What the panel treated as outcome-determinative, and which side it favoured.
PQME Dr. Schwartz found no evidence of cumulative trauma through August 4, 2023, and noted applicant's symptoms and reports were completely unreliable.
Favours Defendant prevailed
This medical opinion was relied upon to deny the injury claim due to lack of substantial evidence.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through
substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr.
Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum
medical improvement with regard to the previous July 2016 cumulative injury but that there was
no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz'
9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP)
Dr. Rosenzweig was not based on an adequate history because he failed to review any medical
records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not
substantial medical evidence, making further analysis of his opinion unnecessary.
PTP Dr. Rosenzweig's opinion was not based on an adequate history and was therefore not substantial medical evidence.
Favours Defendant prevailed
This undermined the applicant's medical evidence supporting injury claim.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through
substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr.
Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum
medical improvement with regard to the previous July 2016 cumulative injury but that there was
no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz'
9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP)
Dr. Rosenzweig was not based on an adequate history because he failed to review any medical
records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not
substantial medical evidence, making further analysis of his opinion unnecessary.
Applicant provided inconsistent and contradictory testimony and history regarding prior injury and work restrictions.
Favours Defendant prevailed
This credibility issue supported the denial of the claim.
From the decision · page 14In this case, we agree with the WCJ that applicant did not meet his burden of proof through
substantial medical evidence that he sustained a cumulative injury through August 4, 2023. Dr.
Schwartz, the panel qualified medical evaluator (PQME), found applicant had reached maximum
medical improvement with regard to the previous July 2016 cumulative injury but that there was
no evidence of cumulative trauma through August 4, 2023, as claimed herein. (Dr. Schwartz'
9/19/24 report, at p. 2. Defendant's Exhibit C.) The opinion of primary treating physician (PTP)
Dr. Rosenzweig was not based on an adequate history because he failed to review any medical
records pertaining to the prior 2016 cumulative injury. This fact alone renders his opinion not
substantial medical evidence, making further analysis of his opinion unnecessary.