What the panel ordered
The WCJ's Findings and Order of September 22, 2025, is rescinded and the matter is returned to the trial level for further proceedings consistent with the opinion.
Applicant sought reconsideration of the WCJ's Findings and Order issued on September 22, 2025, which denied his claims of injury arising out of and in the course of employment and barred a claim by the statute of limitations. The WCJ's decision was rescinded and the matter was returned to the trial level for further proceedings.
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's findings denying injury AOE/COE were not supported by substantial medical evidence, particularly due to deficiencies in the QME's reports and history taking, warranting further development of the record.
From the decision · page 1Applicant, in pro per, seeks reconsideration of the Findings and Order (F&O) issued by the workers' compensation administrative law judge (WCJ) on September 22, 2025. The WCJ found, in relevant part, that applicant did not sustain injury arising out of and occurring during the course of employment (AOE/COE) to his left leg, left groin, hernia, right ankle, right shoulder, neck, left testicle, and nasal during the period from February 10, 2019 through May 10, 2019; applicant did not sustain injury AOE/COE to his right shoulder, neck, and head on March 19, 2019; and the March 19, 2019 claim of injury was barred by the statute of limitations pursuant to Labor Code section 54051. The WCJ ordered that applicant take nothing.
The statute of limitations issue was not decided due to the need for further medical evaluation and record development.
From the decision · page 1Applicant, in pro per, seeks reconsideration of the Findings and Order (F&O) issued by the workers' compensation administrative law judge (WCJ) on September 22, 2025. The WCJ found, in relevant part, that applicant did not sustain injury arising out of and occurring during the course of employment (AOE/COE) to his left leg, left groin, hernia, right ankle, right shoulder, neck, left testicle, and nasal during the period from February 10, 2019 through May 10, 2019; applicant did not sustain injury AOE/COE to his right shoulder, neck, and head on March 19, 2019; and the March 19, 2019 claim of injury was barred by the statute of limitations pursuant to Labor Code section 54051. The WCJ ordered that applicant take nothing.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME Dr. Abitbol's reports were deficient and did not constitute substantial medical evidence due to incorrect history, inadequate job duty discussion, and questionable credibility statements.
Favours Applicant prevailed
This undermined the WCJ's denial of injury AOE/COE and warranted further development of the record.
From the decision · page 5QME Dr. Abitbol did not find a cumulative injury AOE/COE and noted "[t]here was no report of a specific industrial incident while he was employed..." (Defendant's Exhibit #B, at p. 3.) However, upon review, we do not find the QME's reports constitute substantial medical evidence.
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.
Did not find cumulative injury AOE/COE; noted no report of specific industrial incident; history and job duties inadequately addressed; opinions not substantial medical evidence; possible ethical violations.
The QME's reports were found deficient and not substantial medical evidence due to incorrect history, inadequate job duty discussion, and questionable statements about the applicant's credibility.
From the decision · page 5QME Dr. Abitbol did not find a cumulative injury AOE/COE and noted "[t]here was no report of a specific industrial incident while he was employed..." (Defendant's Exhibit #B, at p. 3.) However, upon review, we do not find the QME's reports constitute substantial medical evidence.
Found the cumulative injury to be industrial.
Initial PTP evaluation found the cumulative injury industrial, supporting the applicant's claim.
From the decision · page 2FACTS We will briefly review the relevant facts. On September 6, 2019, applicant filed an Application for Adjudication (Application) claiming a cumulative injury to his left leg, left groin, hernia, right ankle, right shoulder, neck, left testicle, and nasal while employed by defendant as a handyman from February 10, 2019 to May 10, 2019. On November 18, 2024, applicant filed a second Application claiming a second injury to his right shoulder, neck, and head while employed by defendant as a handyman on March 19, 2019. On August 21, 2019, applicant was initially evaluated by his primary treating physician (PTP), Veerinder Anand, M.D., who found the cumulative injury to be industrial. (Applicant's Exhibit #1.) On November 2, 2020, applicant was evaluated by the orthopedic panel qualified medical evaluator (QME), Jean-Jacques Abitbol, M.D., who diagnosed him with a right groin strain, cervical spine strain, right shoulder strain, and right wrist strain. (Defendant's Exhibit #A.) The QME issued a supplemental report dated September 27, 2021.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 3600(a)
An employer is liable for workers' compensation benefits without regard to negligence; employee bears burden of proving injury AOE/COE by preponderance of evidence.
The Board reviewed the evidence and found the WCJ's denial of injury AOE/COE unsupported by substantial medical evidence.
From the decision · page 4II. Section 3600(a) provides liability for injuries sustained "arising out of and in the course of the employment." (Lab. Code, § 3600(a).) An employer is liable for workers' compensation benefits "without regard to negligence." (Ibid.) An employee bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing, Inc. v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a), 3202.5.) Whether an employee's injury arose out of and in the course of employment is generally a question of fact to be determined in light of the particular circumstances of the case. (Wright v. Beverly Fabrics (2002) 95 Cal.App.4th 346, 353 [67 Cal.Comp.Cases 51].) For the purpose of meeting the causation requirement in a workers' compensation injury claim, it is sufficient if the work is a contributing cause of the injury. (South Coast Framing, supra, at pp.
Lab. Code, 5409
The burden of proving the statute of limitations is on the party opposing the claim; it must be liberally construed in favor of the employee.
The Board deferred ruling on the statute of limitations defense pending further medical evaluation and record development.
From the decision · page 7III. The running of the statute of limitations is an affirmative defense, and the burden of proving it is on the party opposing the claim. (Lab. Code, § 5409; Kaiser Foundation Hospitals v. Workers' Comp. Appeals Bd. (Martin) (1985) 39 Cal.3d 57, 67, fn. 8 [50 Cal.Comp.Cases 411].) The burden is on defendant to show when the statute of limitations began to run, "starting from any and all three points designated [in Labor Code section 5405]." (Colonial Ins. Co. v. Industrial Acc. Com. (Nickles) (1945) 27 Cal.2d 437, 441 [10 Cal.Comp.Cases 321].) The three points designated in
What proof carried it
The evidence the panel weighed, by kind.
QME's reports were deficient and not substantial medical evidence due to incorrect history, inadequate job duty discussion, and questionable credibility statements.
From the decision · page 5QME Dr. Abitbol did not find a cumulative injury AOE/COE and noted "[t]here was no report of a specific industrial incident while he was employed..." (Defendant's Exhibit #B, at p. 3.) However, upon review, we do not find the QME's reports constitute substantial medical evidence.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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