What the panel ordered
The Petition for Reconsideration filed by defendant is denied, affirming the WCJ's findings of industrial injury and the substantiality of the AME Dr. Bertoldi's medical evidence, and rejecting the claim of impermissible ex parte contact.
This docket was decided more than once. Shown here is the latest released decision; we also hold May 16, 2023.
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 participation of applicant's sister in the AME evaluation was found necessary and permissible due to applicant's impaired memory and need for accurate medical history, consistent with prior panel decisions and due process principles.
From the decision · page 12Here, the AME has testified that applicant's ability to recall his medical history was significantly compromised, and that the assistance of applicant's sister was "essential" to the medical-legal evaluation. (Ex. B, Transcript of the Deposition of Roger V. Bertoldi, M.D., dated November 19, 2021, at 56:3.) Moreover, the AME was aware of the participation of applicant's sister in the preparation of the medical history and applicant's symptoms and complaints, and exercised his judgement to determine that her assistance was timely and necessary. (Ibid.) Pursuant to the reasoning in Belling, supra, and Trujillo, supra, we are persuaded that the participation of applicant's sister in the evaluation by AME Dr. Bertoldi was both necessary and permissible under the circumstances, as the failure to obtain an appropriate medical history would have invalidated any resulting reporting from the AME, and because applicant's sister was communicating on applicant's behalf during the course of the medical-legal evaluation. (Lab. Code § 4628; Hegglin v. Workers' Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93].)
The WCJ and WCAB found the AME Dr. Bertoldi's report to be substantial medical evidence based on reasonable medical probability, supported by review of treating neurosurgeon and pathologist opinions, and applicant's credible testimony.
From the decision · page 6II. We first address the sufficiency of the medical-legal evidence. The WCJ has determined that applicant sustained two industrial injuries, a specific injury of September 10, 2015, and a cumulative injury from September 10, 2005 to September 10, 2015. In both instances, the WCJ has based his findings on applicant's credible testimony and the reporting of AME Dr. Bertoldi. (Opinion on Decision, at p. 2.) The burden of proving industrial injury rests with the applicant. (Lab. Code, § 3202.5, 5705; LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644, 650 [63 Cal.Comp.Cases 253].) Where the question of industrial causation is beyond the bounds of ordinary knowledge, proof in the form of expert medical evidence is required. (State Comp. Ins. Fund v. Industrial Acc. Com. (Willson) (1924) 195 Cal.174, 184 [11 IAC 277]; Ins. Co. of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905, 911 [46 Cal.Comp.Cases 913].) In order to constitute substantial evidence on industrial causation, a reporting physician must state his or her opinion in terms of reasonable medical probability. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416, 419 [33 Cal.Comp.Cases 660]; LaTourette, supra, 17 Cal.4th at p. 650.) In his report of January 20, 2021,3 Dr.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
AME Dr. Bertoldi's report linked applicant's workplace fall on September 10, 2015, to intracranial hemorrhage and subdural hematoma occurring days later, stated to reasonable medical probability.
Favours Applicant prevailed
This medical opinion was relied upon by the WCJ and WCAB as substantial evidence to establish industrial injury causation.
From the decision · page 6II. We first address the sufficiency of the medical-legal evidence. The WCJ has determined that applicant sustained two industrial injuries, a specific injury of September 10, 2015, and a cumulative injury from September 10, 2005 to September 10, 2015. In both instances, the WCJ has based his findings on applicant's credible testimony and the reporting of AME Dr. Bertoldi. (Opinion on Decision, at p. 2.) The burden of proving industrial injury rests with the applicant. (Lab. Code, § 3202.5, 5705; LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644, 650 [63 Cal.Comp.Cases 253].) Where the question of industrial causation is beyond the bounds of ordinary knowledge, proof in the form of expert medical evidence is required. (State Comp. Ins. Fund v. Industrial Acc. Com. (Willson) (1924) 195 Cal.174, 184 [11 IAC 277]; Ins. Co. of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905, 911 [46 Cal.Comp.Cases 913].) In order to constitute substantial evidence on industrial causation, a reporting physician must state his or her opinion in terms of reasonable medical probability. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416, 419 [33 Cal.Comp.Cases 660]; LaTourette, supra, 17 Cal.4th at p. 650.) In his report of January 20, 2021,3 Dr.
