ADJ8177678 — California WCAB decision

What the panel ordered

Petition for Reconsideration is DENIED.

Defendant State Compensation Insurance Fund petitioned for reconsideration of the WCJ's Findings & Award of February 16, 2021, which found psychiatric injury and good cause to reopen for new and further disability. The WCAB reviewed the record and the WCJ's report, which it adopted and incorporated.

Read the official decision →

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.

Reopening / new and further disabilityApplicant prevailedpsyche

Applicant's psychiatric condition intensified after the 2014 award, with formal diagnosis and treatment only occurring after that date, meeting the standard for new and further disability.

From the decision · page 5Applying these principles to the facts of this case, applicant's psychiatric condition qualifies as "new and further disability." While applicant unquestionably had psychiatric symptoms at the time of the earlier 2014 award, it was not until 2016 that applicant's symptoms progressed to the point of her obtaining treatment for them from a psychologist, Dr. Johnson. Applicant's history to Dr. Laasi of what occurred in her psychological state after the 2014 award is what Dr. Rose described as an "intensification of symptoms" and fits what the Nicky Blair Court included as a "demonstrable change in an employee's condition....A gradual increase in disability... [or]...A change in physical condition necessitating further medical treatment."

The facts that decided it

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

Applicant's psychiatric symptoms intensified after the 2014 award, leading to formal treatment and diagnosis only after that date.

Favours Applicant prevailed

Showed a demonstrable change in condition and met the standard for new and further disability.

From the decision · page 5Applying these principles to the facts of this case, applicant's psychiatric condition qualifies as "new and further disability." While applicant unquestionably had psychiatric symptoms at the time of the earlier 2014 award, it was not until 2016 that applicant's symptoms progressed to the point of her obtaining treatment for them from a psychologist, Dr. Johnson. Applicant's history to Dr. Laasi of what occurred in her psychological state after the 2014 award is what Dr. Rose described as an "intensification of symptoms" and fits what the Nicky Blair Court included as a "demonstrable change in an employee's condition....A gradual increase in disability... [or]...A change in physical condition necessitating further medical treatment."

No physician prior to 2014 provided an opinion on causation or disability from psychiatric symptoms, nor was there a formal diagnosis or treatment.

Favours Applicant prevailed

Established that the psychiatric injury was not compensable until after the original award, supporting reopening.

From the decision · page 5Finally, none of the doctors noting psychological symptoms before 2014 said that the symptoms were causally related to the industrial injury or causing disability. It was not until 2018 that a psychologist (Dr. Laasi) addressed those issues. When applicant reported psychological symptoms to her doctors prior to entering into Stipulations with Request for Award in 2014, the doctors did not provide opinions on causation, did not enroll her in a course of treatment by a mental health professional and did not say that those symptoms caused disability. Applicant's symptoms, according to her, progressed, until by 2016, she was receiving mental health treatment from psychologist Johnson. Expert opinion on the causation and disability issues was not provided until Dr. Laasi evaluated applicant in 2018. The psychiatric problems were a compensable consequence of the already pled physical injuries. Defendant was not taken off guard by applicant's claim for them, having apparently

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.

QMERelied upon · psychology

Concluded applicant met requirements of Labor Code Sec. 3208.3, had a mental disorder per DSM predominantly caused by the industrial injury, reached MMI, permanent impairments, GAF 50, 90% PD apportioned to industrial injury.

Relied upon for finding psychiatric injury and apportionment.

From the decision · page 4On p. 31 of her 2018 report, Dr. Laasi concluded that applicant met the requirements of Labor Code Sec. 3208.3, because she had a mental disorder per the DSM that was predominantly caused by the industrial injury in August of 2011. She found applicant had reached maximum medical improvement and that applicant was left with permanent impairments in functioning, warranting a GAF score of 50. She apportioned 90% of the PD to the 8/19/11 injury and 10% to non-industrial factors.

otherRelied upon · psychology

Provided mental health treatment to applicant starting in 2016, after symptoms intensified post-2014 award.

Treatment history used to establish intensification of symptoms and new and further disability.

From the decision · page 5Applying these principles to the facts of this case, applicant's psychiatric condition qualifies as "new and further disability." While applicant unquestionably had psychiatric symptoms at the time of the earlier 2014 award, it was not until 2016 that applicant's symptoms progressed to the point of her obtaining treatment for them from a psychologist, Dr. Johnson. Applicant's history to Dr. Laasi of what occurred in her psychological state after the 2014 award is what Dr. Rose described as an "intensification of symptoms" and fits what the Nicky Blair Court included as a "demonstrable change in an employee's condition....A gradual increase in disability... [or]...A change in physical condition necessitating further medical treatment."

The rules the panel named

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

Lab. Code, § 3208.3(a)

A psychiatric injury does not fall within the ambit of the workers' compensation system until it causes either disability or a need for medical treatment and it is diagnosed using the terminology and criteria of the DSM or other nationally accepted psychiatric diagnostic manuals.

Applied to determine whether applicant's psychiatric symptoms prior to 2014 constituted a compensable injury.

From the decision · page 1However, a psychiatric injury does not fall within the ambit of the workers' compensation system until it causes either disability or a need for medical treatment and it is diagnosed "using the terminology and criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or the terminology and diagnostic criteria of other psychiatric diagnostic manuals generally approved and accepted nationally by practitioners

Nicky Blair's Restaurant v. WCAB (1980) 109 Cal. App. 3rd 941

'New and further disability' means a demonstrable change in an employee's condition, including a gradual increase in disability or a change in physical condition necessitating further medical treatment, and 'good cause' to reopen includes facts which for the first time develop subsequent to the decision sought to be reopened.

Applied to determine whether applicant's post-2014 psychiatric condition qualified as new and further disability.

From the decision · page 5In its decision in Nicky Blair's Restaurant v. WCAB (1980) 109 Cal. App. 3rd 941, at pp. 954 et seq., the Court defined the term, "new and further disability" to mean a "demonstrable change in an employee's condition....A gradual increase in disability is a `new and further disability'...A change in physical condition necessitating further medical treatment is considered `new and further disability' whether or not accompanied by time lost from work...'Good cause' [to reopen] includes facts which for the first time develop subsequent to the decision sought to be reopened."

ADJ8177678 · May 3, 2021

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page