What the panel ordered
Findings and Award of March 17, 2020 affirmed; petition for reconsideration denied
Petition for reconsideration filed by applicant challenging apportionment medical opinion; WCJ decision affirmed after reconsideration
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 Appeals Board found Dr. Han's medical reports substantial evidence supporting 60% apportionment to non-industrial factors, affirming the WCJ's decision and rejecting the applicant's contention based on Hikida.
From the decision · page 1In the Findings and Award of March 17, 2020, the Workers' Compensation Judge ("WCJ") found, in pertinent part, that applicant sustained industrial injury to her right knee and left knee on March 6, 2015, that Dr. James Han is the Panel Qualified Medical Evaluator ("PQME"), and that the injury resulted in permanent disability of 21%, after 60% apportionment to "other factors" of permanent disability under Labor Code section 4663(c).
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Han's medical reports showing 60% apportionment to non-industrial factors
Favours Defendant prevailed
Supported the WCJ's finding of apportionment and was found substantial evidence by the Appeals Board
From the decision · page 1In the Findings and Award of March 17, 2020, the Workers' Compensation Judge ("WCJ") found, in pertinent part, that applicant sustained industrial injury to her right knee and left knee on March 6, 2015, that Dr. James Han is the Panel Qualified Medical Evaluator ("PQME"), and that the injury resulted in permanent disability of 21%, after 60% apportionment to "other factors" of permanent disability under Labor Code section 4663(c).
Applicant's history of prior knee surgeries, obesity, and degenerative changes
Favours Defendant prevailed
Provided basis for apportionment of permanent disability to non-industrial factors
From the decision · page 3the doctor apportioning 60% of the above permanent impairment "to pre-existing conditions and 40% to the specific [industrial] incident of March 6, 2015." (Exhibit CC, p. 15.) Dr. Han further supported his opinion on apportionment by explaining that applicant had prior surgeries, fell off a curb in 2016, and had obesity, which all contributed to degenerative changes in applicant's knees that necessitated her bilateral knee replacement surgeries. (Id.) In his supplemental report of July 5, 2019, Dr. Han reaffirmed his prior opinion on apportionment, stating that applicant's "long history of pre-existing knee conditions and injuries and surgeries and morbid obesity significantly contributed to the ultimate need for total knee replacements bilaterally." (Exhibit DD, p. 2.)
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. Han opined 60% of permanent disability was due to non-industrial factors including prior surgeries, obesity, and degenerative changes, and 40% due to the industrial injury, based on bilateral knee replacement surgeries.
Dr. Han's reports provided detailed explanation of pre-existing conditions and their contribution to permanent disability, meeting the substantial evidence standard under Escobedo.
From the decision · page 1In the Findings and Award of March 17, 2020, the Workers' Compensation Judge ("WCJ") found, in pertinent part, that applicant sustained industrial injury to her right knee and left knee on March 6, 2015, that Dr. James Han is the Panel Qualified Medical Evaluator ("PQME"), and that the injury resulted in permanent disability of 21%, after 60% apportionment to "other factors" of permanent disability under Labor Code section 4663(c).
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Escobedo v. Marshalls (2007) 70 Cal. Comp. Cases 604
Medical-legal report must describe in detail the exact nature of the apportionable disability and set forth the basis for the opinion
Applied to evaluate Dr. Han's apportionment opinion as substantial evidence
From the decision · page 7The basis for apportionment must be clear; the medical-legal report must "describe in detail the exact nature of the apportionable disability, and set forth the basis for the opinion." Escobedo v. Marshalls (2007) 70 Cal. Comp. Cases 604, 621. This means that the medical-legal report must explain the nature of the non-industrial factor, and how and why the non-industrial factor is responsible for part of the disability. Id. at 622. In his report dated report dated April 5, 2019, Dr. Han apportioned 60% of the disability to pre-existing and 40% to the industrial injury. He explained that Applicant had prior surgeries, fell off a curb in 2016, and had obesity resulting in degenerative changes that made the bilateral total knee replacement surgeries necessary, which is the basis for the permanent disability. (Joint Exhibit CC)
Hikida v. Workers' Comp. Appeals Bd. (2017) 12 Cal.App.5th 1249
Employer responsible for medical treatment and consequences without apportionment when treatment is sole cause of disability
Distinguished and not adopted in this case due to pre-existing conditions contributing to disability
From the decision · page 3However, we do not adopt or incorporate the discussion of Hikida found in the WCJ's Report. In Hikida, the injured employee sustained industrial injury in the form of carpal tunnel syndrome, and she underwent surgery to alleviate that condition. The surgery was unsuccessful and resulted in the injured employee developing chronic regional pain syndrome ("CRPS"). The CRPS left her permanently and totally disabled. On one hand, the Agreed Medical Evaluator ("AME") concluded that the permanent and total disability was entirely due to the injured employee's new CRPS condition. On the other hand, the AME found apportionment based on his opinion that 10% of the disability resulting from the original carpal tunnel syndrome condition was non-industrial. On those facts, the Court of Appeal framed the issue as "whether an employer is responsible for both the medical treatment and any disability arising directly from unsuccessful medical intervention, without apportionment." (Hikida, supra, 12 Cal.App.5th at 1260, italics added.) Although the Court answered yes to that specific question, the Court further explained in pertinent part: "Nothing in the 2004 legislation [broadening application of apportionment] had any impact on the reasoning that has long supported the employer's responsibility to compensate
What proof carried it
The evidence the panel weighed, by kind.
Applicant's prior surgeries, obesity, and degenerative knee conditions
From the decision · page 3the doctor apportioning 60% of the above permanent impairment "to pre-existing conditions and 40% to the specific [industrial] incident of March 6, 2015." (Exhibit CC, p. 15.) Dr. Han further supported his opinion on apportionment by explaining that applicant had prior surgeries, fell off a curb in 2016, and had obesity, which all contributed to degenerative changes in applicant's knees that necessitated her bilateral knee replacement surgeries. (Id.) In his supplemental report of July 5, 2019, Dr. Han reaffirmed his prior opinion on apportionment, stating that applicant's "long history of pre-existing knee conditions and injuries and surgeries and morbid obesity significantly contributed to the ultimate need for total knee replacements bilaterally." (Exhibit DD, p. 2.)
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.