What the panel ordered
Petition for reconsideration denied.
Petition for reconsideration filed by Defendant California Insurance Guarantee Association (CIGA) challenging WCJ's Findings of Fact of January 27, 2022, regarding cumulative injuries sustained by applicant.
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.
Both reporting physicians opined that applicant sustained two separate cumulative injuries, and there was no medical evidence to rebut these uncontroverted opinions. The WCJ's factual findings on this issue were upheld.
From the decision · page 1Defendant California Insurance Guarantee Association (CIGA) seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings of Fact of January 27, 2022 wherein it was found that while employed as a professional gridiron football player applicant sustained two separate cumulative injuries. The WCJ found "The first cumulative trauma injury is for the period June 15, 1975 through November 10, 1979 while applicant was employed by the [Los Angeles] Rams and the second cumulative trauma injury is for the period April 29, 1983 through the 1984 season while applicant was employed by the Washington Federals and the Houston Gamblers." The only issue for adjudication at trial was whether applicant sustained one or two periods of cumulative injury. (Minutes of Hearing and Summary of Evidence of August 16, 2021 trial at p. 2.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant sustained two separate cumulative trauma injuries during distinct periods of professional football employment.
Favours Applicant prevailed
This fact was supported by uncontroverted medical opinions and was the basis for denying the petition for reconsideration.
From the decision · page 1Defendant California Insurance Guarantee Association (CIGA) seeks reconsideration of a workers' compensation administrative law judge's (WCJ) Findings of Fact of January 27, 2022 wherein it was found that while employed as a professional gridiron football player applicant sustained two separate cumulative injuries. The WCJ found "The first cumulative trauma injury is for the period June 15, 1975 through November 10, 1979 while applicant was employed by the [Los Angeles] Rams and the second cumulative trauma injury is for the period April 29, 1983 through the 1984 season while applicant was employed by the Washington Federals and the Houston Gamblers." The only issue for adjudication at trial was whether applicant sustained one or two periods of cumulative injury. (Minutes of Hearing and Summary of Evidence of August 16, 2021 trial at p. 2.)
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.
Opined that applicant sustained two separate cumulative trauma injuries during two distinct periods of professional football employment.
Based on the applicant's employment history and medical history, concluded two separate cumulative trauma periods were applicable.
From the decision · page 2Turning to the merits, in this matter both reporting physicians qualified medical evaluator orthopedist Theodore Georgis, Jr., M.D. and qualified medical evaluator Michael J. Einbund, M.D. opined that applicant sustained two separate cumulative injuries. Dr. Georgis wrote in his January 5, 2016 report:
Agreed with Dr. Georgis that applicant sustained two separate cumulative injuries.
Uncontroverted medical opinion supporting two separate cumulative injuries.
From the decision · page 3the WCJ's Opinion on Decision, "There was no medical evidence offered to rebut the
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Aetna Cas. & Surety Co. v. Workmen's Comp. Appeals Bd. (1973) 35 Cal.App.3d 329
The number and nature of injuries suffered are questions of fact for the WCJ or the WCAB.
The WCJ's factual findings on the number of cumulative injuries were upheld based on medical testimony and events leading to the injury.
From the decision · page 3In any given situation, there can be more than one injury, either specific or cumulative or a combination of both, arising from the same event or from separate events. (Chevron U.S.A., Inc. v. Workers' Comp. Appeals Bd. (1990) 219 Cal.App.3d 1265, 1271; City of Los Angeles v. Workers' Comp. Appeals Bd. (1978) 88 Cal.App.3d 19, 29; State Comp. Ins. Fund v. Workmen's Comp. App. Bd. (1969) 1 Cal.App.3d 812, 819.) The number and nature of the injuries suffered are questions of fact for the WCJ or the WCAB. (Aetna Cas. & Surety Co. v. Workmen's Comp. Appeals Bd. (1973) 35 Cal.App.3d 329, 341; LeVesque v. Workmen's Comp. App. Bd. (1970) 1 Cal.3d 627, 637.) For example, if an employee becomes disabled, is off work and then returns to work only to again become disabled, there is a question of fact as to whether the new disability is due to the old injury or whether it is due to a new and separate injury. (See Assurance Corp. v. Industrial Acc. Com. (1922) 57 Cal.App.
What proof carried it
The evidence the panel weighed, by kind.
Uncontroverted medical opinions of Dr. Einbund and Dr. Georgis that there are two separate cumulative traumas.
From the decision · page 3the WCJ's Opinion on Decision, "There was no medical evidence offered to rebut the
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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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