ADJ11434587 · March 12, 2024

The WCJ erred in rejecting Dr. Mirza's reports on the basis that he was not the primary treating physician. The Appeals Board held that the issue of primary treating physician is a payment issue and does not affect the reliability of the medical reports for permanent disability and further medical treatment. The Board found that Dr. Mirza's reports constitute substantial evidence and the record must be further developed.

From the decision · page 6II. Applicant contends that the issue in this case is whether the WCJ appropriately decided that he could not rely on Dr. Mirza's medical reports when deciding the issues of applicant's permanent disability and further medical treatment because Dr. Mirza was not applicant's primary treating physician. The parties disagree on whether Dr. Mirza was in defendant's MPN and disagree as to whether Dr. Mirza is applicant's primary treating physician. As noted above, while the WCJ made no finding as to the issue of Dr. Mirza's reports, he determined that he could not rely on Dr. Mirza's medical reports as he believed that Dr. Mirza was not applicant's primary treating physician. (OOD, pp. 2-3.) However, whether Dr.

Dr. Mirza was a treating physician who provided an impairment rating of 26% in April 2022.

Favours Applicant prevailed

The Appeals Board held that Dr. Mirza's reports are substantial evidence for permanent disability and further medical treatment and should not be rejected based on primary treating physician status.

From the decision · page 2FACTS Applicant claimed injury to his low back while employed as a factory representative for defendant on September 6, 2017. Dr. Jeffrey Holmes served as the panel QME in this matter. In his January 10, 2022 report, he provided an impairment rating for applicant of 10%. (Ex. I, QME report of Dr. Holmes, dated 1/3/22, p. 6.) Applicant began treating with Dr. Mirza in approximately November 2018, and the record contains treatment records through 2022. In his permanent and stationary report of April 1, 2022, Dr. Mirza provided an impairment rating of 26%. (Ex. 4, P&S Report of Dr. Mirza, dated 4/1/22, p. 8.) Although defendant paid for applicant's medical treatment with Dr. Mirza (Exhibit D, Printout of Medical Benefits), defendant claims that it objected to treatment by Dr. Mirza because Dr. Mirza was not part of its MPN. (Ex. C, pp. 1, 10, 26, 39, 41, 52, 54, 61, 68, 69, 86, 88, 103.) The parties proceeded to trial on April 6, 2023. Defendant objected to the admission of the reports of Dr. Mirza (Exhibits 4 and 5) because it asserted that Dr.

The WCJ relied solely on QME Dr. Holmes' report which provided a 10% impairment rating and rejected Dr. Mirza's reports.

Favours Applicant prevailed

The Appeals Board found Dr. Holmes' report insufficient as it did not consider Dr. Mirza's later reports and ordered further development of the record.

From the decision · page 2FACTS Applicant claimed injury to his low back while employed as a factory representative for defendant on September 6, 2017. Dr. Jeffrey Holmes served as the panel QME in this matter. In his January 10, 2022 report, he provided an impairment rating for applicant of 10%. (Ex. I, QME report of Dr. Holmes, dated 1/3/22, p. 6.) Applicant began treating with Dr. Mirza in approximately November 2018, and the record contains treatment records through 2022. In his permanent and stationary report of April 1, 2022, Dr. Mirza provided an impairment rating of 26%. (Ex. 4, P&S Report of Dr. Mirza, dated 4/1/22, p. 8.) Although defendant paid for applicant's medical treatment with Dr. Mirza (Exhibit D, Printout of Medical Benefits), defendant claims that it objected to treatment by Dr. Mirza because Dr. Mirza was not part of its MPN. (Ex. C, pp. 1, 10, 26, 39, 41, 52, 54, 61, 68, 69, 86, 88, 103.) The parties proceeded to trial on April 6, 2023. Defendant objected to the admission of the reports of Dr. Mirza (Exhibits 4 and 5) because it asserted that Dr.

The issue of whether Dr. Mirza was in the defendant's MPN is a payment issue and irrelevant to the reliability of his medical reports.

Favours Applicant prevailed

This distinction clarified that the WCJ erred in rejecting Dr. Mirza's reports on the basis of MPN status or primary treating physician designation.

From the decision · page 7As stated above, the issue of whether Dr. Mirza was in the defendant's MPN is only

Provided an impairment rating of 26% in permanent and stationary report dated April 1, 2022. His reports were initially rejected by the WCJ but later accepted by the Appeals Board as substantial evidence for permanent disability and further medical treatment.

The Appeals Board held that Dr. Mirza's reports are substantial evidence and should be considered for permanent disability and further medical treatment despite the WCJ's initial rejection based on primary treating physician status.

