ADJ12055950 · January 21, 2025

The WCJ found no industrial injury based on the medical evidence, but the Appeals Board found the record incomplete and granted reconsideration to allow further review of the injury AOE/COE issue.

From the decision · page 1Lien Claimant Dental Trauma Center (DTC) seeks reconsideration of the Findings of Fact and Order issued by the workers' compensation administrative law judge (WCJ) in this matter on October 10, 2024. In that decision, the WCJ found that DTC did not prove that an industrial injury occurred in this case, and that they did not establish that they provided valid medical-legal services.

QME Dr. Steven Brourman issued reports and deposition testimony indicating industrial causation of orthopedic injuries.

Favours Applicant prevailed

Supports applicant's claim of industrial injury, challenging WCJ's finding of no injury.

From the decision · page 6The parties to the case-in-chief selected Dr. Brourman as a Qualified Medical Evaluator (PQME) through the panel process. Dr. Brourman issued at least two reports, which initially found industrial injury to the orthopedic body parts. See Exhibit 11, Supplemental Report of Dr. Brourman of 07 April 2021 at pp. 21 § 22. In this supplemental report Dr. Brourman seemed to have done a good job of supporting his opinion on industrial causation despite prior spinal surgery approximately 25 years before the examination date.

Treating dentist Dr. Schames found dental conditions industrial in permanent and stationary report.

Favours Applicant prevailed

Supports applicant's claim of industrial injury to dental and related body parts.

From the decision · page 7The only medical-legal reporting relative to applicant's teeth appears to be the permanent and stationary report from applicant's treating physician in the field of dentistry, Dr. Schames, who finds applicant's conditions of aggravated bruxism, myalgia of the facial muscles, and aggravated inflammation of the gums industrial. (Ex. 19, 2/25/21.)

WCJ's record was incomplete and did not fully develop the medical evidence, leading to reconsideration grant.

Favours Applicant prevailed

Indicates need for further review and development of record to ensure just decision.

Initially found industrial injury to orthopedic body parts; deferred causation opinion pending formal job analysis at deposition; opined injuries were industrial in reports and deposition.

The Appeals Board noted Dr. Brourman's reports and deposition showing industrial causation opinions but deferred final causation pending further analysis.

From the decision · page 6The parties to the case-in-chief selected Dr. Brourman as a Qualified Medical Evaluator (PQME) through the panel process. Dr. Brourman issued at least two reports, which initially found industrial injury to the orthopedic body parts. See Exhibit 11, Supplemental Report of Dr. Brourman of 07 April 2021 at pp. 21 § 22. In this supplemental report Dr. Brourman seemed to have done a good job of supporting his opinion on industrial causation despite prior spinal surgery approximately 25 years before the examination date.

Found applicant's dental conditions (aggravated bruxism, myalgia of facial muscles, aggravated gum inflammation) industrial.

The Appeals Board noted Dr. Schames' permanent and stationary report finding dental conditions industrial.

From the decision · page 7The only medical-legal reporting relative to applicant's teeth appears to be the permanent and stationary report from applicant's treating physician in the field of dentistry, Dr. Schames, who finds applicant's conditions of aggravated bruxism, myalgia of the facial muscles, and aggravated inflammation of the gums industrial. (Ex. 19, 2/25/21.)

South Coast Framing v. WCAB (Clark) (2015) 61 Cal. 4th 291; Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793

Causation requires work to be a contributing cause of injury

Connection between work and injury must be a contributing cause.

From the decision · page 7In general, for the purposes of the causation requirement in workers' compensation, it is sufficient if the connection between work and the injury be a contributing cause of the injury...." (South Coast Framing v. WCAB (Clark) (2015) 61 Cal. 4th 291; Nash v. Workers' Comp. Appeals Bd. (1994) 24 Cal.App.4th 1793, 1809.)

McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408

Reasonable medical probability standard for causation

Causation must be shown by reasonable medical probability, more likely than not.

From the decision · page 8When translated to the standard necessary for expert medical opinions, this means reasonable medical probability, meaning more likely than not. Certainty, or anything approaching certainty, is not the proper standard. (McAllister v. Workmen's Comp. App. Bd. (1968) 69 Cal.2d 408, 413, 416-417, 419 [33 Cal. Comp. Cases 660].)

Labor Code section 3202.5

Preponderance of the evidence

All parties and lien claimants must meet the evidentiary burden by preponderance of the evidence.

From the decision · page 7Section 3202.5 states, in pertinent part, "All parties and lien claimants shall meet the evidentiary burden of proof on all issues by a preponderance of the evidence in order that all parties are considered equal before the law. `Preponderance of the evidence' means that evidence that, when weighed with that opposed to it, has more convincing force and the greater probability of truth."

Medical reports of QME Dr. Brourman and treating dentist Dr. Schames supporting industrial injury

From the decision · page 6The parties to the case-in-chief selected Dr. Brourman as a Qualified Medical Evaluator (PQME) through the panel process. Dr. Brourman issued at least two reports, which initially found industrial injury to the orthopedic body parts. See Exhibit 11, Supplemental Report of Dr. Brourman of 07 April 2021 at pp. 21 § 22. In this supplemental report Dr. Brourman seemed to have done a good job of supporting his opinion on industrial causation despite prior spinal surgery approximately 25 years before the examination date.