ADJ15186514 — California WCAB decision

What the panel ordered

The Workers' Compensation Appeals Board affirmed the May 3, 2023 decision, denying the defendant's petition for reconsideration.

Defendant sought reconsideration of the Findings of Fact and Award issued by the workers' compensation arbitrator on May 3, 2023, challenging the substantial evidence supporting the PTSD diagnosis and the exclusion of a supplemental report by Dr. Keins.

Read the official decision →

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 evidence / credibilityApplicant prevailedpsyche

The Board found Dr. Jacks' report to be thorough, based on extensive psychiatric consultation, psychological testing, and review of medical records, constituting substantial evidence supporting the PTSD diagnosis and industrial causation, while Dr. Keins' report was found unsubstantial due to lack of medical record review and untimely supplemental report.

From the decision · page 16As to the sufficiency of Dr. Jacks 4/18/2022 IME Report, as summarized herein above, I find it qualifies as substantial medical evidence regarding his diagnosis of Applicant's PTSD. He noted references in the medical records after the September 23, 2019 date listing diagnoses of PTSD. He reviewed several of the work-related traumatic events experienced by Applicant as a Firefighter with the Richmond Fire Department, and found a link between the September 2019 school shooting incident, and subsequent work traumas, and the development of Applicant's PTSD symptomology.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Dr. Jacks' report included extensive psychiatric consultation, psychological testing, and review of medical records supporting PTSD diagnosis and industrial causation.

Favours Applicant prevailed

This report constituted substantial evidence supporting the applicant's claim and was relied upon by the Board.

From the decision · page 16As to the sufficiency of Dr. Jacks 4/18/2022 IME Report, as summarized herein above, I find it qualifies as substantial medical evidence regarding his diagnosis of Applicant's PTSD. He noted references in the medical records after the September 23, 2019 date listing diagnoses of PTSD. He reviewed several of the work-related traumatic events experienced by Applicant as a Firefighter with the Richmond Fire Department, and found a link between the September 2019 school shooting incident, and subsequent work traumas, and the development of Applicant's PTSD symptomology.

Dr. Keins' report lacked review of medical records and her supplemental report was not admitted due to untimeliness.

Favours Applicant prevailed

This deficiency rendered her report unsubstantial and not reliable evidence against the applicant's claim.

From the decision · page 15In this instance, it is not a matter that a small portion of medical records had not been reviewed; in this case none of the medical records were reviewed. This, on its face, presents an "incomplete medical history" sufficient to render Dr. Keins' medical opinion unsubstantial. Again, Dr. Keins herself stated in April 2022 "No medical records were available for review... Prior to my being able to reach binding medial/legal conclusions, it is essential that I review his mental health records to issue a supplemental report" (417/2022 Keins Report, pg 14).

Defendant delayed providing medical records to its own IME for eight months prior to arbitration, preventing timely supplemental report.

Favours Applicant prevailed

This delay was found to be due to lack of diligence and prejudiced the applicant's case, favoring the applicant.

From the decision · page 8Applicant concludes that the Defendant's failure to provide medical records in its possession to its own IME for eight (8) months after they were requested, and only a month prior to the arbitration hearing date, together with Defendant's inability to explain such a lengthy delay, was solely due to lack of diligence on the part of the Defendant (Applicant's Answer 7:26 - 8:6).

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.

AMERelied upon · psychiatry

Diagnosed PTSD as industrially caused, based on extensive psychiatric consultation, psychological testing, and review of medical records; found 100% industrial causation and no apportionment to non-industrial stressors.

The Board relied on Dr. Jacks' thorough evaluation and found it constituted substantial evidence supporting the PTSD diagnosis and industrial causation.

From the decision · page 16As to the sufficiency of Dr. Jacks 4/18/2022 IME Report, as summarized herein above, I find it qualifies as substantial medical evidence regarding his diagnosis of Applicant's PTSD. He noted references in the medical records after the September 23, 2019 date listing diagnoses of PTSD. He reviewed several of the work-related traumatic events experienced by Applicant as a Firefighter with the Richmond Fire Department, and found a link between the September 2019 school shooting incident, and subsequent work traumas, and the development of Applicant's PTSD symptomology.

AMERejected · psychiatry

Diagnosed non-industrial bipolar disorder without reviewing medical records; supplemental report was not admitted due to untimeliness, rendering her initial report unsubstantial.

The Board found Dr. Keins' report unsubstantial because it lacked review of medical records and the supplemental report was not timely admitted, thus not curing the deficiency.

From the decision · page 15In this instance, it is not a matter that a small portion of medical records had not been reviewed; in this case none of the medical records were reviewed. This, on its face, presents an "incomplete medical history" sufficient to render Dr. Keins' medical opinion unsubstantial. Again, Dr. Keins herself stated in April 2022 "No medical records were available for review... Prior to my being able to reach binding medial/legal conclusions, it is essential that I review his mental health records to issue a supplemental report" (417/2022 Keins Report, pg 14).

ADJ15186514 · December 13, 2024

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page