § 10787.) "It is the responsibility of the parties and the WCJ to ensure that the record is complete when a case is submitted for decision on the record. At a minimum, the record must contain, in properly organized form, the issues submitted for decision, the admissions and stipulations of the parties, and admitted evidence." (Hamilton, supra, at
Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389
WCAB has discretionary authority to develop the record when medical evidence is absent or insufficient.
WCAB will develop record to provide due process and fully adjudicate issues when medical evidence is lacking.
From the decision · page 7It is also well established that the Appeals Board has the discretionary authority to develop the record when appropriate to provide due process or fully adjudicate the issues. (Lab. Code, § 5701, 5906; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 9 Cal.App.4th 389 [62 Cal.Comp.Cases 924]; see McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117 [63 Cal.Comp.Cases 261].)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's lack of credibility noted by WCJ but not dispositive due to absence of medical evidence on causation.
From the decision · page 7Here, the WCJ's finding that applicant failed to meet his burden of proof that he sustained injury on May 27, 2017 AOE/COE is not supported by any medical evidence. Although we acknowledge the WCJ's reservations regarding applicant's lack of credibility, the WCJ's determination is not dispositive. There is no medical evidence in the record with respect to whether the applicant sustained an industrial injury on May 27, 2017. Applicant was never evaluated by a medical-legal evaluator nor a treating physician regarding the alleged injury. The only medical
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