What the panel ordered
May 7, 2021 Findings and Order rescinded; new Findings of Fact issued finding injury AOE/COE on October 15, 2018; all other issues deferred; matter returned to trial level for further proceedings.
Petition for reconsideration granted; prior Findings and Order of May 7, 2021 rescinded and replaced; matter returned to WCJ for further proceedings.
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.
Substantial medical evidence from QME Dr. Kesho Hurria supports a finding that applicant sustained injury AOE/COE on October 15, 2018, meeting the lien claimant's burden of proof.
From the decision · page 7In the QME Report of July 20, 2019, QME Dr. Hurria stated that applicant suffered from an industrial injury AOE/COE. (LC Ex. 1, p. 19.) Based on applicant's recounting of the incident, Dr. Hurria reported that the injury was specific and occurred in October 2018, when applicant held a falling pallet in place for approximately 10 minutes. (LC Ex. 1, pp. 3, 14-17.) The QME report included a history of the injury according to applicant, pre-existing injuries, a physical examination, and a review of applicant's medical records and his deposition before concluding that the injury was industrial. (LC Ex. 1, pp. 2-19.) In the QME report of November 7, 2019, Dr. Hurria again concluded that applicant had suffered an industrial injury that was specific in nature. (LC Ex. 1, p. 36.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
QME Dr. Kesho Hurria's medical opinion that applicant sustained an industrial injury AOE/COE on October 15, 2018.
Favours Applicant prevailed
This opinion was based on adequate examination, history, and medical records, and was relied upon by the Appeals Board to find injury AOE/COE.
From the decision · page 7In the QME Report of July 20, 2019, QME Dr. Hurria stated that applicant suffered from an industrial injury AOE/COE. (LC Ex. 1, p. 19.) Based on applicant's recounting of the incident, Dr. Hurria reported that the injury was specific and occurred in October 2018, when applicant held a falling pallet in place for approximately 10 minutes. (LC Ex. 1, pp. 3, 14-17.) The QME report included a history of the injury according to applicant, pre-existing injuries, a physical examination, and a review of applicant's medical records and his deposition before concluding that the injury was industrial. (LC Ex. 1, pp. 2-19.) In the QME report of November 7, 2019, Dr. Hurria again concluded that applicant had suffered an industrial injury that was specific in nature. (LC Ex. 1, p. 36.)
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 sustained an industrial injury arising out of and in the course of employment on October 15, 2018, based on history, medical records, clinical examination, and medical literature review.
Dr. Hurria's opinion was based on adequate examination and history, was not speculative, and provided reasoning supporting the conclusion of industrial injury.
From the decision · page 7In the QME Report of July 20, 2019, QME Dr. Hurria stated that applicant suffered from an industrial injury AOE/COE. (LC Ex. 1, p. 19.) Based on applicant's recounting of the incident, Dr. Hurria reported that the injury was specific and occurred in October 2018, when applicant held a falling pallet in place for approximately 10 minutes. (LC Ex. 1, pp. 3, 14-17.) The QME report included a history of the injury according to applicant, pre-existing injuries, a physical examination, and a review of applicant's medical records and his deposition before concluding that the injury was industrial. (LC Ex. 1, pp. 2-19.) In the QME report of November 7, 2019, Dr. Hurria again concluded that applicant had suffered an industrial injury that was specific in nature. (LC Ex. 1, p. 36.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code, 5705
Burden of proof rests on the party or lien claimant holding the affirmative of the issue.
Lien claimant Spectrum Medical Group met burden of proof for injury AOE/COE.
From the decision · page 5II. Substantial medical evidence supports a finding of injury AOE/COE. Pursuant to section 5705, the "burden of proof rests upon the party or lien claimant holding the affirmative of the issue." (Lab. Code, § 5705.) "All parties and lien claimants shall meet the evidentiary burden of proof on all issues by a preponderance of the evidence." (Lab. Code § 3202.5.) "A lien claimant... has the burden of proving by a preponderance of the evidence that the claim is industrial...." (Hand
Lab. Code 3202.5
All parties and lien claimants shall meet the evidentiary burden of proof on all issues by a preponderance of the evidence.
Lien claimant Spectrum Medical Group met burden of proof for injury AOE/COE.
From the decision · page 5II. Substantial medical evidence supports a finding of injury AOE/COE. Pursuant to section 5705, the "burden of proof rests upon the party or lien claimant holding the affirmative of the issue." (Lab. Code, § 5705.) "All parties and lien claimants shall meet the evidentiary burden of proof on all issues by a preponderance of the evidence." (Lab. Code § 3202.5.) "A lien claimant... has the burden of proving by a preponderance of the evidence that the claim is industrial...." (Hand
Lab. Code 3600(a)
Employer is liable for workers' compensation benefits without regard to negligence for injuries arising out of and in the course of employment.
Applicant's injury found to be industrial under this standard.
From the decision · page 6Section 3600(a) provides for liability for injuries sustained "arising out of and in the course of the employment." An employer is liable for workers' compensation benefits "without regard to negligence." (Lab. Code, § 3600(a).) Whether an employee's injury arose out of and in the course of employment is generally a question of fact to be determined in light of the particular circumstances of the case. (Wright v. Beverly Fabrics (2002) 95 Cal.App.4th 346, 353 [67 Cal.Comp.Cases 51].)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's detailed history of injury and medical records reviewed by QME Dr. Hurria
From the decision · page 7In the QME Report of July 20, 2019, QME Dr. Hurria stated that applicant suffered from an industrial injury AOE/COE. (LC Ex. 1, p. 19.) Based on applicant's recounting of the incident, Dr. Hurria reported that the injury was specific and occurred in October 2018, when applicant held a falling pallet in place for approximately 10 minutes. (LC Ex. 1, pp. 3, 14-17.) The QME report included a history of the injury according to applicant, pre-existing injuries, a physical examination, and a review of applicant's medical records and his deposition before concluding that the injury was industrial. (LC Ex. 1, pp. 2-19.) In the QME report of November 7, 2019, Dr. Hurria again concluded that applicant had suffered an industrial injury that was specific in nature. (LC Ex. 1, p. 36.)
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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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