What the panel ordered
Reconsideration granted, WCJ decision rescinded, matter returned to trial level for further proceedings and a new decision.
Applicant sought reconsideration of the May 20, 2022 Findings of Fact, which found injury to some body parts but not to the hands; the WCAB granted reconsideration, rescinded the decision, and remanded for further proceedings.
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.
The PQME provided inconsistent opinions on causation of hand impairment and did not provide an analysis of causation; further development of the record is required.
From the decision · page 4In this case, while we agree with the WCJ that finding impairment is not the same as finding injury, the PQME has not provided an analysis of the causation of applicant's hand impairment. Dr. Heron should be provided with an opportunity to comment on this issue. Therefore, we will return this matter to the trial level for further development of the medical record.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The PQME provided inconsistent opinions on whether applicant sustained an injury to her hands and did not analyze causation for hand impairment.
Favours neutral
This lack of analysis and inconsistency in the medical evidence required further development of the record and precluded a finding on industrial injury to the hands.
From the decision · page 4In this case, while we agree with the WCJ that finding impairment is not the same as finding injury, the PQME has not provided an analysis of the causation of applicant's hand impairment. Dr. Heron should be provided with an opportunity to comment on this issue. Therefore, we will return this matter to the trial level for further development of the medical record.
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.
Dr. Heron provided inconsistent opinions on whether applicant sustained an injury to her hands and did not provide an analysis of causation for hand impairment.
The PQME has not provided an analysis of the causation of applicant's hand impairment; further comment is needed.
From the decision · page 4In this case, while we agree with the WCJ that finding impairment is not the same as finding injury, the PQME has not provided an analysis of the causation of applicant's hand impairment. Dr. Heron should be provided with an opportunity to comment on this issue. Therefore, we will return this matter to the trial level for further development of the medical record.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274, 281 [39 Cal.Comp.Cases 310]
A decision whether applicant sustained a cumulative injury must be supported by substantial evidence in light of the entire record.
The WCAB must ensure that findings of injury are supported by substantial medical evidence, and that medical opinions are based on reasonable medical probability and relevant factual basis.
From the decision · page 2must be supported by substantial evidence in light of the entire record. (Lab. Code,
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (en banc); Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93, 97]
To constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability and a relevant factual basis.
Medical opinions must be based on correct legal theory, relevant facts, and not on speculation or conjecture.
From the decision · page 3It is well established that all decisions by the WCAB must be supported by substantial evidence and all decisions requiring medical evidence must be supported by substantial medical evidence. Not all expert medical opinion constitutes substantial evidence. (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93, 97]; Place v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 372, 378-379 [35 Cal.Comp.Cases 525].) To constitute substantial evidence, a medical opinion must be predicated on reasonable medical probability. (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (en banc); McAllister v. Workmen's Comp. Appeals Bd., supra, 69 Cal.2d 408, 413, 416-417; Rosas v. Workers' Comp. Appeals Bd. (1993) 16 Cal.App.4th 1692, 1700-1702, 1705 [58 Cal.Comp.Cases 313].) "A medical report predicated upon an incorrect legal theory and devoid of relevant factual basis, as well as a medical opinion extended beyond the range of the physician's expertise, cannot rise to a higher level than its own inadequate premises." (Zemke v.
Lab. Code, §3208.1; Hegglin, supra, 36 Cal.Comp.Cases at p. 97.
A medical evaluator must have a complete medical history including a history of applicant's job duties to opine on industrial causation.
Medical evaluator must know applicant's job duties to support a finding of injury caused by repetitive activities.
From the decision · page 3When opining on industrial causation, a medical evaluator must have a complete medical history including a history of applicant's job duties. A medical evaluator must know what applicant did at work to have a relevant factual basis to support a finding on whether an injury was caused by "repetitive mentally or physically traumatic activities extending over a period of time." (Lab. Code, § 3208.1; Hegglin, supra, 36 Cal.Comp.Cases at p. 97.)
Lab. Code, §§ 5701, 5906; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389 [62 Cal.Comp.Cases 924]
The Appeals Board has discretionary authority to develop the record when the medical record is not substantial evidence or to provide due process.
The Board may return a matter for further development of the medical record when necessary.
From the decision · page 3The Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence or when appropriate to provide due process or fully adjudicate the issues. (Lab. Code, § 5701, 5906; Tyler v. Workers' Comp. Appeals Bd. (1997) 56
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
- If you are named in this decision and want this page removed, write to privacy@similarcase.com.