What the panel ordered
Petition for Reconsideration is denied.
Defendant filed a timely and verified Petition for Reconsideration of the WCJ's decision finding industrial injury to Applicant's right leg resulting in deep vein thrombosis but no injury to the nervous system.
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 AME Dr. Ross's report was not substantial medical evidence due to inaccuracies in the medical history and lack of explanation for discrepancies, while the report of Dr. Saghafi was found to be substantial evidence supporting industrial causation of deep vein thrombosis.
From the decision · page 3Applicant was employed as a pump installer for defendant where he sustained an injury during the period January 1, 2004 through June 1, 2017 to his right leg (deep vein thrombosis) and circulatory system. Applicant's claim was accepted as it was presumed compensable due to defendant having failed to issue a timely denial of Applicant's claim.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Ross's medical-legal report contained multiple inaccuracies in Applicant's medical history.
Favours Defendant prevailed
These inaccuracies undermined the reliability of Dr. Ross's opinion, leading the WCJ to reject it as substantial medical evidence.
From the decision · page 4In the present matter, the initial report by Dr. Ross dated July 16, 2020, contained incorrect information as to Applicant's medical history. The report states that Applicant had undergone a left hip replacement, that his sister suffered short-term memory issues. (Joint Exhibit BB, page 9). He also reported that Applicant's father passed away from complications of dementia and a heart attack (Exhibit BB, pages 9, 11). Applicant is also noted as having denied being seen by a psychiatrist. (Joint Exhibit BB, page 11).
Applicant testified at trial that he never had left hip surgery, has no sister, and his father died of pneumonia, contradicting Dr. Ross's report.
Favours Applicant prevailed
Applicant's credible testimony contradicted the inaccurate history in Dr. Ross's report, supporting rejection of that report.
From the decision · page 4At trial Applicant testified that he has never undergone any surgery to his left hip or made any complaints of hip problems. Testimony was also taken that he does not have a sister and that his father passed away from pneumonia unrelated to a heart attack or dementia.
The parties were ordered to obtain supplemental reports to correct errors in Dr. Ross's initial report, but the supplemental report did not adequately address the inaccuracies.
Favours Defendant prevailed
Failure to adequately correct errors in the supplemental report further undermined Dr. Ross's opinion as substantial evidence.
From the decision · page 4Dr. Ross was deposed after his initial report on January 21, 2021, and a supplemental report as obtained dated May 24, 2022. While the deposition brings to light the errors contained in the reporting regarding Applicant's medical history, the deposition testimony and subsequent report do not explain the reason for the discrepancy or point to where the error originated from. (Exhibit CC, page 23 line 10, page 25 line 12, page 32 line 1).
The report of Dr. Saghafi was found to constitute substantial medical evidence supporting industrial causation of deep vein thrombosis.
Favours Applicant prevailed
The WCJ relied on Dr. Saghafi's report over Dr. Ross's to find industrial injury causation.
From the decision · page 5Having found the AME reporting not to be substantial medical evidence and having the reporting of Dr. Saghafi which was found to be such, the undersigned believed that a finding based
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.
Initial report contained inaccurate history; deposition and supplemental report did not explain discrepancies; report not substantial medical evidence for causation of deep vein thrombosis.
Report contained multiple factual inaccuracies and lacked explanation for errors, undermining its reliability as substantial medical evidence.
From the decision · page 3The parties utilized AME internist Dr. Alan Ross regarding Applicant's claim of having developed deep vein thrombosis as a result of industrial exposure. Dr. Ross issued an initial report after which he was subsequently deposed. At the initial trial setting it was revealed that Dr. Ross's report contained an inaccurate history, and the parties were ordered to procure supplemental reporting to address the inaccuracies in the report.
Report found to constitute substantial medical evidence supporting industrial causation of deep vein thrombosis.
Report was relied upon by the WCJ as substantial medical evidence in contrast to Dr. Ross's report.
From the decision · page 5Having found the AME reporting not to be substantial medical evidence and having the reporting of Dr. Saghafi which was found to be such, the undersigned believed that a finding based
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
California Labor Code section 4628(a)
California Labor Code section 4628(a)
Defines essential requirements for medical-legal reports, including accurate history and examination.
From the decision · page 3As stated in the opinion on decision, the undersigned did not find the reporting of AME Ross to constitute substantial medical evidence. California Labor Code section 4628(a) denotes the essential requirements of a med-legal report:
8 CCR 10682
8 CCR 10682
Specifies what should be included in medical reporting and compliance with Labor Code section 4628.
From the decision · page 48 CCR 10682 provides more elaboration regarding physicians' reports as evidence by indicating what should be included in medical reporting. Section (b)(5) lists "The patient's medical history, including injuries and condition, and residuals thereof, if any;". Section (c) continues by stating "All medical-legal reports shall comply with the provisions of Labor Code section 4628. Except as otherwise provided by the Labor Code and the Rules of Practice and Procedure of the Workers' Compensation Appeals Board, failure to comply with the requirements of this rule will not make the report inadmissible but will be considered in weighing the evidence."
E.L Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928
E.L Yeager v. Workers' Comp. Appeals Bd. (Gatten) (2006) 145 Cal.App.4th 922, 928
Expert medical opinion must be based on accurate history and examination and framed in reasonable medical probability.
From the decision · page 4In order to constitute substantial evidence, expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and an examination, and must set forth reasoning to support the expert conclusions reached. (E.L Yeager 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 (Appeals Board en banc).) Based upon Applicant's testimony at trial when compared with the medical reporting and deposition transcript of Dr. Ross, the undersigned did not find that the reporting constituted substantial medical evidence as the history presented was incorrect as to multiple factual points. Furthermore, when provided the
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc)
Expert medical opinion must be based on accurate history and examination and framed in reasonable medical probability.
From the decision · page 4In order to constitute substantial evidence, expert medical opinion must be framed in terms of reasonable medical probability, be based on an accurate history and an examination, and must set forth reasoning to support the expert conclusions reached. (E.L Yeager 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 (Appeals Board en banc).) Based upon Applicant's testimony at trial when compared with the medical reporting and deposition transcript of Dr. Ross, the undersigned did not find that the reporting constituted substantial medical evidence as the history presented was incorrect as to multiple factual points. Furthermore, when provided the
What proof carried it
The evidence the panel weighed, by kind.
Inaccurate medical history in Dr. Ross's report, including incorrect statements about hip surgery, family medical history, and psychiatric evaluation.
From the decision · page 4In the present matter, the initial report by Dr. Ross dated July 16, 2020, contained incorrect information as to Applicant's medical history. The report states that Applicant had undergone a left hip replacement, that his sister suffered short-term memory issues. (Joint Exhibit BB, page 9). He also reported that Applicant's father passed away from complications of dementia and a heart attack (Exhibit BB, pages 9, 11). Applicant is also noted as having denied being seen by a psychiatrist. (Joint Exhibit BB, page 11).
Applicant's testimony at trial contradicted Dr. Ross's medical history report.
From the decision · page 4At trial Applicant testified that he has never undergone any surgery to his left hip or made any complaints of hip problems. Testimony was also taken that he does not have a sister and that his father passed away from pneumonia unrelated to a heart attack or dementia.
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About this page
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