Applicant's memory impairment necessitated sister's assistance during AME evaluation to provide accurate medical history, which was deemed essential and permissible by the AME and the WCAB.
Favours Applicant prevailed
This justified the participation of a third party without constituting impermissible ex parte contact, supporting the validity of the AME report.
From the decision · page 12Here, the AME has testified that applicant's ability to recall his medical history was significantly compromised, and that the assistance of applicant's sister was "essential" to the medical-legal evaluation. (Ex. B, Transcript of the Deposition of Roger V. Bertoldi, M.D., dated November 19, 2021, at 56:3.) Moreover, the AME was aware of the participation of applicant's sister in the preparation of the medical history and applicant's symptoms and complaints, and exercised his judgement to determine that her assistance was timely and necessary. (Ibid.) Pursuant to the reasoning in Belling, supra, and Trujillo, supra, we are persuaded that the participation of applicant's sister in the evaluation by AME Dr. Bertoldi was both necessary and permissible under the circumstances, as the failure to obtain an appropriate medical history would have invalidated any resulting reporting from the AME, and because applicant's sister was communicating on applicant's behalf during the course of the medical-legal evaluation. (Lab. Code § 4628; Hegglin v. Workers' Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93].)
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. Bertoldi concluded that applicant's work fall caused intracranial hemorrhage and subdural hematoma, supported by imaging and medical history, stated to a reasonable degree of medical probability.
The WCJ and WCAB relied on Dr. Bertoldi's detailed causation analysis and medical probability opinion as substantial evidence.
From the decision · page 6II. We first address the sufficiency of the medical-legal evidence. The WCJ has determined that applicant sustained two industrial injuries, a specific injury of September 10, 2015, and a cumulative injury from September 10, 2005 to September 10, 2015. In both instances, the WCJ has based his findings on applicant's credible testimony and the reporting of AME Dr. Bertoldi. (Opinion on Decision, at p. 2.) The burden of proving industrial injury rests with the applicant. (Lab. Code, § 3202.5, 5705; LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644, 650 [63 Cal.Comp.Cases 253].) Where the question of industrial causation is beyond the bounds of ordinary knowledge, proof in the form of expert medical evidence is required. (State Comp. Ins. Fund v. Industrial Acc. Com. (Willson) (1924) 195 Cal.174, 184 [11 IAC 277]; Ins. Co. of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905, 911 [46 Cal.Comp.Cases 913].) In order to constitute substantial evidence on industrial causation, a reporting physician must state his or her opinion in terms of reasonable medical probability. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416, 419 [33 Cal.Comp.Cases 660]; LaTourette, supra, 17 Cal.4th at p. 650.) In his report of January 20, 2021,3 Dr.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, §§ 3202.5, 5705; McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408; LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644
The burden of proving industrial injury rests with the applicant, requiring expert medical evidence stated in terms of reasonable medical probability for causation.
Applied to assess the sufficiency of AME Dr. Bertoldi's medical evidence on industrial injury causation.
From the decision · page 6II. We first address the sufficiency of the medical-legal evidence. The WCJ has determined that applicant sustained two industrial injuries, a specific injury of September 10, 2015, and a cumulative injury from September 10, 2005 to September 10, 2015. In both instances, the WCJ has based his findings on applicant's credible testimony and the reporting of AME Dr. Bertoldi. (Opinion on Decision, at p. 2.) The burden of proving industrial injury rests with the applicant. (Lab. Code, § 3202.5, 5705; LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644, 650 [63 Cal.Comp.Cases 253].) Where the question of industrial causation is beyond the bounds of ordinary knowledge, proof in the form of expert medical evidence is required. (State Comp. Ins. Fund v. Industrial Acc. Com. (Willson) (1924) 195 Cal.174, 184 [11 IAC 277]; Ins. Co. of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905, 911 [46 Cal.Comp.Cases 913].) In order to constitute substantial evidence on industrial causation, a reporting physician must state his or her opinion in terms of reasonable medical probability. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416, 419 [33 Cal.Comp.Cases 660]; LaTourette, supra, 17 Cal.4th at p. 650.) In his report of January 20, 2021,3 Dr.
