ADJ19682404 · August 3, 2026

The WCJ initially found no credible evidence of a spider bite at work and no substantial medical evidence establishing AOE/COE, but the Appeals Board found the medical-legal report by Dr. Haghighinia relevant and remanded for further proceedings to allow supplementation and further evidence.

From the decision · page 7Turning to the first determination, no credible evidence was presented that a spider bite occurred at work on June 17, 2024. The only evidence of a spider bite occurring was Dr. Haghighinia’s medical report of October 3rd, 2024. In the report, Applicant self-reports a spider bite.... While an applicant can report a mechanism of injury to a doctor, the determination of whether that incident occurred is a question of fact. Central to such a determination is whether the testimony is credible. Here, Applicant did not testify at trial....Therefore, there is insufficient evidence to establish that a spider bite occurred at work on June 17, 2024. This alone is enough to not find AOE/COE in this case.

Applicant did not testify at trial, so there was insufficient evidence to establish that a spider bite occurred at work on June 17, 2024.

Favours Defendant prevailed

Credibility of the injury occurrence was central to finding injury AOE/COE; lack of applicant testimony led to denial of AOE/COE by WCJ.

From the decision · page 7Turning to the first determination, no credible evidence was presented that a spider bite occurred at work on June 17, 2024. The only evidence of a spider bite occurring was Dr. Haghighinia’s medical report of October 3rd, 2024. In the report, Applicant self-reports a spider bite.... While an applicant can report a mechanism of injury to a doctor, the determination of whether that incident occurred is a question of fact. Central to such a determination is whether the testimony is credible. Here, Applicant did not testify at trial....Therefore, there is insufficient evidence to establish that a spider bite occurred at work on June 17, 2024. This alone is enough to not find AOE/COE in this case.

Dr. Haghighinia’s medical-legal report was the only medical evidence of the spider bite but lacked supporting medical records and was considered speculative by the WCJ.

Favours Applicant prevailed

The WCJ found the report not substantial medical evidence of injury, leading to denial of the lien; the Appeals Board found the report relevant and remanded for further proceedings.

From the decision · page 7Nevertheless, turning to the second determination, there is also no substantial medical evidence establishing AOE/COE.... The Dr. Haghighinia causation section merely reiterates Applicant’s account of events. Applicant is alleging that a bug bite led to an infection, which then led to two surgeries, which then led to a need for further treatment before Dr. Haghighinia. Competent medical analysis is required to explain the medical nexuses in this case between the bug bite, need for surgery, and then need for treatment months later, post-surgeries. Moreover, the commentary in the report is speculative. Dr. Haghighinia reviews no medical report that confirms a surgery occurred, the outcome of the surgery, or the rationale of the surgery. Instead, Dr. Haghighinia relies on Applicant’s lay opinion as to these medical facts, which are outside Applicant’s knowledge as a lay person. For the foregoing reasons, the report is not substantial medical evidence of injury.

Performed a comprehensive medical-legal evaluation on October 3, 2024, reporting applicant's account of a spider bite at work on June 17, 2024, and linking the injury to subsequent infection and surgeries, but the report lacked supporting medical records and was considered speculative by the WCJ.

The report was the only medical evidence of the spider bite but relied heavily on applicant's self-report and lacked corroborating medical records, leading the WCJ to find it not substantial evidence; the Appeals Board found it relevant and remanded for further development.

From the decision · page 2(Joint Exhibit 1, 9/11/2024, p. 1.) On October 2, 2024, applicant designated Dr. Haghighinia as his primary treating physician (PTP) for all purposes under section 4600. The letter requests that at the time of the initial evaluation, the doctor should perform a comprehensive evaluation and prepare a narrative report discussing all medical-legal issues including causation, apportionment, recommended treatment and disability status. (Exhibit 1, 10/2/2024, p. 1.) The proof of service does not identify the parties being served. On October 3, 2024, Dr. Haghighinia examined applicant and issued a Primary Treating Physician’s Comprehensive Medical-Legal Report for applicant’s claimed injury. (Exhibit 3, 10/3/2024.) The report is addressed to the applicant’s attorney and defendant. The report begins by saying:

Labor Code §§4060, 4064, 4620, 4621, 4622

A medical-legal evaluation performed by an employee’s treating physician is a medical-legal evaluation pursuant to Labor Code section 4060 and the employer is liable for reasonable and necessary medical-legal costs under section 4064.

The Appeals Board held that Dr. Haghighinia’s medical-legal report is a compensable medical-legal evaluation and that the lien claimant met the burden to show a contested claim and reasonableness of the expense.

From the decision · page 8Section 4060(b) allows a medical-legal evaluation by the treating physician. Section 4620(a) defines medical-legal expense as “any costs and expenses…for the purpose of proving or disproving a contested claim.” Section 4064(a) provides that the employer is liable for the cost of a comprehensive medical evaluation that is authorized by section 4060. The regulations provide that the “primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation...” (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) “Medical-legal expense” means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical

Applicant did not testify at trial, leading to credibility issues regarding the occurrence of the spider bite at work.

From the decision · page 7Turning to the first determination, no credible evidence was presented that a spider bite occurred at work on June 17, 2024. The only evidence of a spider bite occurring was Dr. Haghighinia’s medical report of October 3rd, 2024. In the report, Applicant self-reports a spider bite.... While an applicant can report a mechanism of injury to a doctor, the determination of whether that incident occurred is a question of fact. Central to such a determination is whether the testimony is credible. Here, Applicant did not testify at trial....Therefore, there is insufficient evidence to establish that a spider bite occurred at work on June 17, 2024. This alone is enough to not find AOE/COE in this case.