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.
PTPRejected · psychologist
Dr. Michaels' evaluation report lacked adequate foundation and was not substantial medical evidence on industrial causation or any significant litigated issue.
Did not review PQME reports or relevant medical information; opinion was a bare conclusion without reasoning.
From the decision · page 5Premier's Petition does not raise any issue about the finding that the claimed injury was non-
industrial, or that the treatment costs were non-compensable, so those issues are final. Premier is
seeking recovery of the amounts it billed for Dr. Michaels' initial evaluation report and other
services he provided on the initial date of service as claimed medical-legal costs. Because Dr.
Michaels' report lacks adequate foundation and is not substantial medical evidence on any
significant litigated issue, the recommendation is that the Petition be denied in full.
QMERelied upon · internist
Found the applicant's strokes and Antiphospholipid Syndrome to be entirely non-industrial with extensive medical literature and record support.
Provided extensive discussion and references supporting non-industrial causation.
From the decision · page 11From the histories given in the various medical reports, the applicant suffered a series of minor
strokes that started in 2007 and culminated in a more serious stroke in June 2008, while he was
on vacation, which left significant residual effects, including left-sided weakness. He was only
27 at the time of the most serious stroke, and was diagnosed and subsequently treated for
Antiphospholipid Syndrome, a condition that causes unusual clotting (Internal PQME Dr. Ross,
Ex. D p. 27 § 28). Dr. Ross found that the strokes, and the condition that caused them, were
entirely non-industrial, and provided an extensive discussion of what he based this on that
included references to relevant medical literature as well as the applicant's medical records (Id.
p. 28 § 31). His conclusions were confirmed by Neurology PQME Dr. Gorinstein, who provided
a detailed discussion of the applicant's complaints, the cause of his series of strokes and cause of
QMERelied upon · neurologist
Confirmed Dr. Ross's findings that the strokes were caused by a non-industrial condition and employment did not contribute.
Provided detailed discussion of applicant's complaints and cause of strokes supporting non-industrial causation.
From the decision · page 12As noted above, two PQMEs with relevant expertise, Internist Dr. Ross and Neurologist Dr.
Gorinstein, found after evaluating the applicant and reviewing his extensive treatment record that
his strokes were caused by a non-industrial condition, Antiphospholipid Syndrome, and that his
employment did not contribute to them. They both supported their findings appropriately, and
their reports and findings meet the standards for substantial medical evidence set forth in
Escobedo v. Marshalls (2005), 70 Cal.Comp.Cases 604, 621. There is no medical evidence in the
record that counters their findings, and no reports from other doctors in their respective areas of
expertise. The applicant's neurological injury is therefore found non-industrial.
QMERelied upon · psychologist
Found that psychological problems were partly due to non-industrial stroke condition and partly due to work-related stress, with no threshold met for industrial psychological injury.
Provided detailed analysis of causation percentages and supported by substantial medical evidence.
From the decision · page 13He gave a detailed analysis of his findings on causation in his initial report and discussed it
further in his cross-examination (Ex. H). Focusing on the period in 2013, when the applicant
reported that perceived harassment at work was at its most intense and therefore the chance of
meeting the threshold for industrial causation for a psychological injury would be highest, and
considering the applicant's own breakdown of the contribution of different factors to his
psychological problems, he found that at least 40% of the applicant's psychological problems
were due to the stroke condition that both Dr. Ross and Dr. Gorinstein found non-industrial, 50%
were due to work-related stress and 10% to the perceived harassment. Of the work-related stress,
he found that half (25% of the total) was due to stress from the cognitive and physical effects of
the applicant's strokes, which would therefore be non-industrial, and half (25% of the total) was
due to inherent stress of his job.