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ADJ9920866 — California WCAB decision · SimilarCase

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California WCABPanel decision

ADJ9920866 · December 24, 2021

The Findings and Order of October 21, 2019 is rescinded and the matter is returned to the WCJ for further proceedings consistent with this opinion.

Issues decided: 1
Medical opinions weighed: 1
Authorities named: 2
District office: Fresno

What the panel ordered

The Findings and Order of October 21, 2019 is rescinded and the matter is returned to the WCJ for further proceedings consistent with this opinion.

Applicant sought reconsideration of the Findings and Order issued by the WCJ on October 21, 2019, which found the injury not arising out of employment; the WCAB granted reconsideration and issued this decision rescinding the F&O and returning the matter to the WCJ for further proceedings.

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.

Psyche AOE/COERemandedpsyche

The WCAB found that the WCJ's original decision lacked sufficient medical evidence to support the finding that the injury did not arise out of employment. The psychiatric QME's opinion was not substantial evidence due to misunderstanding of cumulative injury law. The matter was remanded for further proceedings to clarify events and obtain further medical evidence.

From the decision · page 1Applicant seeks reconsideration of the Findings and Order (F&O), issued by the workers' compensation administrative law judge (WCJ) on October 21, 2019, wherein the WCJ found in pertinent part that applicant's injury did not arise out of or in the course of her employment (AOE/COE).

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Psychiatric QME Dr. Paul misunderstood cumulative injury law and incorrectly identified two separate injuries instead of a single cumulative injury.

Favours Applicant prevailed

This misunderstanding led to the medical reports not constituting substantial evidence to support the WCJ's original finding.

From the decision · page 8It is apparent that he misunderstood the legal definition of a cumulative injury and misunderstood that a number of events occurring within a continuous period of time could constitute a single cumulative injury and misunderstood that the effects of an injury may not constitute a separate injury. Thus, his reports do not constitute substantial medical evidence. Accordingly, once the WCJ has clarified the events of employment and the period of injury, the record must be further developed by way of further medical evidence to determine whether the events of applicant's employment were the predominant cause of her injury.

Applicant's testimony and co-worker's testimony established that actual events of employment occurred, including stressful interactions and investigation regarding alleged misrepresentation to court.

Favours Applicant prevailed

Supports the first prong of the Rolda analysis that actual events of employment were involved.

There was no evidence supporting defendant's contention that applicant's injury was caused by lawful, nondiscriminatory, good faith personnel actions.

Favours Applicant prevailed

Lack of evidence on personnel actions affected the compensability determination.

From the decision · page 9which resulted in applicant feeling "complicit in lying to an officer of the court." However, it is unclear from applicant's testimony at trial how or if her position changed after August 2014, and defendant presented no evidence that changes had occurred. Accordingly, at this juncture, it appears that the evidence in the record does not support defendant's contention that applicant's injury was caused by personnel actions, that were lawful, nondiscriminatory, and made in good faith. (See Larch (Fleming) v. Contra Costa County (1998) 63 Cal.Comp.Cases 831, 833 [defining a personnel action as conduct either by or attributable to management, which includes actions taken by someone who has the authority to "review, criticize, demote, transfer or discipline an employee in good faith"].)