What the panel ordered
Petition for Reconsideration granted; matter referred to status conference; final decision deferred pending further review of merits and record.
Applicant sought reconsideration of the August 2, 2023 Findings and Order denying the cumulative trauma claim; the WCJ had found the denial timely and no injury arising out of employment during the period October 20, 2020 to October 20, 2021. The Appeals Board granted reconsideration and deferred final decision pending further review.
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 WCJ found the denial of the cumulative trauma claim timely and no injury arising out of employment during the period, but the Appeals Board found the record unclear and granted reconsideration for further review.
From the decision · page 1Applicant seeks reconsideration of the August 2, 2023 Findings and Order wherein the workers' compensation administrative law judge (WCJ) found that applicant "did not timely raise the issue of untimely denial of the cumulative trauma [CT] claim during the period of [October 20, 2020 to October 20, 2021]" though there was no prejudice to defendant; that defendant's denial of the CT claim during the period October 20, 2020 to October 20, 2021 was timely; and that applicant did not suffer injury arising out of and occurring in the course of employment (AOE/COE) on October 20, 2021 or during the period of October 20, 2020 to October 20, 2021. Based on these findings, the WCJ ordered that applicant take nothing for the claim of injury on October 20, 2021 or during the period of October 20, 2020 to October 20, 2021.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The WCJ found defendant's denial of the cumulative trauma claim timely and no injury arising out of employment during the period October 20, 2020 to October 20, 2021.
Favours Defendant prevailed
This finding led to denial of the claim and applicant taking nothing.
From the decision · page 1Applicant seeks reconsideration of the August 2, 2023 Findings and Order wherein the workers' compensation administrative law judge (WCJ) found that applicant "did not timely raise the issue of untimely denial of the cumulative trauma [CT] claim during the period of [October 20, 2020 to October 20, 2021]" though there was no prejudice to defendant; that defendant's denial of the CT claim during the period October 20, 2020 to October 20, 2021 was timely; and that applicant did not suffer injury arising out of and occurring in the course of employment (AOE/COE) on October 20, 2021 or during the period of October 20, 2020 to October 20, 2021. Based on these findings, the WCJ ordered that applicant take nothing for the claim of injury on October 20, 2021 or during the period of October 20, 2020 to October 20, 2021.
The Appeals Board found the record unclear and granted reconsideration for further review of the merits and record.
Favours Applicant prevailed
This led to granting reconsideration and deferring final decision.
From the decision · page 2contents of the Report. Based upon our preliminary review of the record, we will grant applicant's
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.
Opinion found unsubstantial by the WCJ.
The applicant contended the WCJ erred in relying on the unsubstantial opinion of QME Leisure Yu.
From the decision · page 1Applicant appears to contend that the WCJ erred in finding defendant's denial of applicant's claim timely, in failing to find the injury presumptively compensable pursuant to Labor Code section 5402, and in relying on the unsubstantial opinion of qualified medical examiner (QME) Leisure Yu, M.D.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 5412
Date of injury for cumulative trauma claims is when employee first suffered disability and knew or should have known it was work-related (Lab. Code, § 5412).
Labor Code section 3208.2
Anti-merger statute requires separate determination of facts and law for each injury (Lab. Code, § 3208.2).
From the decision · page 4When disability, need for medical treatment, or death results from the combined effects of two or more injuries, either specific, cumulative, or both, all questions of fact and law shall be separately determined with respect to each such injury, including, but not limited to, the apportionment between such injuries of liability for disability benefits, the cost of medical treatment, and any death benefit.
What proof carried it
The evidence the panel weighed, by kind.
The record must contain issues submitted for decision, admissions and stipulations, and admitted evidence; the WCJ must set forth reasons and evidence relied on.
From the decision · page 3Decisions of the Appeals Board "must be based on admitted evidence in the record." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc).) An adequate and complete record is necessary to understand the basis for the WCJ's decision. (Lab. Code, § 5313; see also Cal. Code Regs., tit. 8, § 10787.) "It is the responsibility of the parties and the WCJ to ensure that the record is complete when a case is submitted for decision on the record. At a minimum, the record must contain, in properly organized form, the issues submitted for decision, the admissions and stipulations of the parties, and admitted evidence." (Hamilton, supra, 66 Cal.Comp.Cases at p. 475.) The WCJ's decision must "set[] forth clearly and concisely the reasons for the decision made on each issue, and the evidence relied on," so that "the parties, and the Board if reconsideration is sought, [can] ascertain the basis for the decision[.]... For the opinion on decision to be meaningful, the WCJ must refer with specificity to an adequate and completely developed record." (Id. at p. 476 (citing Evans v. Workmen's Comp. Appeals Bd. (1968) 68 Cal.2d 753, 755 [33 Cal.Comp.Cases 350]).)
The WCJ and Appeals Board have a duty to further develop the record where evidence is insufficient.
From the decision · page 3The WCJ and the Appeals Board have a duty to further develop the record where there is insufficient evidence on an issue. (McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261].) The Appeals Board has a constitutional mandate to "ensure substantial justice in all cases." (Kuykendall v. Workers' Comp. Appeals Bd.
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About this page
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