ADJ10266348 — California WCAB decision

ADJ10266348 · September 25, 2023

The WCAB panel granted the petition for reconsideration, amended the Findings and Award to defer issues of industrial causation for diabetes, hypertension, dental, and urological conditions, and awarded temporary total disability benefits, future medical care, and attorney fees to the applicant.

Issues decided

Medical opinions weighed

Authorities named

District office

Santa Ana

What the panel ordered

Applicant sought reconsideration of the WCJ's 1st Amended Findings, Award and Order of July 14, 2023, which was granted by the WCAB panel on September 25, 2023, amending the decision to defer issues of industrial injury to diabetes, hypertension, dental, and urological conditions for further medical development.

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.

Medical treatment / UR / IMRApplicant prevailedright knee · left knee · lumbar spine · cervical spine · hearing

Applicant was found in need of future medical care to cure or relieve effects of admitted industrial injuries.

From the decision · page 49. The applicant is in need of future medical care to cure or relieve the effects of the industrial injuries to the applicant's right knee, left knee, lumbar spine, and cervical spine, with symptomology radiating into his bilateral shoulders and upper extremities and hearing.

The facts that decided it

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

Applicant's counsel was recently substituted and had limited opportunity for discovery.

Favours Applicant prevailed

WCAB granted reconsideration to allow further discovery and development of medical evidence.

From the decision · page 2Applicant's current counsel first appeared in this matter in September of 2022. Soon after applicant's counsel was substituted into the case, defendant filed a Declaration of Readiness to Proceed which was objected to on the basis that applicant's counsel had only just substituted in, and had not yet received the prior attorney's file. Nevertheless, a mandatory settlement conference took place on December 6, 2022. In the pretrial conference statement prepared on that date, applicant's counsel objected to setting a trial date, stating, "Applicant's counsel was attempting to conduct discovery but due to tactics by Defense counsel, has been unable to complete said discovery." The mandatory settlement conference was continued to February 21, 2023. On December 7, 2022, applicant filed an Amended Application for Adjudication alleging injury to the psyche, "internal," "dental," and in the forms of irritable bowel syndrome, gastroesophageal reflux disorder, diabetes, and hypertension. At the February 21, 2013 mandatory settlement conference, the matter was set for trial on May 8, 2023 with discovery left open only for the deposition of the orthopedic agreed medical evaluator.

Insufficient medical evidence to determine industrial causation for diabetes, hypertension, dental and urological conditions.

Favours Applicant prevailed

Led to deferral of these issues for further medical development to ensure substantial justice.

From the decision · page 33. There is insufficient medical evidence to determine if the injury to the applicant in the form of anxiety, depression, sleep problems, vision (eyes), gastrointestinal problems, hypertension, dental problems, urological problems, and/or diabetes are nonindustrial or industrial.

What proof carried it

The evidence the panel weighed, by kind.

Testimony and credibilityfavours Applicant prevailed

Applicant's counsel had only recently substituted into the case and had not yet received the prior attorney's file, limiting discovery initially.

From the decision · page 2Applicant's current counsel first appeared in this matter in September of 2022. Soon after applicant's counsel was substituted into the case, defendant filed a Declaration of Readiness to Proceed which was objected to on the basis that applicant's counsel had only just substituted in, and had not yet received the prior attorney's file. Nevertheless, a mandatory settlement conference took place on December 6, 2022. In the pretrial conference statement prepared on that date, applicant's counsel objected to setting a trial date, stating, "Applicant's counsel was attempting to conduct discovery but due to tactics by Defense counsel, has been unable to complete said discovery." The mandatory settlement conference was continued to February 21, 2023. On December 7, 2022, applicant filed an Amended Application for Adjudication alleging injury to the psyche, "internal," "dental," and in the forms of irritable bowel syndrome, gastroesophageal reflux disorder, diabetes, and hypertension. At the February 21, 2013 mandatory settlement conference, the matter was set for trial on May 8, 2023 with discovery left open only for the deposition of the orthopedic agreed medical evaluator.

treatment coursefavours Applicant prevailed

The WCJ ordered further development of the medical record on several conditions including diabetes, hypertension, dental and urological issues.

From the decision · page 1Applicant seeks reconsideration of a workers' compensation administrative law judge's (WCJ) 1st Amended Findings, Award and Order of July 14, 2023 wherein it was found that while employed during a cumulative period ending December 15, 2015, applicant sustained admitted injury to his hearing, right knee and left knee, as well as non-admitted injury to his "lumbar spine and cervical spine with symptomology radiating into his bilateral shoulders and upper extremities" causing broken periods of compensable temporary disability totaling 104 weeks. It was also found that applicant did not sustain industrial injury to the head, hands, wrists, trunk, waist, "dental," "urological" or in the forms of hypertension or diabetes. It was further found that "there is insufficient medical evidence to determine if the injury to the applicant in the form of anxiety, depression, sleep problems, vision (eyes) and gastrointestinal problems are nonindustrial or industrial." The WCJ ordered further development of the medical record with regard to these body parts, and deferred all other outstanding issues.

ADJ10266348 · September 25, 2023

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

The rules the panel named

What proof carried it

About this page