ADJ11969576 — California WCAB decision

What the panel ordered

Defendant's Petition for Reconsideration of the September 12, 2023 Opinion and Order Granting Petition for Reconsideration and Decision After Reconsideration is denied.

Defendant seeks reconsideration of the September 12, 2023 Opinion and Order Granting Petition for Reconsideration and Decision After Reconsideration, which granted applicant's July 14, 2023 Petition for Reconsideration, rescinded the June 16, 2023 Findings and Award and Orders, and substituted a new Findings and Award finding injury to low back and left elbow but not hip, and entitlement to an additional panel in internal medicine.

Read the official decision →

This docket was decided more than once. Shown here is the latest released decision; we also hold September 12, 2023.

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.

QME/AME processApplicant prevailedlow back · left elbow · circulatory system · hypertension · blood infection

Applicant exercised due diligence in requesting the additional PQME and there was a dispute necessitating the additional panel; defendant's denial of the referral and refusal to agree to the panel justified the order for the additional PQME.

From the decision · page 5

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.

PTPRelied upon · orthopedic surgery

Discussed lumbar spine, left elbow, left hip; recommended internal medicine evaluation and treatment due to persistent complaints.

Applicant's persistent complaints warranted referral to internal medicine specialist.

From the decision · page 2In the Primary Treating Physician's (PTP) Progress Report (PR-2 Report) of January 25, 2021, PTP Dr. Shahab Mahboubian, D.O., in orthopedic surgery, discussed applicant's lumbar spine, left elbow, and left hip and also made a specialty referral for an internal medicine evaluation and treatment. (Ex. 2, PR-2 Report, pp. 1-3.) Dr. Mahboubian stated "The patient will [be] referred for evaluation and/or diagnostic testing in the capacity of internal medicine evaluation and/or testing per MTUS GUIDES 8 C.C.R. § 9792.20-9792.26 Page 1 of 127, `If the complaint persists, the physician needs to reconsider the diagnosis and decide whether a specialist evaluation is necessary.'" (Ex. 2, p. 3.)

AMENot substantial evidence · orthopedic surgery

Conducted orthopedic evaluation; did not address elbow laceration, blood infection, or psychological complaints; found applicant permanent and stationary.

From the decision · page 2Agreed Medical Evaluator (AME) in orthopedic surgery Dr. Peter M. Newton, M.D., conducted an orthopedic evaluation of applicant on February 24, 2021. (Ex. X1, AME Report of Dr. Newton dated 2/24/21.) Applicant disclosed her injury and treatment to him, including the infection in her elbow. (Ex. X1, p. 3.) Dr. Newton also noted that applicant had high blood pressure, which was controlled with medication, and that she suffered from depression, anxiety, stress, headaches, and sleep disturbances due to her injuries. (Ex. X1, pp. 7-8.) After Dr. Newton re-examined applicant on May 18, 2021, he found her permanent and stationary. (Ex. X2, AME Report of Dr. Newton dated 5/19/21, p. 12.)

ADJ11969576 · December 5, 2023

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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