What the panel ordered
Petition for Reconsideration granted; August 8, 2023 Findings and Order rescinded and substituted; Petition to Reopen for New and Further Disability dismissed; Defendant's Petition to Dismiss granted.
Applicant filed a Petition for Reconsideration from the August 8, 2023 Findings and Order issued by the WCJ, which was granted for reconsideration and amendment of jurisdictional findings.
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.
Applicant did not sustain new and further disability; no good cause shown to reopen award based on QME report and lack of new medical evidence.
From the decision · page 2FINDINGS AND ORDER 1. applicant, while employed on September 13, 2016, as a mechanic, Occupational Group No. 370, at Watsonville, California, by Dick Peixoto, sustained injury arising out of and in the course of employment to his head and neck. 2. At the time of the injury, the employer's workers' compensation carrier was Star Insurance Company, administered by Meadowbrook Insurance Group. 3. Applicant's September 1, 2021 Petition to Reopen for New and Further Disability was filed timely. 4. Applicant has not sustained new and further disability; therefore, good cause has not been shown to reopen Applicant's Award. 5. Defendant's Petition to Dismiss Applicant's September 1, 2021 Petition for New and Further Disability is granted. 6. This decision does not affect Applicant's August 1, 2017 Award of further medical treatment, which remains in effect.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME Dr. Gwalani's report found no new and further disability; applicant's condition permanent and stationary since 1/24/17; no additional impairment or work restrictions.
Favours Defendant prevailed
Report constituted substantial medical evidence supporting denial of reopening petition.
From the decision · page 5Appeals Bd. (1992) 5 Cal.App.4th 703, 711] As to the merits of the case, the court reviewed the new evidence, which consisted of a reevaluation by QME Dr. Gwalani. Dr. Gwalani's report constitutes substantial medical evidence. In his report of 10/24/22, Dr. Gwalani opined that the applicant has remained permanent and stationary since 1/24/17. Applicant's subjective complaints remained the same as those stated in the QME's 2/20/17 report. Applicant's cervical sprain and head contusion have resolved, and he has no work restrictions. Dr. Gwalani found that the applicant had not sustained additional impairment. The applicant sought no treatment in the five years between evaluations. (Board Ex. X-1, p. 5) The applicant was unable to produce any medical evidence of an increase in disability or need for treatment.
Applicant refused to sign pre-trial conference statement and did not testify at trial despite presence; had multiple opportunities to participate; no due process violation found.
Favours Defendant prevailed
Supported finding that applicant did not show good cause to reopen award.
From the decision · page 4ID: 76383393) At the 3/27/23 MSC, the applicant had not completed his part of the PTCS, so was directed by the court to meet with the Information and Assistance Consultant to complete the PTCS. Over applicant's objection, the matter was to be set for trial when the PTCS was completed. (MOH, 3/27/23, EAMS Doc. ID: 76588823.) Per case notes, the I&A Consultant met with the applicant at least twice--on the second visit, he refused to sign the PTCS. The undersigned noted the applicant's refusal to sign on the PTCS. (PTCS, d. 4/25/23; EAMS Doc. ID: 76686445) The matter was submitted for decision after trial on 5/31/23. The applicant was present at trial, but did not testify. (Minutes of Hearing, 5/31/23; EAMS Doc. ID: 77023402)
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.
Applicant has remained permanent and stationary since 1/24/17; cervical sprain and head contusion resolved; no work restrictions; no additional impairment; no new treatment sought in five years.
Report constitutes substantial medical evidence supporting no new and further disability.
From the decision · page 5Appeals Bd. (1992) 5 Cal.App.4th 703, 711] As to the merits of the case, the court reviewed the new evidence, which consisted of a reevaluation by QME Dr. Gwalani. Dr. Gwalani's report constitutes substantial medical evidence. In his report of 10/24/22, Dr. Gwalani opined that the applicant has remained permanent and stationary since 1/24/17. Applicant's subjective complaints remained the same as those stated in the QME's 2/20/17 report. Applicant's cervical sprain and head contusion have resolved, and he has no work restrictions. Dr. Gwalani found that the applicant had not sustained additional impairment. The applicant sought no treatment in the five years between evaluations. (Board Ex. X-1, p. 5) The applicant was unable to produce any medical evidence of an increase in disability or need for treatment.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Katzin v. Workers' Comp. Appeals Bd. (1992) 5 Cal.App.4th 703, 711
Due process requires all parties to be fully apprised of evidence and given opportunity to cross-examine, inspect documents, and offer evidence in explanation or rebuttal.
Applicant was not deprived of due process; no basis for reconsideration on due process grounds.
From the decision · page 5III DISCUSSION A WCJ's report "cures any technical or alleged defect in satisfying the requirements of Labor Code section 5313." [City of San Diego v. Workers' Comp. Appeals Bd (Rutherford) (1989) 54 Cal.Comp.Cases 57 (writ den.); Smales v. Workers' Comp. Appeals Bd (1980) 45 Cal.Comp.Cases 1026 (writ den.)] To the extent that the undersigned failed to elaborate on her conclusions, they will be discussed below. The undersigned set forth some of the procedural history above to demonstrate that the applicant had numerous opportunities to participate in the process. The applicant has not been deprived of any due process right, which might be a basis for granting reconsideration. Due process requires that all parties `must be fully apprised of the evidence submitted or to be considered, and must be given opportunity to cross-examine witnesses, to inspect documents and to offer evidence in explanation or rebuttal. In no other way can a party maintain its rights or make its defense. [Citations.]'" (Citation omitted.) [Katzin v. Workers' Comp.
What proof carried it
The evidence the panel weighed, by kind.
Applicant did not testify at trial but was present; refused to sign pre-trial conference statement; had multiple opportunities to participate in process; no due process violation found.
From the decision · page 4ID: 76383393) At the 3/27/23 MSC, the applicant had not completed his part of the PTCS, so was directed by the court to meet with the Information and Assistance Consultant to complete the PTCS. Over applicant's objection, the matter was to be set for trial when the PTCS was completed. (MOH, 3/27/23, EAMS Doc. ID: 76588823.) Per case notes, the I&A Consultant met with the applicant at least twice--on the second visit, he refused to sign the PTCS. The undersigned noted the applicant's refusal to sign on the PTCS. (PTCS, d. 4/25/23; EAMS Doc. ID: 76686445) The matter was submitted for decision after trial on 5/31/23. The applicant was present at trial, but did not testify. (Minutes of Hearing, 5/31/23; EAMS Doc. ID: 77023402)
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About this page
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