What the panel ordered
Defendant's Petition for Reconsideration of the August 13, 2024 decision is dismissed.
Defendant sought reconsideration of the August 13, 2024 Appeals Board decision that rescinded the May 28, 2024 WCJ Findings and Award and returned the matter to trial level for further proceedings. The Appeals Board dismissed the defendant's petition for reconsideration.
This docket was decided more than once. Shown here is the latest released decision; we also hold August 13, 2024.
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.
No doctor provided a clear causation opinion for lumbar spine injury. The QME's equivocal testimony requires further development for credibility determinations. The record is insufficient to determine industrial injury to lumbar spine.
From the decision · page 11Next, the parties dispute whether applicant's injury to the low back was industrial. No doctor has provided a clear opinion explaining causation to the low back. At one point, the QME concludes that there is no way to answer that question. The QME failed to adequately explain how and why he was incapable of answering the question. It further appears that the QME failed to consider the proper legal standard of causation in workers' compensation, which is contributory causation. The September 13, 2022 injury need not be the sole cause of injury to the low back. It is sufficient if the September 13, 2022 injury aggravated or exacerbated prior injury to the low back.
The evidence indicates applicant is not permanent and stationary as both QME and primary treater agree, and the QME's unambiguous testimony supports this. The F&A erred in finding permanent and stationary status.
From the decision · page 10The evidence in this case indicates that applicant is not permanent and stationary. Both the QME and the primary treater appear to agree. The QME testified: "I think, by definition, because things are slowly progressing, he's not permanent and stationary." (Defendant's Exhibit B, supra at p. 15, lines 1-15.) While other parts of the record contain ambiguous indications of permanent
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME Dr. Stark testified applicant is not permanent and stationary.
Favours Applicant prevailed
This testimony directly contradicts the WCJ's finding and supports rescission of the F&A.
From the decision · page 10The evidence in this case indicates that applicant is not permanent and stationary. Both the QME and the primary treater appear to agree. The QME testified: "I think, by definition, because things are slowly progressing, he's not permanent and stationary." (Defendant's Exhibit B, supra at p. 15, lines 1-15.) While other parts of the record contain ambiguous indications of permanent
No clear medical opinion on causation of lumbar spine injury; QME equivocal and failed to apply proper legal standard.
Favours Applicant prevailed
Insufficient evidence on industrial injury to lumbar spine requires further development and remand.
From the decision · page 11Next, the parties dispute whether applicant's injury to the low back was industrial. No doctor has provided a clear opinion explaining causation to the low back. At one point, the QME concludes that there is no way to answer that question. The QME failed to adequately explain how and why he was incapable of answering the question. It further appears that the QME failed to consider the proper legal standard of causation in workers' compensation, which is contributory causation. The September 13, 2022 injury need not be the sole cause of injury to the low back. It is sufficient if the September 13, 2022 injury aggravated or exacerbated prior injury to the low back.
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.
Applicant is not permanent and stationary; condition slowly progressing; no clear causation opinion for lumbar spine injury; equivocal on industrial injury to lumbar spine.
Dr. Stark testified that applicant is not permanent and stationary and that the lumbar spine injury causation is unclear, requiring further development.
From the decision · page 10The evidence in this case indicates that applicant is not permanent and stationary. Both the QME and the primary treater appear to agree. The QME testified: "I think, by definition, because things are slowly progressing, he's not permanent and stationary." (Defendant's Exhibit B, supra at p. 15, lines 1-15.) While other parts of the record contain ambiguous indications of permanent
Agrees with QME that applicant is not permanent and stationary; recommends modified duty with restrictions.
Dr. Wedemeyer's report supports that applicant is not permanent and stationary and provides work restrictions.
From the decision · page 9I agree with PQME Dr. Stark that the applicant is not yet permanent and stationary.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 9811(k)
Permanent and stationary status means maximal medical improvement and stable condition unlikely to change substantially in next year.
Applied to determine permanent and stationary status.
From the decision · page 10"`Permanent and stationary status' means the point when the employee has reached maximal medical improvement his or her condition is well stabilized and unlikely to change substantially in the next year with or without medical treatment." (Cal. Code Regs., tit. 8, § 9811(k).)
Labor Code sections 3202.5, 3600(a)
Applicant must prove injury occurred AOE/COE by preponderance of evidence.
Applied to causation and compensability issues.
From the decision · page 9must prove by a preponderance of the evidence that an injury occurred AOE/COE. (Lab. Code1,
What proof carried it
The evidence the panel weighed, by kind.
QME's equivocal causation opinion and lack of clear explanation on lumbar spine injury
From the decision · page 11Next, the parties dispute whether applicant's injury to the low back was industrial. No doctor has provided a clear opinion explaining causation to the low back. At one point, the QME concludes that there is no way to answer that question. The QME failed to adequately explain how and why he was incapable of answering the question. It further appears that the QME failed to consider the proper legal standard of causation in workers' compensation, which is contributory causation. The September 13, 2022 injury need not be the sole cause of injury to the low back. It is sufficient if the September 13, 2022 injury aggravated or exacerbated prior injury to the low back.
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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.
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