From the decision · page 2FACTS Applicant claimed injury to his low back while employed as a factory representative for defendant on September 6, 2017. Dr. Jeffrey Holmes served as the panel QME in this matter. In his January 10, 2022 report, he provided an impairment rating for applicant of 10%. (Ex. I, QME report of Dr. Holmes, dated 1/3/22, p. 6.) Applicant began treating with Dr. Mirza in approximately November 2018, and the record contains treatment records through 2022. In his permanent and stationary report of April 1, 2022, Dr. Mirza provided an impairment rating of 26%. (Ex. 4, P&S Report of Dr. Mirza, dated 4/1/22, p. 8.) Although defendant paid for applicant's medical treatment with Dr. Mirza (Exhibit D, Printout of Medical Benefits), defendant claims that it objected to treatment by Dr. Mirza because Dr. Mirza was not part of its MPN. (Ex. C, pp. 1, 10, 26, 39, 41, 52, 54, 61, 68, 69, 86, 88, 103.) The parties proceeded to trial on April 6, 2023. Defendant objected to the admission of the reports of Dr. Mirza (Exhibits 4 and 5) because it asserted that Dr.

Provided an impairment rating of 10% in QME report dated January 3, 2022. His report was relied upon by the WCJ but found insufficient by the Appeals Board as it did not consider Dr. Mirza's later reports.

The Appeals Board found Dr. Holmes' report insufficient as it did not consider the full medical record including Dr. Mirza's later reports, requiring further development of the record.

From the decision · page 2FACTS Applicant claimed injury to his low back while employed as a factory representative for defendant on September 6, 2017. Dr. Jeffrey Holmes served as the panel QME in this matter. In his January 10, 2022 report, he provided an impairment rating for applicant of 10%. (Ex. I, QME report of Dr. Holmes, dated 1/3/22, p. 6.) Applicant began treating with Dr. Mirza in approximately November 2018, and the record contains treatment records through 2022. In his permanent and stationary report of April 1, 2022, Dr. Mirza provided an impairment rating of 26%. (Ex. 4, P&S Report of Dr. Mirza, dated 4/1/22, p. 8.) Although defendant paid for applicant's medical treatment with Dr. Mirza (Exhibit D, Printout of Medical Benefits), defendant claims that it objected to treatment by Dr. Mirza because Dr. Mirza was not part of its MPN. (Ex. C, pp. 1, 10, 26, 39, 41, 52, 54, 61, 68, 69, 86, 88, 103.) The parties proceeded to trial on April 6, 2023. Defendant objected to the admission of the reports of Dr. Mirza (Exhibits 4 and 5) because it asserted that Dr.

Valdez v. Workers' Comp. Appeals Bd. (2013) 57 Cal.4th 1231

Valdez v. Workers' Comp. Appeals Bd. (2013) 57 Cal.4th 1231 regarding privately retained doctors' reports.

A privately retained doctor's report may provide some basis for an award but cannot be the sole basis. A treating physician's report may be relied upon.

From the decision · page 8an award. (See Place, supra, 3 Cal.3d 372, 378-379.) By way of comparison, a privately retained doctor's report may provide some basis for an award, although it cannot be the sole basis of an award of compensation. (Valdez v. Workers' Comp. Appeals Bd. (2013) 57 Cal.4th 1231, 1232.) Therefore, the WCJ should have considered Dr. Mirza's report to determine the issues of applicant's permanent disability and need for further medical treatment.

Labor Code section 4606

Labor Code section 4606 regarding the use of attending physicians' reports and the role of QMEs.

The Board held that a treating physician's report may be relied upon for permanent disability and further medical treatment regardless of MPN status or primary treating physician designation.

Labor Code section 4064(d)

Labor Code section 4064(d) regarding payment issues and reliance on treating physician reports.

The issue of whether a provider is in the MPN is a payment issue and does not affect the reliability of the medical reports for permanent disability and further medical treatment.

From the decision · page 7As stated above, the issue of whether Dr. Mirza was in the defendant's MPN is only

Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379

Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 regarding substantial evidence from a treating physician.

A treating physician's report may constitute substantial evidence even if inconsistent with other medical opinions.

From the decision · page 7opinion of one physician may constitute substantial evidence, even if inconsistent with other

Applicant's testimony about ongoing treatment with Dr. Mirza and functional limitations such as problems lifting and bracing himself while showering and brushing teeth.

From the decision · page 2Mirza was not applicant's treating physician. Applicant testified that he had been seeing Dr. Mirza approximately once per month. (4/6/23 Minutes of Hearing/Summary of Evidence (MOH/SOE), p. 4.) Dr. Mirza had been trying to obtain an MRI for applicant for over a year but it had been denied by Utilization Review. (MOH/SOE, p. 4.) Applicant has problems lifting items and has to brace himself while showering and brushing his teeth. (MOH/SOE, p. 4.) Relying on Dr. Holmes' medical reports and not Dr. Mirza's reports, the WCJ found that applicant's injury caused permanent disability of 17% and awarded permanent disability indemnity benefits based on that permanent disability finding of 17%. (FA&O, pp. 1-2; Opinion on Decision (OOD), pp. 2-3.)