ADJ12471786 — California WCAB decision

What the panel ordered

Petition for reconsideration granted; Findings and Orders of July 13, 2021, rescinded; matter returned to WCJ for further proceedings and new decision.

Applicant sought reconsideration of the Findings and Orders issued by the WCJ on July 13, 2021, which found no psychiatric injury AOE/COE; the WCAB granted reconsideration, rescinded the F&O, and returned the matter to the WCJ for further proceedings.

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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.

Psyche AOE/COEApplicant prevailedpsyche

The WCAB found that the WCJ's denial of psychiatric injury AOE/COE was based on Dr. Reiss's opinions, which were not substantial evidence because they relied on speculation, surmise, and inadequate examination, and the applicant's credible testimony contradicted Dr. Reiss's conclusions. The WCAB granted reconsideration and remanded for further proceedings including a new medical evaluation.

From the decision · page 6Here, the Finding that applicant did not sustain injury AOE/COE is based on the opinions of QME Dr. Reiss, as stated in his supplemental reports and deposition testimony. (F&O, p. 2.)

The facts that decided it

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162

A medical opinion must be based on pertinent facts, an adequate examination, and an accurate history, and cannot be based on surmise, speculation, conjecture, or guess.

Dr. Reiss's opinion was rejected because it was based on surmise and speculation and lacked an adequate examination.

From the decision · page 6(1970) 3 Cal.3d 312, 317 [35 Cal.Comp.Cases 500]; LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627, 635 [35 Cal.Comp.Cases 16].) To be substantial evidence a medical opinion must be based on pertinent facts, on an adequate examination and an accurate history, and it cannot be based on surmise, speculation, conjecture, or guess. (Hegglin v. Workmen's Comp. Appeals Bd. (1971) 4 Cal.3d 162 [36 Cal.Comp.Cases 93]; Granado v. Workers' Comp. Appeals Bd. (1970) 69 Cal.2d 399 [33 Cal.Comp.Cases 647]; Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604 (Appeals Board en banc).)

Labor Code section 4062.3(b)

An evaluating physician is to consider only the records/evidence provided by the parties; social media searches are inappropriate and cannot be considered in reaching conclusions.

Dr. Reiss's use of a 'quick Google search' was inappropriate and not a proper basis for his opinion.

From the decision · page 73 It is also important to note that an evaluating physician is to consider only the records/evidence provided by the parties. (Lab. Code, § 4062.3(b).) A "quick Google search" is not records provided to the doctor by the parties. A social media search regarding an injured worker is inappropriate conduct for an evaluating physician and information from a social media search cannot be a factor considered by the physician in reaching his or her conclusions.

Labor Code sections 5701, 5906; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389; McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117

The Appeals Board has discretionary authority to develop the record when substantial evidence is lacking on a threshold issue.

The WCAB exercised its authority to remand for further proceedings and a new medical evaluation due to lack of substantial evidence.

ADJ12471786 · November 8, 2021

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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