What the panel ordered
Findings and Order of October 21, 2020 rescinded; matter returned to trial level for further proceedings.
Petition for Reconsideration granted to study factual and legal issues; matter returned to trial level 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.
The WCJ's finding of lack of industrial causation was based on applicant's history being not credible, but the WCAB found the credibility findings inconsistent and the QME's opinion inadequate due to lack of medical records, thus remanding for further proceedings.
From the decision · page 1The WCJ found that applicant failed to prove industrial causation of her injury because the WCJ found that applicant's history of injury was not credible.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's testimony was not rejected based on demeanor and no witnesses contradicted her.
Favours Applicant prevailed
Supports credibility of injury occurrence testimony, favoring applicant's claim.
From the decision · page 4the motions she performed in her usual work for FXI. It is quite common for legitimate injuries to take place without witnesses, and none of the witnesses presented were able to directly rebut the Applicant's testimony about how the injury occurred. There was nothing in Applicant's testimony, manner, or demeanor that would, by itself, lead one to reject her testimony.
QME's medical opinion was based on an inadequate history due to lack of medical records and thus not substantial evidence.
Favours neutral
Without substantial medical evidence, the Board could not decide industrial causation and remanded the case.
From the decision · page 5Here, the present QME reporting does not constitute substantial medical evidence because no party provided the QME with applicant's medical records, and thus, the QME's preliminary opinions on AOE/COE are based upon an inadequate history. Without any substantial medical opinion, we cannot decide the issue of industrial injury.
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.
Determined with reasonable medical probability that the patient received injuries as a result of work exposure, but noted no medical records were provided and requested them to complete review.
The QME's opinion was preliminary and based on an inadequate history due to lack of medical records, thus not constituting substantial medical evidence.
From the decision · page 2Applicant was seen by Qualified Medical Evaluator (QME) Diane Michael, D.C., who authored two reports in evidence. (Joint Exhibits AA and BB. ) Dr. Michael took the following history of injury:
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Clark (2015) 61 Cal.4th 291
Applicant must prove by preponderance of evidence that injury occurred AOE/COE.
The Board applied the standard to assess industrial causation and credibility of evidence.
From the decision · page 3v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302; § 5705.) Applicant
Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604
Medical opinion must be framed in terms of reasonable medical probability, based on pertinent facts and adequate examination, and set forth reasoning to constitute substantial evidence.
The Board found the QME's opinion inadequate as it lacked medical records and was preliminary, thus not substantial evidence.
From the decision · page 4Next, and for the same reasons discussed above, even if we accept applicant's description of the injury as true, a decision on injury arising out of and occurring in the course of employment requires substantial medical evidence.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony about injury occurrence was not rejected based on demeanor; no witnesses contradicted her testimony.
From the decision · page 4the motions she performed in her usual work for FXI. It is quite common for legitimate injuries to take place without witnesses, and none of the witnesses presented were able to directly rebut the Applicant's testimony about how the injury occurred. There was nothing in Applicant's testimony, manner, or demeanor that would, by itself, lead one to reject her testimony.
Applicant reported injury delayed until after disciplinary incident, warranting investigation but not sole basis to deny injury.
From the decision · page 4As the WCJ noted, it is common for injured workers to delay reporting a claim and to do so only after self-treatment fails. While reporting a delayed claim in tandem with employee discipline warrants additional investigation, it cannot be the sole basis to deny an industrial injury. There must be evidence, either factual or medical, supporting the conclusion that applicant's injury is non-industrial.
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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.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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