Medical-legal evaluators may interview collateral sources when necessary to obtain an accurate and adequate history as part of the employee's examination, consistent with due process and Labor Code provisions.
Applied to determine permissibility of applicant's sister's participation in AME evaluation and to reject ex parte contact claim.
From the decision · page 12Here, the AME has testified that applicant's ability to recall his medical history was significantly compromised, and that the assistance of applicant's sister was "essential" to the medical-legal evaluation. (Ex. B, Transcript of the Deposition of Roger V. Bertoldi, M.D., dated November 19, 2021, at 56:3.) Moreover, the AME was aware of the participation of applicant's sister in the preparation of the medical history and applicant's symptoms and complaints, and exercised his judgement to determine that her assistance was timely and necessary. (Ibid.) Pursuant to the reasoning in Belling, supra, and Trujillo, supra, we are persuaded that the participation of applicant's sister in the evaluation by AME Dr. Bertoldi was both necessary and permissible under the circumstances, as the failure to obtain an appropriate medical history would have invalidated any resulting reporting from the AME, and because applicant's sister was communicating on applicant's behalf during the course of the medical-legal evaluation. (Lab. Code § 4628; Hegglin v. Workers' Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93].)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's credible testimony and detailed medical reports by AME Dr. Bertoldi and treating neurosurgeon Dr. Mortazavi.
From the decision · page 6II. We first address the sufficiency of the medical-legal evidence. The WCJ has determined that applicant sustained two industrial injuries, a specific injury of September 10, 2015, and a cumulative injury from September 10, 2005 to September 10, 2015. In both instances, the WCJ has based his findings on applicant's credible testimony and the reporting of AME Dr. Bertoldi. (Opinion on Decision, at p. 2.) The burden of proving industrial injury rests with the applicant. (Lab. Code, § 3202.5, 5705; LaTourette v. Workers' Comp. Appeals Bd. (1998) 17 Cal.4th 644, 650 [63 Cal.Comp.Cases 253].) Where the question of industrial causation is beyond the bounds of ordinary knowledge, proof in the form of expert medical evidence is required. (State Comp. Ins. Fund v. Industrial Acc. Com. (Willson) (1924) 195 Cal.174, 184 [11 IAC 277]; Ins. Co. of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905, 911 [46 Cal.Comp.Cases 913].) In order to constitute substantial evidence on industrial causation, a reporting physician must state his or her opinion in terms of reasonable medical probability. (McAllister v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 408, 413, 416, 419 [33 Cal.Comp.Cases 660]; LaTourette, supra, 17 Cal.4th at p. 650.) In his report of January 20, 2021,3 Dr.
Applicant's impaired memory necessitating sister's participation in AME evaluation to provide accurate medical history.
From the decision · page 12Here, the AME has testified that applicant's ability to recall his medical history was significantly compromised, and that the assistance of applicant's sister was "essential" to the medical-legal evaluation. (Ex. B, Transcript of the Deposition of Roger V. Bertoldi, M.D., dated November 19, 2021, at 56:3.) Moreover, the AME was aware of the participation of applicant's sister in the preparation of the medical history and applicant's symptoms and complaints, and exercised his judgement to determine that her assistance was timely and necessary. (Ibid.) Pursuant to the reasoning in Belling, supra, and Trujillo, supra, we are persuaded that the participation of applicant's sister in the evaluation by AME Dr. Bertoldi was both necessary and permissible under the circumstances, as the failure to obtain an appropriate medical history would have invalidated any resulting reporting from the AME, and because applicant's sister was communicating on applicant's behalf during the course of the medical-legal evaluation. (Lab. Code § 4628; Hegglin v. Workers' Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93].)
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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.
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