ADJ14373904 — California WCAB decision

What the panel ordered

Petition for reconsideration granted in part; December 1, 2022 Findings and Award affirmed except for amendment to temporary disability period and deferral of credit issue.

Defendant sought reconsideration of the December 1, 2022 Findings and Award regarding temporary disability and overpayment credit issues.

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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.

Other disputed issueDeferred

The issue of defendant's entitlement to credit for overpayment of permanent disability advances was deferred for further consideration at the trial level due to equitable considerations.

From the decision · page 2In the portion of the Report we are not adopting, the WCJ incorrectly implied that defendant could automatically take a credit for overpayment of permanent disability against temporary disability.

Temporary disabilityApplicant prevailedlumbar spine

The WCJ found the applicant temporarily disabled from January 6, 2021 through May 2, 2022 based on the better-reasoned opinion of the PTP Dr. Longacre, despite the PQME Dr. Dunlap's differing opinion.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Applicant was temporarily disabled from January 6, 2021 through May 2, 2022 based on PTP Dr. Longacre's opinion and applicant's credible testimony.

Favours Applicant prevailed

This supported the finding of the longer temporary disability period over the PQME's shorter period.

From the decision · page 9The applicant was credible when testifying that she saw improvement when she began treating with Dr. Longacre, who was the authorized PTP. Subsequently, as testified to by the applicant and as set forth in Dr. Longacre's reporting, all further treatment recommendations were denied by the defendant. The applicant requested acupuncture, chiropractic treatment, an MRI, aquatic therapy, and a lumbar epidural steroid injection, all of which were denied at various times throughout her time with Dr. Longacre. Questioning at the time of trial by the defense attorney suggested that Utilization Review (UR) issued the denials (Minutes of Hearing and Summary of Evidence, page 7, line 17). If this court were to push back the P&S date merely on the sole basis that UR denied various RFAs, then UR would, in effect, be the de facto trier of fact when it comes to periods of TD. In other words, UR decisions would bootstrap periods of TD and tie the hands of the WCAB, and thus would be the be-all, end-all on this issue. That result defies logic.

Applicant was a candidate for epidural steroid injections and other treatments recommended but denied by defendant.

Favours Applicant prevailed

Supported the finding that the applicant was not permanent and stationary as of the PQME's date, justifying the longer temporary disability period.

From the decision · page 7Dr. Janet Dunlap acted as the panel qualified medical evaluator (PQME), evaluated the applicant one time (which resulted in the September 9, 2021 medical report) and issued a supplemental report dated July 15, 2022. In her September 9, 2021 P&S report, Dr. Dunlap, on page 16 under the caption of "future medical care", provides that the applicant has symptoms into her legs and believes that the applicant "...is [a] candidate for epidural steroid injections" (emphasis added). Furthermore, the doctor allows for future medical care to include physician visits, physical therapy, acupuncture, chiropractic care, and non-addictive medication. The report does not reconcile the P&S finding with the finding that the applicant "is" a candidate for epidural steroid injections.

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.

PTPRelied upon · orthopedics

Found applicant permanent and stationary as of May 2, 2022, recommended future medical care including epidural steroid injections, chiropractic treatment, physical therapy, acupuncture, and surgery if symptoms worsen.

His opinion was found better-reasoned and supported the longer temporary disability period.

From the decision · page 6Longacre notes on page 2 that that the applicant "...underwent chiropractic and acupuncture treatment with symptomatic improvement", but that all additional treatment was denied, including acupuncture, chiropractic treatment, an MRI, aquatic therapy, and a lumbar epidural steroid injection, after having submitted Requests for Authorization. Having found the applicant permanent and stationary (P&S), Dr. Longacre found reasonable future medical care to include access to a treating physician, medication, chiropractic treatment, physical therapy, acupuncture, and even epidural steroid injections and decompressive surgery, should her symptoms worsen. All 13 of his medical reports were admitted into evidence without objection, including the final report dated May 2, 2022 finding the applicant P&S. The parties stipulated that the PTP report rated 18%, after 10% apportionment, and that all PD was attributed to the May 1, 2020 injury.

QMEPartially credited · orthopedics

Found applicant permanent and stationary as of September 9, 2021, but noted applicant was a candidate for epidural steroid injections and other future medical care.

Her opinion was considered substantial evidence but less persuasive than the PTP's opinion on the temporary disability period.

From the decision · page 7Dr. Janet Dunlap acted as the panel qualified medical evaluator (PQME), evaluated the applicant one time (which resulted in the September 9, 2021 medical report) and issued a supplemental report dated July 15, 2022. In her September 9, 2021 P&S report, Dr. Dunlap, on page 16 under the caption of "future medical care", provides that the applicant has symptoms into her legs and believes that the applicant "...is [a] candidate for epidural steroid injections" (emphasis added). Furthermore, the doctor allows for future medical care to include physician visits, physical therapy, acupuncture, chiropractic care, and non-addictive medication. The report does not reconcile the P&S finding with the finding that the applicant "is" a candidate for epidural steroid injections.

ADJ14373904 · February 21, 2023

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

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