California WCABDecision and order

ADJ9458289 · June 10, 2021

Applicant's petition granted; defendant's petition denied; F&O affirmed as amended to find no psychiatric injury AOE/COE and defer headaches issue; matter returned to WCJ

Issues decided: 2
Medical opinions weighed: 4
Authorities named: 4
District office: Salinas

What the panel ordered

Applicant's petition granted; defendant's petition denied; F&O affirmed as amended to find no psychiatric injury AOE/COE and defer headaches issue; matter returned to WCJp. 10

Petitions for reconsideration filed by both parties from WCJ's Findings and Order of March 23, 2021

Read the official decision →

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.

AOE/COEApplicant prevailedneck · right shoulder · right upper extremity

WCJ's credibility determination accepted; applicant's consistent history to multiple physicians supports specific injury on 11/3/13

From the decision · page 111. applicant, sustained injury on or about 11/3/13, as alleged in ADJ9458289, to her neck, right shoulder and right upper extremity, arising out of and occurring in the course of her employment (AOE/COE) as a housekeeper, Occupational Group 340, by Block & Company Realtors, dba Portola Hotel & Spa;

AOE/COE

Private workspace

Your case already resembles someone else’s. Find whose.

Paste the dispute. The extractor builds the factors, the search finds the decisions the same facts won, and the matter stays saved. Free account.

Start a matter Search without an account →

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.

QMERelied upon · psychiatry

November 3, 2013 injury was not predominant cause of psychiatric condition; termination was primary cause

Only physician addressing Lab. Code § 3208.3(b) criteria; reports constitute substantial evidence

From the decision · page 7Lopez and we find his reports to be substantial evidence that the November 3, 2013 industrial injury is not the predominant cause of any psychiatric injury. The WCJ did not make a specific finding that applicant did not sustain a psychiatric injury and an issue raised at trial and not ruled upon is

QMENot reached · pain medicine

Applicant had intermittent daily headaches that were stress-related; condition not MMI at first evaluation

Noted headaches but did not address causation

From the decision · page 3He stated that in addition to her orthopedic symptoms, applicant had “intermittent headaches, typically having a headache each and every day …,” that her headaches were “stress related”, that she was, “obviously experiencing some irritability and sadness secondary to her current condition” and he determined that applicant’s condition had not

PTPNot reached · physiatry

Applicant positive for headaches

Treating physician notes

From the decision · page 8In addition to Dr. Reynolds stating that applicant “typically” had headaches every day, treating physician Dr. Panchal noted that applicant was “positive for headaches.” (App. Exh. A4, p.2.) Clearly, the trial record contains evidence that applicant experienced headaches on a regular basis subsequent to her November 3, 2013 injury.

QMEPartially credited · pain medicine

Applicant gave history of specific injury on 11/3/13 while cleaning bathroom glass door; condition not MMI at first evaluation

WCJ accepted applicant's consistent history to Dr. Brose as credible; WCJ rejected Dr. Brose's opinion that applicant's history was unreliable

From the decision · page 8Defendant did not present any rebuttal testimony from employer witnesses. ¶ When seen initially by QME Brose, Applicant gave him a history of injury consistent with this, telling him, “On 10/01/2013 … she was cleaning a sliding glass door in the bathroom very quickly and felt a very strong pain in her right

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Garza v. WCAB (1970) 3 Cal.3d 312; Sheffield Medical Group v. WCAB (Perez) (1999) 70 Cal.App.4th 868

WCJ credibility determinations entitled to great weight

WCJ's credibility finding regarding applicant's testimony accepted

From the decision · page 9It is well established that a WCJ’s opinions regarding witness credibility are entitled to great weight. ( Garza v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 312, 319 [35 Cal.Comp.Cases 500, 505]; Sheffield Medical Group v. Workers’ Comp. Appeals Bd.

Lab. Code, § 5952(d); Lamb v. WCAB (1974) 11 Cal.3d 274; Garza v. WCAB (1970) 3 Cal.3d 312

Substantial evidence requirement for Appeals Board decisions

Applied to evaluate whether medical evidence supports findings on injury AOE/COE

From the decision · page 6It is well established that an award, order, or decision of the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5952(d); Lamb v. Workmen’s Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]; Garza v. Workmen’s Comp. Appeals Bd. (1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500].)

Lab. Code, § 3208.3(b)

Psychiatric injury compensability requires actual events of employment predominant as to all causes combined

Applied to QME Lopez's opinion that termination was predominant cause

From the decision · page 7A psychiatric evaluator must first determine the threshold issue of whether an injured worker sustained a psychiatric injury. Once a psychiatric injury has been found, the doctor must then address the issue of whether actual events of employment were the predominate (greater than 50%) cause of the psychiatric condition. (Lab.

Lab. Code, § 5701, 5906; Tyler v. WCAB (1997) 56 Cal.App.4th 389; McClune v. WCAB (1998) 62 Cal.App.4th 1117

Appeals Board authority to develop record when substantial evidence lacking on threshold issue

Record to be developed regarding headaches causation

From the decision · page 8The record as it now stands is not adequate to make a final determination as to the threshold issue of injury AOE/COE pertaining to applicant’s headaches. The Appeals Board has the discretionary authority to develop the record when the record does not contain substantial evidence pertaining to a threshold issue. (Lab. Code, § 5701, 5906; Tyler v.

What proof carried it

The evidence the panel weighed, by kind.

Evidence weighed

Applicant's credible trial testimony that injury occurred 11/3/13 while cleaning crystals in restroom; reported injury immediately to supervisor Carmen and manager's assistant Julia

From the decision · page 8Applicant credibly testified at trial that, “Her injury was on 11/3/13 … cleaning crystals in the restroom, and she discovered she could not move her head or her right arm in her usual way.” She reported her injury “right away” to her supervisor, Carmen, and to the manager’s assistant, Julia (MOH/SOE, 1/23/19, p. 4).

Evidence weighed

Applicant's consistent history to multiple physicians (Drs. Brose, Panchal, Lopez) regarding specific injury on 11/3/13 while cleaning bathroom glass door

From the decision · page 8Defendant did not present any rebuttal testimony from employer witnesses. ¶ When seen initially by QME Brose, Applicant gave him a history of injury consistent with this, telling him, “On 10/01/2013 … she was cleaning a sliding glass door in the bathroom very quickly and felt a very strong pain in her right

Evidence weighed

No rebuttal testimony from employer witnesses contradicting applicant's account of injury reporting

From the decision · page 8Applicant credibly testified at trial that, “Her injury was on 11/3/13 … cleaning crystals in the restroom, and she discovered she could not move her head or her right arm in her usual way.” She reported her injury “right away” to her supervisor, Carmen, and to the manager’s assistant, Julia (MOH/SOE, 1/23/19, p. 4).

Evidence weighed

QME Lopez's opinion that termination (not industrial injury) was predominant cause of psychiatric condition

From the decision · page 7(1970) 3 Cal.3d 372, [35 Cal.Comp.Cases 525].) In his initial report, Dr. Lopez stated that applicant developed depression following the November 2013 event but, “ … her depression developed primarily (over 50%) from [the] fact that she was terminated January 2014.” App. Exh. A3, p. 15.) In his supplemental report, Dr. Lopez stated:

ADJ9458289 · June 10, 2021

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page