What the panel ordered
The Appeals Board affirmed the WCJ's findings of industrial injury in ADJ11380104 but rescinded and deferred findings on temporary disability, permanent disability, and need for medical treatment for further proceedings. The findings of no compensable injury in ADJ11997925 and ADJ11997956 were affirmed. The matter was returned to the trial level for further proceedings and new decision by the WCJ.
Applicant filed a timely Petition for Reconsideration of the Joint Findings and Orders of March 4, 2021, challenging the denial of compensable injuries and benefits in three case numbers. The WCJ submitted a Report and Recommendation, and the Appeals Board granted reconsideration to study the factual and legal issues.
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 WCJ found industrial injury to the left shoulder and back despite the QME's contrary opinion, creating an irreconcilable conflict requiring further development on disability and medical treatment.
From the decision · page 2Based on our review of the record, and for the reasons stated in the WCJ's Report, which we adopt and incorporate to the extent set forth in the attachment to this opinion, we will affirm the WCJ's finding in ADJ111380104 that on June 27, 2018, applicant sustained industrial injury by way of intercostal muscle strain, and to his left shoulder and back; the WCJ's finding in ADJ11997925 that the injury claimed by applicant, allegedly involving his back and lower extremities on June 29, 2018, is not compensable; and the WCJ's finding in ADJ11997956 that the injury claimed by applicant during the period of employment ending June 29, 2018, allegedly involving his back and lower extremities, is not compensable. In ADJ111380104, however, we are persuaded that furth
The injury claimed on June 29, 2018, involving back and lower extremities, was found not compensable by the WCJ and affirmed by the Appeals Board.
From the decision · page 1In ADJ11997925, the WCJ found that the injury claimed by applicant took place on June 29, 2018, that the injury allegedly involved the back and lower extremities, and that the injury is not compensable.
The injury claimed during the employment period ending June 29, 2018, involving back and lower extremities, was found not compensable by the WCJ and affirmed by the Appeals Board.
From the decision · page 2In ADJ11997956, the WCJ found that the injury claimed by applicant took place during the period of employment ending June 29, 2018, that the injury allegedly involved the back and lower extremities, and that the injury is not compensable.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant sustained industrial injury to left shoulder and back on June 27, 2018, supported by applicant's and coworker's reports and medical records.
Favours Applicant prevailed
This fact led the WCJ to find injury despite the QME's contrary opinion, requiring further inquiry on disability and treatment.
From the decision · page 3In his Report, the WCJ states, in relevant part, that he "did not find that substantial medical evidence supported either temporary or permanent disability, nor that any of these injuries had caused further need for medical treatment." However, the WCJ also states that Dr. Wellborn, the QME, was "conspicuously dismissive of [applicant] and his claimed injuries, [that the doctor] ignore[d] the fact that pain in the left shoulder and back was reported beginning on the date of the original injury," and that though "the presenting symptoms most prominently mentioned in the medical report generated at the clinic on the date of that injury [were] reported to be in the chest area, applicant and his coworker both reported that he had back pain and shoulder pain, and these very shortly began appearing in the medical reporting." For these reasons, the WCJ "found that those regions were injured, as well as the intercostal area described by Dr. Wellborn."
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.
Concluded intercostal muscle strain but no injury to shoulder or back; dismissive of applicant's claimed injuries; ignored evidence of shoulder and back pain from date of injury.
The WCJ found that Dr. Wellborn ignored evidence of injury to left shoulder and back and was dismissive of the applicant, leading to an irreconcilable conflict requiring further inquiry.
From the decision · page 3In his Report, the WCJ states, in relevant part, that he "did not find that substantial medical evidence supported either temporary or permanent disability, nor that any of these injuries had caused further need for medical treatment." However, the WCJ also states that Dr. Wellborn, the QME, was "conspicuously dismissive of [applicant] and his claimed injuries, [that the doctor] ignore[d] the fact that pain in the left shoulder and back was reported beginning on the date of the original injury," and that though "the presenting symptoms most prominently mentioned in the medical report generated at the clinic on the date of that injury [were] reported to be in the chest area, applicant and his coworker both reported that he had back pain and shoulder pain, and these very shortly began appearing in the medical reporting." For these reasons, the WCJ "found that those regions were injured, as well as the intercostal area described by Dr. Wellborn."
Concluded applicant's complaints were whole body pain and not work-related; stated patient does not have a Workers Comp case.
The WCJ found Dr. Yoshida's reports repetitive and not supportive of work-related injury.
From the decision · page 7Following trial, I reviewed the available medical reports and concluded that applicant's injury on June 27, 2018, involved not only the intercostal area but also the back and left shoulder. [...] While no reports by Dr. Brooks were available at the time of trial, applicant has appended to his petition for reconsideration one such report, dated March 9, 2021, six days after trial. That report does support some need for further medical attention, [but] it does not, as defendant points out, attribute such need to a work-related injury. Moreover, Dr. Yoshida's final report, dated June 19, 2020, concludes that applicant's "complaints is whole body pain and this is why not work related," and "This patient does not have a Workers Comp case" (sic). (Exh. O1)
Provided a report supporting some need for further medical attention but did not attribute it to work-related injury.
The report was considered but did not support compensability as it did not link need for treatment to work injury.
From the decision · page 7Following trial, I reviewed the available medical reports and concluded that applicant's injury on June 27, 2018, involved not only the intercostal area but also the back and left shoulder. [...] While no reports by Dr. Brooks were available at the time of trial, applicant has appended to his petition for reconsideration one such report, dated March 9, 2021, six days after trial. That report does support some need for further medical attention, [but] it does not, as defendant points out, attribute such need to a work-related injury. Moreover, Dr. Yoshida's final report, dated June 19, 2020, concludes that applicant's "complaints is whole body pain and this is why not work related," and "This patient does not have a Workers Comp case" (sic). (Exh. O1)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
California Labor Code
Labor Code sections 3200 et seq.
Applied to determine compensability of injuries and entitlement to benefits.
From the decision · page 2Based on our review of the record, and for the reasons stated in the WCJ's Report, which we adopt and incorporate to the extent set forth in the attachment to this opinion, we will affirm the WCJ's finding in ADJ111380104 that on June 27, 2018, applicant sustained industrial injury by way of intercostal muscle strain, and to his left shoulder and back; the WCJ's finding in ADJ11997925 that the injury claimed by applicant, allegedly involving his back and lower extremities on June 29, 2018, is not compensable; and the WCJ's finding in ADJ11997956 that the injury claimed by applicant during the period of employment ending June 29, 2018, allegedly involving his back and lower extremities, is not compensable. In ADJ111380104, however, we are persuaded that furth
What proof carried it
The evidence the panel weighed, by kind.
Applicant and coworker reported pain in left shoulder and back beginning on date of injury; medical reports shortly thereafter documented these symptoms.
From the decision · page 3In his Report, the WCJ states, in relevant part, that he "did not find that substantial medical evidence supported either temporary or permanent disability, nor that any of these injuries had caused further need for medical treatment." However, the WCJ also states that Dr. Wellborn, the QME, was "conspicuously dismissive of [applicant] and his claimed injuries, [that the doctor] ignore[d] the fact that pain in the left shoulder and back was reported beginning on the date of the original injury," and that though "the presenting symptoms most prominently mentioned in the medical report generated at the clinic on the date of that injury [were] reported to be in the chest area, applicant and his coworker both reported that he had back pain and shoulder pain, and these very shortly began appearing in the medical reporting." For these reasons, the WCJ "found that those regions were injured, as well as the intercostal area described by Dr. Wellborn."
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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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