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ADJ352576 — California WCAB decision · SimilarCase

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California WCABPanel decision

ADJ352576 · August 24, 2021

Petition for Reconsideration denied

Issues decided: 1
Medical opinions weighed: 1
Authorities named: 1
District office: Marina Del Rey

What the panel ordered

Petition for Reconsideration denied

Petition for Reconsideration filed by Applicant from the Findings of Fact issued by the WCJ on June 3, 2021

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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.

Reconsideration / removalDefendant prevailedback · psyche

The WCJ's report was adopted and incorporated, and the Petition for Reconsideration was denied for failure to show error in the Findings of Fact.

From the decision · page 1We have considered the allegations of applicant's Petition for Reconsideration, defendant's answer and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto.1 Based on our review of the record, and for the reasons stated in the WCJ's report, which we adopt and incorporate, we will deny reconsideration.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

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SCSIMILARCASE

Factor-based workers' compensation case-law research. Reference information and research assistance, not legal advice.

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The Stipulated Award approved by WCJ Frank in 2006 required disputes over medical treatment to be referred to either Dr. Sohn or Dr. Greils as appropriate, not both for all treatment types.

Favours Defendant prevailed

This fact established that non-psychiatric treatment disputes must follow the IMR/UR process after Dr. Sohn's death, limiting Dr. Greils' role to psychiatric issues only.

From the decision · page 7Applicant's specific injury of August 13, 2002 involves two parts of body back (orthopedic) and psyche. As noted above, the May 16, 2017 Decision specifically found that the determination of disputed medical treatment by either Dr. Sohn or Dr. Greils as appropriate. (emphasis added) It also required Defendant to refer any dispute over the medical treatment to either Dr. Sohn or Dr. Greils as appropriate. (emphasis added) It did not state that either doctor could address any medical treatment in the area of specialization by the other Agreed Medical Examiner as asserted by Applicant. As noted above the Petition for Reconsideration of the May 16, 2017 filed by Defendant was denied. No Petition for Reconsideration was filed by Applicant challenging the Findings to include a determination that any medical treatment dispute could go to both doctors.

Dr. Greils stated he is not qualified to address orthopedic treatment and deferred to specialists.

Favours Defendant prevailed

Supported the denial of the Petition for Reconsideration by confirming the limitation of Dr. Greils' role to psychiatric treatment only.

From the decision · page 1The other authorization responses that I am asked to address today are in regard to denied requests for: aquatic therapy three to four times per week for two weeks and for Percocet 10/325 mg four times per day for 30 days. Unfortunately, these requests for pain management therapy and medications are outside of my area of expertise, and I must defer to the appropriate specialists for the related determinations.

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.

AMERelied upon · psychiatry

Dr. Greils stated he is not qualified to address the reasonableness and necessity of treatment modalities related to the applicant's orthopedic condition and deferred to appropriate specialists.

Dr. Greils' report was considered in the decision denying reconsideration, noting his limitation to psychiatric issues and deferral on orthopedic treatment.

From the decision · page 1It is further noted that in his January 16, 2020 report, the psychiatric agreed medical evaluator (AME) Dr. Howard Greils stated:

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code Section 4610

Labor Code Section 4610 IMR/UR process

The decision applied the IMR/UR process for non-psychiatric treatment disputes following the death of orthopedic AME Dr. Sohn.

From the decision · page 3A. The WCJ incorrectly found that non-psychiatric treatment disputes that would have been forwarded to Dr. Sohn, but for his death, will now have to follow the procedures outlined in Labor Code Section 4610 (IMR/UR process)

What proof carried it

The evidence the panel weighed, by kind.

Medical recordsfavours Defendant prevailed

Dr. Greils' admission that he is not qualified to address orthopedic treatment requests and defers to specialists

From the decision · page 1Dr. Greils, per his own admission, is not qualified to address the reasonableness and necessity of treatment modalities recommended in relation to applicant's orthopedic condition.

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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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